Atlanta ENT, Sinus & Allergy Associates, P.C.
HIPAA Notice of Privacy Practices
Effective Date: August 9, 2025
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. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT Becky Mitchell, (404) 255-2918.
WHO WILL FOLLOW THIS NOTICE:
This notice applies to all departments, locations, workforce members, and clinicians providing services at Atlanta ENT, Sinus & Allergy Associates, P.C. These individuals, sites, and locations may share health information with each other or with third-party specialists for treatment, payment, and health care operations as described below.
OUR RESPONSIBILITIES:
We are committed to protecting your medical information. We keep records of the care and services you receive to provide quality care and meet legal requirements. This notice applies to those records. We are required by law to maintain the privacy of your Personal Health Information, provide you with an electronic or paper copy of this notice, follow its terms, and notify affected individuals following a breach of unsecured protected health information.
OUR USES AND DISCLOSURES
The following are the ways we may use and share your health information as allowed or required by HIPAA:
For Treatment:
We may use your health information to treat you and coordinate your care, including sharing with staff and outside providers. We may also share with family or others involved in your care when you agree, do not object, or when allowed by law. If you have a legal guardian or have given someone medical power of attorney, they may act for you regarding your health information. We will verify their authority before doing so. (Example: A provider treating you for an injury may ask another provider about your overall health).
For Payment:
We may use or share your health information to bill and collect payment for the care you receive, including checking coverage or sending information to your health insurance plan about services or procedures you received. (Example: We give information to your health plan so it will pay for your services or approve a prior authorization.)
For Health Care Operations:
We may use or share your health information to run our practice, improve quality, train staff, and contact you when needed. We may also contact you about treatment options or other health-related services or benefits. (Example: We may use your information to assess the performance of our doctors, nurses, and other staff to ensure we provide quality care.)
For Public Health, Disaster & Safety
We may share information for public health and safety, including reporting conditions to public health authorities, product recalls, adverse events, suspected abuse or neglect, preventing or reducing serious threats, and working with coroners, medical examiners, or funeral directors. This may include disaster response to inform loved ones, organ and tissue donation requests, approved health research, and preventing serious threats to health or safety such as contagious diseases or warning those at risk.
For Legal, Law Enforcement & Government
We may share information for judicial or administrative proceedings (e.g., court or administrative orders, subpoenas), for law enforcement purposes, workers’ compensation claims, with health oversight agencies, when required by federal or state law, (including the U.S. Department of Health and Human Services to check HIPAA compliance), and for certain government functions such as military, national security, and presidential protective services.
Protections for Reproductive Health Care Information:
We are committed to protecting your sensitive health information, including information related to reproductive health care, consistent with applicable federal and state laws.
Other Uses of Personal Health Information
We will not use or share your information for purposes not described in this notice unless you give us written permission. This includes most uses of psychotherapy notes, marketing communications, and the sale of health information. If you give permission and later change your mind, you may revoke your authorization in writing at any time. We may not be able to take back information already shared in reliance on your authorization, including when we already acted on it or when your authorization was part of obtaining insurance coverage and the insurer has legal rights to review, contest a claim, or coverage.
YOUR RIGHTS
The following are your rights concerning your Personal Health Information:
Right to Inspect and Copy Your Personal Health Information:
You can see and get a copy of most information we maintain about you (such as billing records) in electronic or paper format, or as a summary. We usually provide it within 30 days, but there may be circumstances where we need more time. Your request must be in writing, and we may charge a reasonable, cost-based fee. Some information (e.g., psychotherapy notes, information compiled for legal proceedings) is not available for inspection or copying. In some cases, we may deny a request; if we do, we will tell you why and explain how you may request a review.
Right to Amend Your Personal Health Information:
If you think information is incorrect or incomplete, you can ask us to amend it while it is kept by or for us. Your request must be in writing. We may deny your request in certain cases (e.g., information is accurate and complete; we did not create it and the creator is available; the information is not part of records we maintain or that you could inspect).
Right to an Accounting of Disclosures:
You can ask for a list of certain disclosures we made about you for up to six years (not including some routine disclosures such as treatment, payment, health care operations, lawful reasons, or disclosures made directly to you). This request must be in writing. We provide one list per year at no charge; a reasonable, cost-based fee may apply for additional requests within 12 months.
Right to Request Restrictions:
You can ask us to limit how we use or share information for treatment, payment, or operations, or with people involved in your care. We are not required to agree, except when you pay out-of-pocket in full for a service and ask us not to share that information with your health plan for payment or operations. You must make your request in writing.
Right to Request Confidential Communications:
You can ask us to contact you in a specific way or at a different location (for example, by mail at a different address). We will accommodate reasonable requests. If you prefer not to be contacted by text message, phone, or through a patient portal, you can ask us to use a different method. You must make your request in writing.
Rights in the Case of Fundraising:
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Right to get a Paper Copy of this Notice:
You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly.
Right to File a Complaint:
If you believe your privacy rights have been violated, you may file a complaint with us. If you have questions on how to file a complaint, or want to file a complaint with us, please contact us at:
Atlanta ENT, Sinus & Allergy Associates, P.C.
Attn: Privacy Officer
5555 Peachtree Dunwoody Road Suite 235, Atlanta, GA 30342
(404) 255-2918
All complaints must be submitted in writing. You will not be penalized for filing a complaint. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201
1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints
Changes to this Notice:
We reserve the right to change the terms of this Notice at any time. Any changes will apply to the health information we already have about you, as well as any information we receive in the future. The effective date of this Notice, and any revised version, is shown on the first page of this notice. The updated Notice will be made available. You may request a copy of this Notice at any time.
