Protecting the privacy of your personal health information is important to us. This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
We reserve the right to change our privacy practices and the terms of this notice at any time. We reserve the right to make changes to our privacy practices and the terms of our notice effective for all health information we maintain.
USES AND DISCLOSURES OF HEALTH INFORMATION
We may use and disclose health information about you for treatment, payment, and healthcare operations. For example:
Treatment: We may use or disclose your health information to a physician, or healthcare facility with the intention of providing treatment to you.
Legal Representation: We may use or disclose your health information to an attorney or law firm who is representing you for injuries in an auto accident or work-related injury.
Payment: We may use or disclose your health information to obtain payment for services provided to you.
Healthcare Operations: We may use or disclose your health information in connection with our healthcare operations. Healthcare operations include, quality assessment and improvement activities, reviewing the competence of qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Abuse or Neglect: We may use or disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may use or disclose your health information to the extent necessary to avert a serious threat to your health or safety, or the health or safety of others.
Appointment Reminders/ Follow Up Procedures: By signing this notice, you are authorizing that we may use or disclose your health information to provide you with appointment reminders and/or follow-up on your treatment plan or health status (such as telephone calls, voicemail, text messages, letters and e-mails.)
I give permission to Dr. Joseph Hans and Duluth Injury & Rehab Center to use my address, phone number and clinical records to contact me with appointment reminders, missed reservations, birthday cards, holiday related cards and information about treatment alternatives or other health related information.
If Duluth Injury & Rehab Center contacts me by phone, I give them permission to leave a phone message on my answering machine or voice mail.
I give Duluth Injury & Rehab Center permission to treat me in a semi-open room where other patients are also being treated. I. am aware other people in the office may overhear some of my protected health information during the course of my care. If I need to speak with the doctor at any time in private, the doctor will provide a room for these conversations.
EXPIRATION: The Authorization shall expire on the following date 01/01/2025
RIGHT TO REVOKE AUTHORIZATION
You have the right to revoke AUTHORIZATION, in writing at any time. However, your written request to revoke this AUTHORIZATION is not effective to the extent that we have provided services or taken action in reliance on your authorization. You may revoke this AUTHORIZATION by mailing or hand delivering a written notice to the Privacy Official of Duluth Injury & Rehab Center. The written notice must contain the following information:
YOUR NAME, SS NUMBER and YOUR DATE OF BIRTH
A clear statement of your intent to revoke this AUTHORIZATION, The date of your request, and your signature.
This revocation is not effective until Duluth Injury & Rehab Center receives it.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made regarding the disclosure of your health information, you may file a complaint with our privacy officer. You may also submit a written complaint to the U.S. Department of Health and Human Services.
We support your right to the privacy of your health information. We respect your right to file a complaint and will not take any action against you if you choose to do so. While you may make an oral complaint at any time, written comments should be sent to us at the address listed below.
To Contact Us:
Duluth Injury & Rehab Center
3780 Old Norcross Rd., Suite 301 B
Duluth, Georgia 30096
Privacy Officer: Sharyn Jenkins