THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW PROTECTED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY COLUMBUS AND HOW YOU CAN GET ACCESS TO THIS PROTECTED HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

Purpose:

This Notice of Privacy Practices describes how Columbus may use and disclose your protected health information for treatment, payment, health care operations, and for certain other purposes. This Notice of Privacy Practices also describes your rights to access and control your protected health information, and provides information about your right to make a complaint if you believe Columbus has improperly used or disclosed your protected health information.

Protected health information is information that may personally identify you and relates to your past, present, or future physical or mental health or condition, and related MHDDAD services. Columbus is required to abide by the terms of this Notice of Privacy Practices and may change the terms of this Notice of Privacy Practices at any time. A new Notice of Privacy Practices will be effective for all protected health information that Columbus maintains at the time of issuance.

1. How We May Use and Disclose Protected Health Information About You. Your protected health information may be used and disclosed by Columbus, its administrative and clinical staff, and others involved in your care, services and treatment for the purpose of providing MHDDAD services to you and to assist in obtaining payment of your MHDDAD services bills. We have included a few examples of what we mean. These examples are not a complete list, but should give you an idea of the types of uses and disclosures that we may make. Uses and disclosures of your protected health information that are not listed below will be made only with your written authorization.

   1. Treatment. Your protected health information may be used to provide, coordinate, or manage your MHDDAD care and any related services, including coordination of your MHDDAD services with a third party that you have been referred to for treatment or diagnosis, such as a physician who may be treating you.
   2. Payment. Your protected health information may be used to obtain payment for your MHDDAD services. For example, this may include activities that a health insurance plan requires before it approves or pays for MHDDAD services.
   3. Health Care Operations. Columbus may use or disclose your protected health information to support the business activities of Columbus, including, for example, but not limited to, training, licensing, and other business activities.
   4. For appointment reminders. We may use or disclose your protected health information to remind you of your appointment. Our message will include the name of our office and the date and time of your appointment. We may also use or disclose your protected health information to remind you to schedule an appointment.
   5. To provide you with treatment alternatives. We may use or disclose your protected health information to tell you about other treatments or other services that could help you.
   6. To our business associates. Columbus will share your protected health information with services to Columbus such as billing or typing. We will have a written agreement between our office and the business associate that states how the business associate will protect the privacy of your protected health information.
   7. Others involved in your services and supports. Unless you say no or are otherwise prohibited by federal or Georgia law, we may disclose your protected health information to a family member, a friend, or another person that you identify, when they are directly involved in your services and supports. We may use or disclose your protected health information if we believe it is necessary in our professional judgment to let a family member or other person that is responsible for your care know where you are and how you are doing. We may use or disclose your Protected Health Information to an authorized public or private business to help us (1) if a disaster happens and (2) to decide how to use and disclose your protected health information to family or other individuals involved in you r service needs.
   8. As required by law. We may use or disclose your protected health information, as the law requires. The use or disclosure of your protected health information as required by law will be subject to all related Georgia and federal laws.
   9. For public health activities. We may disclose your protected health information for public health purposes to a public health agency. The disclosure may be made to control disease, injury or disability.
   10. As required by the Food and Drug Administration. We may disclose your protected health information to a person or company as required by the Food and Drug Administration.
   11. For communicable disease communicable disease exposure. We may disclose your protected health information, if required by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of getting or spreading the disease.
   12. For abuse or neglect. We may disclose your protected health information to a public health agency that processes reports of child or adult abuse or neglect. We may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence as required or permitted by Georgia and federal law.
   13. For health oversight. We may disclose your protected health information to health agency for activities authorized by law. Health agencies seeking this protected health information include government agencies that oversee the health care system, government benefit programs (such as Medicare or Medicaid), other government regulatory programs and civil rights laws.
   14. In legal proceedings. We may disclose your protected health information in the course of any legal proceeding. We may respond to an order of a court and, in certain circumstances, to a subpoena.
   15. For law enforcement. We may also disclose your protected health information for official law enforcement activities as required or permitted by Georgia and federal law. Examples of these may include (1) helping with identification and/or locating you, (2) assisting the victim(s) of a crime, (3) where it is suspected that a death has occurred as a result of criminal conduct, or (4) in the event that a crime occurs on, in, or around our building.
   16. To coroners, to funeral directors, and for organ donation. We may disclose your protected health information to a coroner or medical examiner as permitted by Georgia and federal law.
   17. For research. We may disclose your protected health information as permitted by Georgia and federal law to researchers when you are participating in a research study.
   18. For personal or public safety. We may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious and immediate threat to the health or safety to you, another person, or the public as permitted by Georgia and federal law.
   19. For military activity and national security. We may use or disclose protected health information to Armed Forces personnel for activities deemed necessary by appropriate military authorities. We may disclose protected health information to determine your eligibility for Veterans benefits. We may also disclose protected health information to authorized federal officials who are conducting national security and intelligence activities.
   20. For workers’ compensation. Your protected health information may be shared as required by Georgia law to comply with workers’ compensation and other employee compensation programs.
   21. Regarding inmates. We may use or disclose your protected health information as permitted by Georgia or federal law, if you are an inmate and if protected health information is requested by or for the correctional facility.
   22. For required uses and disclosures. Under the law, we must give protected health information to you and, when required, to the Secretary of the Department of Health and Human Services to ensure that we follow the requirements of the Health Insurance Portability and Accountability Act and its regulations.
   23. MHDDAD. Columbus, as a “business associate” of MHDDAD, will provide your protected health information to MHDDAD as required to perform our services on behalf of MHDDAD.
   24. For Fund Raising Activities. We may use or disclose your protected health information and the dates that you received services from us so that we can contact you about fundraising activities supported by our office. If you do not want to get these materials, please contact our Privacy Officer and ask that we do not send you this information.
   25. Limited Data Sets. We may use or disclose limited data sets, which is protected health information that has been de-identified, for research, public health, or health care operations purposes.

2. Other Permitted or Required Uses and Disclosures with Your Authorization or Opportunity to Object. Other uses and disclosures of your protected health information will be made only with your written authorization, which you may revoke in writing at any time, except as to the extent Columbus has taken action in reliance thereon or as permitted or required by law as described below. Generally, if there is protected health information, which identifies you as a person who has applied for or received substance abuse services or psychiatric services, that protected health information will not be disclosed without your authorization unless the law allows or requires such a disclosure. Columbus may use and disclose your protected health information when you authorize in writing such use or disclosure of all or part of your protected health information. Columbus may use and disclose certain protected health information to your representative, as that term is defined in the Georgia Mental Health Code, according to applicable Georgia and federal law. You may be given a chance to object to certain other disclosures to your representative.

3. Your Rights with Respect to Your Protected Health Information. Following is a statement of your rights related to your protected health information and a brief description of how you may apply these rights.

   1. You have the right to review and copy your protected health information. You may review or receive a copy of your protected health information in accordance with applicable state and federal law. A reasonable, cost based fee for copying, postage, and labor expense may apply. However, under federal law, you may not review or copy the following records: protected health information compiled in anticipation of or for use in a civil, criminal, or administrative proceeding, and protected health information that, by law, you are not allowed to view. We may deny your request to review your protected health information.
   2. You have the right to request that a restriction be placed on the use or disclosure of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. You may also ask that any part of your protected health information not be disclosed to family members or friends who may be involved in your care. These requests must be in writing to our Privacy Officer and must state what you do not want shared. We are not required to agree to your request. If we agree, we may only share your protected health information if it is needed to provide emergency care to you, or if we provide you with prior notice that we can no longer comply with your request.
   3. You have the right to ask that we change the way we handle your protected health information. We will try to honor your request, but we may still ask you for protected health information about how payment will be made or other protected health information needed to care for you. Please make any request in writing to our Privacy Officer.
   4. You may have the right to ask us to make amendments to your protected health information. We may deny your request in accordance with Georgia and federal law. Please talk with our Privacy Officer if you have questions about making corrections to your record.
   5. You have the right to receive a listing of certain disclosures we have made of your protected health information. This list will not include all disclosures we may have made of your protected health information. We may charge a fee. Your right to receive this protected health information has certain exceptions, restrictions, and limitations.
   6. You have the right to obtain a paper copy of this Notice of Privacy Practices at any time from us. If you would like a paper copy of this Notice of Privacy Practices at any time, please request one from our receptionist.

4. Complaints and Questions. You may complain to us and to the United States Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint by notifying the Columbus Privacy Officer of the basis for your complaint. Columbus will not retaliate against you for filing a complaint. If you have questions about this Notice of Privacy Practices or require additional information please contact the Columbus Privacy Officer. You may contact the Columbus Privacy Officer, Cynthia McBride, by telephone at 1-800-579-7609, facsimile (770) 938-7815, or by mail to: 2300 Henderson Mill Road, Suite 121, Atlanta, GA 30345 for further information about the complaint process or this Notice of Privacy Practices.

5. Effective Date. This Notice of Privacy Practices is effective as of June 17, 2003.