NOTICE OF PRIVACY PRACTICES FOR 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.

As mandated by the Patient Rights component of the Health Insurance Portability and Accountability Act (HIPAA), you, the patient, have rights regarding the safeguarding and accessibility of your Protected Health Information (PHI). PHI is any individually identifiable health information relating to: past, present or future physical or mental health or condition of an individual; the provision of health care to an individual; or past, present or future payment for health care.

Valdosta Medical Clinic (VMC) uses your PHI for your medical treatment, for collection of payment for treatment, for healthcare operations and for government oversight activities.

Valdosta Medical Clinic Staff who are allowed access to your PHI include your doctor, nurse, lab technicians and any other personnel involved in your medical treatment. Insurance billers, receptionists and other VMC personnel involved in obtaining payment or reimbursement also have access to your PHI. Staff members whose job is to keep the clinic operable have access to your PHI. They include medical transcriptionists and medical records personnel.

Your PHI may be disclosed to officials involved in government oversight activities, including audits, investigations, licensures and inspections required for compliance with government programs and laws.

Other uses and disclosures of a patient's PHI that can be made without the patient's consent or authorization are:

•	As required by law. Medical information may be disclosed as required by court order or administrative order, subpoena, or other lawful process; when requested by national security, intelligence, and other federal officials; and/or when the patient is an inmate or under the custody of law enforcement.
•	Upon military command. The PHI of patients who serve or have served in the military will be disclosed upon military command.
•	To prevent a serious threat to health or safety.
•	Emergency treatment. Use or disclosure of PHI in connection with an emergency, so long as the provider attempts to obtain consent as soon as practical after the emergency.
•	Public health responsibilities. PHI may be disclosed to report deaths, child abuse, neglect, domestic violence, problems with products, reactions to medications, product recalls, disease/infection exposure, and to prevent or control disease, injury or disability.
•	Workers' compensation.

Patient Privacy Rights

•	The patient has the right to inspect and receive a copy of his or her own PHI. A request must be written and signed by the patient and there may be a fee charged. VMC may deny requests in limited circumstances. In such an instance, the patient can request a review of denials by another VMC health care professional not involved in the patient's care.
•	The patient has the right to receive confidential communications from the health care provider.
•	The patient has the right to request an amendment to his or her medical information if it is inaccurate or incomplete.
•	The patient has the right to request restriction of use and disclosure of PHI.
•	The patient has the right to receive an accounting of disclosures, i.e. a list of entities to whom the patient's PHI has been disclosed.
•	The patient has the right to receive a paper copy of this notice.
•	The patient has the right to file a grievance with the Composite State Board of Medical Examiners concerning the physician, staff, office and treatment received. The patient should either call the Board (404 657-6487) with such a complaint or send a written complaint to the Board. The patient should be able to provide the name of the physician or practice name, the address and the specific nature of the complaint. The State Board's address is: Composite State Board of Medical Examiners 10 th Floor, # 2 Peachtree Street NW Atlanta, GA 30303

The name and telephone number of Valdosta Medical Clinic's Privacy Contact person is: Maureen Gillespie, (229) 242-8480 ext. 310.

Valdosta Medical Clinic's Responsibilities under HIPAA
•	VMC has a designated Privacy Officer and Privacy Contact person.
•	VMC has developed and implemented policies and procedures to ensure patients' PHI is secure.
•	VMC personnel are trained to be familiar with policies and procedures and abide by them.
•	VMC has established safeguards.
•	VMC imposes sanctions for violating privacy policies.
•	VMC provides a complaint procedure for individuals.
•	VMC maintains records of disclosures.
•	VMC mitigates violations or their effects.
•	VMC does not retaliate against individuals filing complaints.
•	VMC does not require individuals to waive their rights as a condition of treatment.

Valdosta Medical Clinic reserves the right to make changes to this notice. The effective date of this notice is March 6, 2003.