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120 S. Zetterower Ave.
Statesboro, Georgia

(912) 681-7368 (S • ENT)
info@statesboroent.com

HIPPA

NOTICE OF PRIVACY PRACTICES

This Notice of Privacy Practices describes how medical information about you, order the patient, drugstore may be used and disclosed and how you can get access to this information. Please review it carefully.

Uses and Disclosures of Health Information

We use health information about you for treatment, to obtain payment for treatment, and for healthcare operations purposes — for example, to evaluate the quality of care that you receive.

We may contact you to provide appointment reminders, information about treatment alternatives or other heath-related benefits and services that may be of interest to you.

We may use or disclose identifiable health information about you without your authorization for several other reasons. Subject to certain requirements, we may give out health information without your authorization for public health purposes, for auditing purposes, for research studies, and for emergencies. We provide information when otherwise required by law, such as for law enforcement in specific circumstances. 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.

We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice of Privacy Practices and post the new notice in the waiting area and in each examination room. You can also request a copy at any time. For more information about our privacy practices, contact the person listed below.

Individual Rights

In most cases, you have the right to look at or get a copy of health information about you that we use to make decisions about you. If you request copies, we will charge you $35.00 for the first 20 pages and .25 cent for each additional page. You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment or related administrative purposes. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

You may request in writing that we not use or disclose your information for treatment, payment and administrative purposes except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request but are not legally required to accept it.

You may also request to receive confidential communications of protected health information.

Complaints

If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.

Our Responsibilities

We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice. If you have any questions or complaints, please contact our Privacy Officer at:
Name: Tammie Sanford
Practice Name: Statesboro ENT & Sinus Center
Address: 120 S. Zetterower Ave.
Statesboro, GA 30458
Phone: 912-681-7368