Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

IMPORTANT: 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.

Elevation Autism Center is required by law to protect certain aspects of your healthcare information known as Protected Health Information or PHI and to provide you with this Notice of Privacy Practices.

This Notice describes our privacy practices, your legal rights, and lets you know, how Elevation Autism Center is permitted to

· Use and disclose PHI about you

· How you can access and copy that information

· How you may request amendment of that information

· How you may request restrictions on our use and disclosure of your PHI

In most situations we may use this information described in this Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if we are required by law to do so.

We respect your privacy and treat all healthcare information about our patients with care under strict policies of confidentiality that all of our staff are committed to following at all times.

PLEASE READ THE FOLLOWING DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT THE PRIVACY OFFICER LIASON AT ELEVATION AUTISM CENTER.

Purpose of this Notice: This Notice describes your legal rights, advises you of our privacy practices, and lets you know how Elevation Autism Center is permitted to use and disclose Protected Health Information (PHI) about you.

Uses and Disclosures of PHI: Elevation Autism Center may use PHI for the purposes of treatment, payment, and healthcare operations, in most cases without your written permission.

For treatment. This includes such things as verbal, written oral, audio and video information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (including clinical staff, doctors and nurses who give order to allow us to provide treatment to you). It also includes information shared among members of your treatment team. Your PHI may also be shared with outside entities performing ancillary services relating to your treatment.

For payment. This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as organizing your PHI and submitting bills to insurances companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts,

For healthcare operations. This includes quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collections purposes.


Use and Disclosure of PHI Without Your Authorization: Elevation Autism Center is permitted to use PHI without your written authorization, or opportunity to object in certain situations, including:

  • For Elevation Autism Center's use in treating you or in obtaining payment for services provided to you or in other healthcare operations;
  • For the treatment activities of another healthcare provider;
  • To another healthcare provider or entity for the payment activities of the provider or entity that receives the information (such as our insurance company);
  • To another healthcare provider for the healthcare operations activities of the covered entity that receives the information as long as the covered entity receiving the information has or has had a relationship with you and the PHI pertains to that relationship;
  • For healthcare fraud and abuse detection or for activities related to compliance with the law;
  • To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise and objections. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object.
  • To a public health authority in certain situations such as reporting a birth, death or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law;
  • For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the healthcare system;
  • For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;
  • For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;
  • For military, national defense and security and other special government functions;
  • To avert a serious threat to the health and safety of a person or the public at large;
  • For workers' compensation purposes, and in compliance with workers' compensations laws;
  • To coroners, medical examiners, and funeral directors for identifying deceased person, determining cause of death, or carrying on their duties as authorized by law;
  • If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation, bank, as necessary to facilitate organ donations and transplantation;
  • For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law;
  • We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Any other use of disclosure of PHI, other than those listed above will only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information based upon that authorization.

Patient Rights:

As a patient, you have a number of rights with respect to the protection of your PHI, including:

The right to access, copy or inspect your PHI. This means you may come to our offices and inspect and cop most of the medical information about you that we maintain. We will normally provide you with access to this information within 30 days of your written request. We may also charge you a fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We will provide a written response if we deny you access and let you know your appeal rights. If you wish to inspect and copy your medical information, you should contact the privacy officer.

The right to amend your PHI. You have the right to ask us to amend written medical information that we may have about you. If errors are found, we will generally amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information, but only in certain circumstances. For example, if we believe the information is correct and no errors exist, your request will be denied. If you wish to request that we amend the medical information that we have about you, you should contact in writing the privacy officer.

The right to request an accounting of our use and disclosure of your PHI. You may request an accounting from us of certain disclosures of your medical information that we have made in the last six years prior to the date of your request. We are not required to give you an accounting of information we have sued or disclosed for purposes of treatment, payment of healthcare operations, or when we share your health information with our business associates, such as our billing company. We are also not required to give you an accounting of our uses of protected heath information for which you have already given us written authorization. If you wish to request an accounting of the medical information about you that we have used or disclosed that is not exempted from the accounting requirement, you should contact the privacy officer.

The right to request that we restrict the uses and disclosures of your PHI. You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or healthcare operations, or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. However, if you request a restriction and the information you asked us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclose the PHI to a healthcare provider to provide you with emergency treatment. Elevation Autism Center is not required to agree to any restrictions you request, but any restrictions agreed to by Elevation Autism Center are binding on Elevation Autism Center.

Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. If we maintain a website, we will prominently post a copy of this Notice on our website and make the Notice available electronically through the website. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Revisions to the Notice: Elevation Autism Center reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted to our website, if we maintain one. You can get a copy of the latest version of this Notice by contact the Privacy Officer.

Your Legal Rights and Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint with us or to the government. Should you have any questions, comments or complaints you may direct all inquiries to the privacy officer listed at the end of this Notice. Individuals will not be retaliated against for filing a complaint.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/​. We will not retaliate against you for filing a complaint.

If you have any questions, or if you wish to file a complaint or exercise any rights listed in this Notice, please contact the Privacy Officer at:

Elevation Autism Center

4279 Roswell Rd NE, Ste 208-365

Atlanta, GA 30342

(404) 474-0040

office@elevationautism.com