Privacy Policy

PRIVACY POLICY 2024

NOTICE OF PRIVACY PRACTICES
Effective Date: 01/01/2024
1513, LLC
3049 Tower Rd.
Columbus, GA 31909
706-221-4848

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.

OUR COMMITMENT TO YOUR PRIVACY

[Your Hormone Therapy Clinic Name] is dedicated to maintaining the privacy and security of your Protected Health Information (PHI) and is required by law to maintain the confidentiality of your medical information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), other federal law, and the laws of the State of Georgia. We are committed to complying with these requirements and will only use and disclose your PHI as described in this Notice or as otherwise required or permitted by law.

WHO WILL FOLLOW THIS NOTICE

This Notice applies to all staff members of [Your Hormone Therapy Clinic Name], including physicians, nurses, administrative personnel, and any other healthcare professionals authorized to enter information into your medical record. In addition, any business associates (vendors and contractors) who assist us with healthcare operations are required to follow appropriate safeguards and sign Business Associate Agreements to ensure the privacy and security of your PHI.

HOW WE MAY USE AND DISCLOSE YOUR PHI

We may use and disclose your PHI for the following purposes without your written authorization:

  1. Treatment:
    We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, our providers may share your PHI with a specialist or a pharmacist involved in your care.
  2. Payment:
    We may use and disclose your PHI to obtain payment for the healthcare services we provide. For example, we may share your health information with your insurance company or health plan to verify coverage or to obtain payment for services.
  3. Healthcare Operations:
    We may use and disclose your PHI for business activities that are necessary to operate our clinic and maintain high-quality patient care. For example, we may use your PHI to perform quality assessments, staff training, licensing, and accreditation activities.

OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES

We may also use or disclose your PHI in the following situations without your authorization, when required or permitted by law:

  1. Public Health Activities:
    To report communicable diseases, adverse reactions to medications, or other public health information to government agencies authorized to receive such data.
  2. Health Oversight Activities:
    To provide information to state or federal oversight agencies as required by law, such as audits, investigations, licensure, or disciplinary actions.
  3. Law Enforcement or Judicial Proceedings:
    In response to a court order, subpoena, warrant, summons, or similar legal request, and when otherwise required or authorized by law.
  4. Serious Threat to Health or Safety:
    We may disclose PHI if necessary to prevent or reduce a serious and imminent threat to the health or safety of a person or the public.
  5. Specialized Government Functions:
    For certain government and national security functions as authorized by law, such as for military or veteran activities.
  6. Workers’ Compensation:
    We may disclose PHI as authorized by workers’ compensation laws or similar programs.
  7. Deceased Individuals:
    We may disclose PHI to coroners, medical examiners, and funeral directors to assist them in carrying out their duties.
  8. Organ and Tissue Donation:
    We may release PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

In any other situation not described above, we will ask for your written authorization before using or disclosing your PHI. You have the right to revoke this authorization at any time by submitting a written request, except to the extent that we have already acted in reliance on the authorization.

Examples of disclosures that require your authorization include:

  • Psychotherapy notes (except in limited circumstances)
  • Most uses and disclosures of PHI for marketing purposes
  • The sale of your PHI

YOUR RIGHTS REGARDING YOUR PHI

  1. Right to Inspect and Copy:
    You have the right to inspect and obtain a copy of your PHI maintained in our medical or billing records. You must submit a written request to do so. We may charge a reasonable fee for the cost of copying and mailing, as permitted by Georgia and federal law.
  2. Right to Request Amendments:
    If you believe your PHI is incorrect or incomplete, you may request that we amend it. Your request must be in writing and include a reason. We may deny your request if the PHI was not created by us, if it is not part of the records we maintain, or if we believe the information is accurate and complete.
  3. Right to an Accounting of Disclosures:
    You have the right to request an accounting of certain disclosures of your PHI we have made in the past six years, excluding disclosures for treatment, payment, and healthcare operations, and certain other exceptions.
  4. Right to Request Restrictions:
    You may request that we limit the use or disclosure of your PHI for treatment, payment, or healthcare operations. While we are not required to agree to all requests, we will comply with any restrictions we do agree to, unless the PHI is needed for emergency treatment.
  5. Right to Request Confidential Communications:
    You may request that we communicate with you about medical matters in a certain way or at a certain location (e.g., only at your home address or via a specific phone number).
  6. Right to a Paper Copy of This Notice:
    You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

OUR RESPONSIBILITIES

  • We are required by law to maintain the privacy and security of your PHI.
  • We must notify you if a breach occurs that may have compromised the privacy or security of your information.
  • We must abide by the terms of this Notice and will not use or disclose your PHI in a manner inconsistent with it.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. Any changes will apply to all PHI we currently maintain and any PHI we receive in the future. The revised Notice will be available at our clinic and on our website, and we will provide a paper copy upon request.

COMPLAINTS AND QUESTIONS

If you believe your privacy rights have been violated or you have any concerns about our privacy practices, you may contact our Privacy Officer at:

Privacy Officer
1513, LLC
3049 Tower Rd.
Columbus, GA 31909
706-221-4848

You also have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

ACKNOWLEDGMENT OF RECEIPT
You will be asked to sign a form acknowledging that you have received this Notice. Your acknowledgment does not mean you agree with the Notice, only that you received it.