Notice of Privacy Practices
Digestive Healthcare of Georgia, P.C. (DHGPC) presents this Notice to our patients describing how your medical information may be used or disclosed and how you can get access to this information. Please review it carefully. You have the right to obtain a paper copy of this Notice upon request. DHGPC also respects privacy in regards to credit card info acquired while making a payment on this site. No information collected while making a payment will be shared in anyway, shape or form.
Patient Health Information
Under Federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment and related medical information. Your health information also includes payment, billing and insurance information.
How We Use Your Patient Health Information
DHGPC uses health information about you for treatment, analyzing procedures and lab results. We use information to obtain payment and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances where the law applies, we may be required to use or disclose the information without your permission.
Examples of Treatment, Payment, and Health Care Operations
Treatment: DHGPC will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians and other members of your treatment team will record information in your medical record and use it to determine the most appropriate course of care. DHGPC may also disclose this information by fax, in person, or via telecommunication. We may communicate to other health care providers who are participating in your treatment, to pharmacists who are filling and refilling your prescriptions, and to family members who are helping with your care.
Payment: DHGPC will use and disclose your health information for payment purposes. For example, DHGPC may need to obtain authorization from your insurance company before providing certain types of treatment. DHGPC will submit bills and maintain records of payments from your health plan.
Health Care Operations: DHGPC will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it.
Release of Information to Family or Friends
DHGPC knows that family or friends are an integral part of a patient’s care. If you wish to authorize a family member or friend to speak with us regarding your care or test results, please write their name and contact information on the ‘Notice of Privacy Practices Acknowledgement’ form. DHGPC will not release your information to any friend or family without your written consent.
Special Uses
DHGPC may use your information to contact you with appointment reminders by phone or mail. DHGPC may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. This communication may be sent to you via the methods listed above. If you have granted written permission, the above information may also be sent to you via email. If you wish to authorize the use of email as a method for DHGPC to communicate with you, sign the proper section on the ‘Notice of Privacy Practices Acknowledgement’ form.
Other Uses and Disclosures
DHGPC may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, DHGPC is permitted to give out health information without your permission for the following purposes:
Required by Law: DHGPC may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
Research: DHGPC may use or disclose information for approved medical research.
Public Health Activities: As required by law, DHGPC may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
Health Oversight: DHGPC may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
Judicial and Administrative Proceedings: DHGPC may disclose information in response to an appropriate subpoena or court order.
Law Enforcement Purposes: Subject to certain restrictions, DHGPC may disclose information required by law enforcement officials.
Deaths: We may report information regarding deaths to coroners, medical examiners, funeral and organ donation agencies.
Serious Threat to Health or Safety: DHGPC may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Special Government Functions: If you are a member of the armed forces, DHGPC may release information as required by military command authorities. DHGPC may also disclose information to correctional institutions or for national security purposes.
Workers’ Compensation: DHGPC may release information about you for workers’ compensation or similar programs providing benefits for work-related injuries or illness. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.
Individual Rights
You have the following rights with regard to your health information. Submit any concerns in writing to DHGPC’s compliance officer (see below).
Request Restrictions: You may request restrictions on certain uses and disclosures of your health information. DHGPC is not required to agree to such restrictions, but if we do agree, DHGPC must abide by those restrictions.
Confidential Communications: You may ask us to communicate with you confidentially. Please ask to see your DHGPC Office Manager to initiate and document this request.
Inspect and Obtain Copies: You have the right to see or receive a copy of your health information. There may be a small charge dictated by Georgia Law for these copies.
Amend Information: If you believe information in your record is incorrect, you have the right to request that DHGPC correct or amend the existing information. Your DHGPC physician has the right to refuse your request. Regardless, a letter concerning your request will be sent within 30 days of said request.
Accounting of Disclosures: You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or health care operations.
Our Legal Duty
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.
Changes in Privacy Practices
We may change our policies at any time. A current version of our Notice is available in each waiting area at all times. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.
Complaints
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.
Refund Policy
The refund policy is set by Digestive Healthcare of Georgia, P.C. Refund requests must be directed to Digestive Healthcare of Georgia, P.C., ATTN Business Office , 95 Collier RD, Suite 4075, Atlanta, GA 30309, phone: 404-603-3543
If you have any questions, requests or complaints, please contact DHGPC at:
Address:
Digestive Healthcare of Georgia, P.C.
Piedmont Hospital
95 Collier Road, NW, Suite 4075
Atlanta GA 30309
Phone:
404-355-3200
Patient Rights and Responsibilities
1. The patient has the right to considerate, dignified and respectful care.
2. The patient has the right to refuse any treatment or care, and to be informed of any medical consequences of their actions.
3. The patient has the right to the appropriate privacy of care. HIPAA requirements will be followed unless there is imminent danger to the patient or others.
4. The patient has the right to examine and receive a full explanation of their bill and payment policies of fees for service.
5. Upon proper documentation, patient’s medical records are available. If it is medically inadvisable to give such information to a patient, the information is provided to a person designated by the patient or to a legally authorized person.
6. The patient has the right to refuse to participate or engage in human experimentation, and/or experimental research affecting their care or treatment.
7. The patient has the right to receive information regarding their care, diagnosis, treatment and prognosis.
8. The patient has the right to receive information from their provider prior to signing the informed consent. This information will include but not limited to the medical risks and benefits of treatment and alternatives of care.
9. The patient has the responsibility to follow the facility’s protocol regarding their care, not to behave in a disruptive or disturbing manner and to have what is considered civil conduct.
10. The patient has the responsibility to be considerate of other patients and staff members.
11. The patient has the responsibility to have a responsible adult driver present at time of procedure.
12. The patient has the responsibility to provide complete and accurate health care information to the best of their ability regarding their health, medications (including over-the-counter products and dietary supplements), and any allergies or sensitivities.
13. The patient has the responsibility to indicate whether he or she understands the contemplated plan of care and is able to follow the treatment plan prescribed by his/her provider and to participate in his/her care.
14. The patient has the right to change their provider if other qualified providers are available.
15. The patient has the responsibility to be knowledgeable about their health care plan / insurance.
16. The patient has the responsibility to be accountable for their financial responsibilities.
17. The patient is given the opportunity to participate in decisions involving their health care, except when such participation is contraindicated for medical reasons.
18. The patient needs to be aware that it is the policy of Digestive Healthcare Endoscopy Center not to honor Advanced Directives/Allow Natural Death. If you bring an Advanced Directive/Allow Natural Death, it will become a prominent part of your chart. In the event of an adverse occurrence we will resuscitate and/or stabilize the patient and transfer to an acute care facility. Your Advanced Directive/Allow Natural Death will be shared/ sent with you to the acute care facility.
19. The patient has the right to their health care providers’ credentials upon request.
20. The patient has the right to exercise his or her rights without being subjected to discrimination or reprisal.
21. The patient or their representative has the right to verbalize concerns, suggestions, or complaints to any of the below listed agencies. It is the responsibility of Digestive Healthcare Endoscopy Center staff to listen to patient concerns voiced by the patient or their representative. Patients who express concerns or file a grievance will not have their future access to care compromised in any way. To share concerns, verbally or written please contact Lisa Kittner RN,BSN at 706-253-7340 Ext. 1015 , Gaye Pennington at 404-355-3200 Ext. 1111 or any staff member apart of Digestive Healthcare. The governing body will notify the patient of receipt of complaint within three working days. A written decision will be mailed to the patient after seven working days. If you are not satisfied with the resolution of Digestive Healthcare Endoscopy Center you may contact the state agency or Medicare Ombudsman.
Practice Administrator
Digestive Healthcare Endoscopy Center
Gaye Pennington
95 Collier Rd
Suite 4075
Atlanta, GA 30309
Georgia Department of Community Health
Attn: Complaint Department
Two Peachtree St, NW 31-447
Atlanta, GA 30303-3142
Phone: 404-657-8939 or 1-800-878-6442
Medicare Beneficiary Ombudsman:
www.cms.hhs.gov/center/ombudsman.asp
1-800-Medicare
H.B. 416 Consumer Information Awareness Act
To Our Patients:
Due to H.B. 416 Consumer Information and Awareness Act, we want to advise you our patient of the types of caregivers that will be providing you care.
Physicians provide care at all seven office locations and Digestive Healthcare of Georgia Endoscopy Centers, Summit Endoscopy Center, Piedmont Atlanta Hospital, Piedmont Mountainside Hospital and Piedmont Fayetteville Hospital.
Nurse Practitioners provide care at Atlanta offices, Jasper office, Fayetteville office, Newnan office, Blue Ridge office and Ellijay office.
Physician Assistants provide care at the Atlanta offices and at Piedmont Hospital Atlanta.
Certified Medical Assistants, Licensed Practical Nurses and Registered Nurses provide care at all offices locations.
Anesthesiologist and Certified Registered Nurse Anesthetists provide care at both Digestive Healthcare of Georgia Endoscopy Centers in Jasper and Atlanta Ga and Summit Endoscopy Center.
As a patient it is your right to inquire about a practitioner’s license at any location.
Endoscopy labs in all locations Summit, Atlanta, and Jasper have GI Technicians, registered nurses and scope maintenance technicians.
Download a printable version of our Advanced Directives form here.
