Legal

Disclaimer: This is not for everyone. Please speak with your primary care provider or a provider at Bariatric & Metabolic Center for more information. Each patient’s weight-loss plan is individualized to meet the needs of the patient.

Your Choices.

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures.

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you

• We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Help with public health and safety issues
We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

• We can use or share your information for health research.

Comply with the law

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

• We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities.

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

This Notice of Privacy Practices applies to the following organizations:

Notice of Non-Discrimination
Coffee Regional Medical Center and its affiliated entities (hereinafter collectively referred to as “CRMC”) comply with applicable Federal Civil Rights laws and do not exclude, deny access/benefits to health care, or otherwise discriminate against or treat differently any person on the basis of race, color, national origin, age, religion, physical or mental disability, genetic information, and/or sex (including sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions) in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CRMC directly or through a contractor or any other entity with which CRMC arranges to carry out its programs and activities.

CRMC provides free aids and services to people with disabilities to enable them to effectively communicate with us, such as:

• Qualified sign language interpreters
• Written information in other formats (i.e. large print, audio, and accessible electronic formats)

CRMC also provides free language services to people whose primary language is not English, such as:

• Qualified interpreters
• Information written in other languages

If you need these services or if you have any questions, please contact Sherry Thomas, CRMC’s Executive VP, Chief Quality Officer, and Civil Rights Coordinator, at 912-383-5616.

If you believe that CRMC has failed to provide these services or has discriminated in another way on the basis of race, color, national origin, age, religion, physical or mental disability, genetic information, and/or sex, you can file a file a grievance with Sherry Thomas, CRMC’s Executive VP, Chief Quality Officer, and Civil Rights Coordinator, at 1101 Ocilla Road, Douglas, GA 31533, 912-383-5616 (telephone), 912-389-2112 (facsimile), Sherry.Thomas@Coffeeregional.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Sherry Thomas is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at http://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Section 1557 of the Affordable Care Act, and Regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 Code of Federal Regulations Parts 80, 84, and 91.