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Privacy Statement
A.Notice of Privacy Practices Regarding your Protected Health Information
B.Information Handling
C.Circumstances where information about you may be
used or disclosed
D.Individual Rights with Respect to Protected Health
Information/Description
of How to Exercise those Rights
E.Electronic Information Privacy Statement
Notice
of Privacy Practices Regarding Your Protected Health Information
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
Your health information is private. Georgia SAFE understands that the information it
collects about you and your health is personal. Georgia SAFE is required by law to
maintain the privacy of protected health information and to provide individuals
with notice of its legal duties and privacy practices with respect to protected
health information.
Georgia SAFE is required to abide by the terms of the notice currently in effect.
This notice tells you what Georgia SAFE may legally do with your protected health
information (PHI). Georgia SAFE is required to provide you this notice regarding your
protected health information in accordance with the Health Insurance
Portability and Accountability Act of 1996 (HIPPA).
Georgia SAFE reserves the right to change this notice and to make new notice
provisions effective for all protected health information that it maintains.
All changes to this notice will apply to all of your protected health
information. If this notice is changed, the new notice will be available on
Georgia SAFE's website and in Georgia SAFE's office. A privacy notice will be mailed to you
upon request.
Information Handling
In our normal business operations, Georgia SAFE may receive protected health
information (PHI) about you. PHI is and includes some indication of your
medical condition. This information may be about you or your family members.
The law requires that Georgia SAFE protect this information.
Circumstances where
information
about you may be used or disclosed
Georgia SAFE is allowed to use this information and share it with others, if the
protected health information is being used for your treatment, the payment of
your medical expenses, or for health care operations. Examples of this include,
providing this documentation to:
Doctors to obtain medical care
Foster parents to obtain medical care or mental health services
Providers of mental health services
Obtain payment for medical services that you received
Insurance companies about paying claims or procuring insurance
Contracted providers to ensure payment
Hospitals for your treatment
Government authorities (such as the Department of Human Services) if we
believe that you may be the victim of abuse, neglect, or domestic violence.
Legal guardians, biological family members or relatives as permitted by law
Immunizations records to foster parents, contracted providers, or other
applicable individuals
The police or military as required by law
Law enforcement officials are permitted by law
When permitted by law for activities that are recognized as national
priorities (i.e. circumstances defined by the government whereby it is so
important to disclose medical information that it is permissible to do so
without the individual's permission). For example, we may disclose medical
information about you if we believe it is necessary to prevent or lessen a
serious threat to health or safety. For more examples of national priorities,
please contact the organization's privacy officer.
A court or an officer of the court (i.e. attorney) for court and/or
administrative proceedings or if ordered to do so
Funeral directors or coroners;
Worker's compensation officials to comply with worker's compensation laws;
For certain government functions, including but not limited to national
security and intelligence activities. We may also use or disclose medical
information about you to a correctional institution in some circumstances.
Other than the examples listed Georgia SAFE, may not share any of your information
without your written permission. You can allow Georgia SAFE to share as much of your
information as you wish. You can also cancel your permission for Georgia SAFE to share
that information.
Georgia SAFE will share information as required by law, subject to limited
restrictions imposed by law. If both federal and state laws apply, whichever
law is more restrictive is the one that will apply.
Individual rights with Respect
to Protected Health Information/Description of how to Exercise those Rights
1. You have the right to request restrictions on certain uses and disclosures
of protected health information as provided by Section 164.522(a) of the United
States Code of Federal Regulations. Georgia SAFE is not required, however, to agree to
a requested restriction.
2. You have the right to receive your information from Georgia SAFE privately. Georgia SAFE
will provide it to whatever address you choose and in the form you choose.
3. You have the right to request confidential communications of protected
health information as provided by section 164.522 of the United States Code of
Federal Regulations as applicable.
4. You have the right to inspect and copy your personal health information in
accordance with Section 164.524 of the United States Code of Federal
Regulations. This right may be limited if the information contains notes taken
by a mental health provider during treatment sessions.
5. You have the right to amend protected health information as provided by
Section 164.526 of the United States Code of Federal Regulations. However,
there are limitations on what information may be changed.
6. You have the right to receive a list of the parties outside Georgia SAFE that have
received your information.
7. You have the right to receive an accounting of disclosures of protected
health information as provided by Section 164.528 of the United States Code of
Federal Regulations.
8. You also have the right to obtain a paper copy of this notice from Georgia SAFE
upon request.
Individuals may complain to the covered entity and to the Secretary if they
believe their privacy rights have been violated by contacting the privacy
officer listed below. Individuals will not be retaliated against for filing a
complaint.
Electronic
Information Privacy Statement
Georgia SAFE is committed to protecting your privacy. This policy statement is intended to explain the potential situations and uses of information obtained on Georgia SAFE's company website.
Private/Personal Information: Georgia SAFE does not require you to submit personal information to access or make use of the company website. You can learn a great deal about our organization and our services without submission of any information. In the event that private information is provided or required, the private information will be used solely for the provision of services requested. Private information will not be disseminated and distributed for reasons other than the purpose for which it was originally obtained without express permission from the provider of the information. Georgia SAFE will allow only authorized employees or agents access to private information.
Website Tracking: Whenever you access this site, Georgia SAFE may utilize various techniques to analyze website usage, performance, activity, and statistics. The information collected is not personal or identifying and will be used only to improve site operation. These techniques may include but are not limited to the use of cookies or web beacons.
Changes: In the event that our Privacy Statement changes, Georgia SAFE will incorporate said changes on this page. .
These protections and rights will become effective April 14, 2003
If you have questions or complaints or if you want for further information about the covered entity's privacy policies or you want to make a request,
contact:
Wendy J. Goodenough
Georgia SAFE Privacy Officer
307 County Road 120 S
South Point, OH 45680, or
United States Office of Civil Rights
1-866-627-7748 or 1-886-788-4989 TTY
Your health care services will not be affected by any complaint made to DSS or the offices listed above.
Revised May 6, 2003
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