HIPPA

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.

This Notice describes how we may use and disclose your protected health information for purposes of treatment, payment and health care operations, and for other purposes that are permitted or required by law.

We are required by law to:
(1) Maintain the privacy of your protected health information
(2) Provide you with this Notice
(3) Abide by the terms of this Notice; and
(4) Additionally, we reserve the right to change this Notice. We reserve the right to make any new Notice that will be adopted effective for all protected health information we maintain. Any new Notice adopted will be presented at your next appointment.

Protected health information ("PHI") is defined as demographic and individually identifiable health information about you (individually identifiable health information) that will or may identify you and relates to your past, present or future physical, mental health or condition that involves providing health care services or health care payment.

WHY DO YOU SIGN A CONSENT FORM?
When you, as a patient, sign a consent form you are giving Southern Women's Health the right to use and disclose your protected health information and individually identifiable health information for the purpose of treatment, payment and health care operations, except for psychotherapy notes, and other privileged categories of information, i.e., alcoholism/drug abuse treatment records. Additionally, the federal law requires providers to obtain your authorization to release your protected health information for any reason other than treatment, payment or healthcare operations. [WHY DO YOU SIGN AN AUTHORIZATION FORM?] However, the federal law requires providers to obtain authorization (not consent) to use or disclose PHI maintained in psychotherapy notes (see definition below) for treatment by persons other than the originator of the notes, for payment, or for health care operations purposes, except as otherwise specified by federal law.

HOW IS HEALTH CARE OPERATIONS DEFINED?

Health care operations include conducting quality assessment and improvement activities, reviewing the competence or qualifications and accrediting/licensing of health care professionals and plans, evaluating health care professionals health plans performance, training future health care professionals, insurance activities relating to the renewal of a contract for insurance, conducting or arranging for medical review and auditing services, compiling and analyzing information in anticipation of or for use in civil or criminal legal proceedings, general administrative and business functions necessary for the covered entity to remain a viable business.

WHY DO YOU SIGN AN AUTHORIZATION FORM?

In order to release your protected health information for any reason other than treatment, payment and health care operations, you must sign an authorization that clearly explains how your information will be used.

HOW IS YOUR MEDICAL INFORMATION USED?

Southern Women's Health, P.L.L.C. uses medical records as a basis for recording individually identifiable health information and planning care and treatment and as a tool for routine health care operations such as assessing quality. Your insurance company may request information that we are required to submit in order to provide and bill for your care, such as procedure and diagnosis information. Other health care providers or health plans reviewing your records must follow the same confidentiality laws and rules required of Southern Women's Health, P.L.L.C.

USE OF YOUR CONSENT/AUTHORIZATION

Southern Women's Health, P.L.L.C. will contractually require our business associates to follow the same confidentiality laws and rules required of Southern Women's Health, P.L.L.C., health care providers or health plans. We will not allow others outside of Southern Women's Health, P.L.L.C. and Southern Women's Health, P.L.L.C.' s business associates to have access to your medical information unless we have the appropriate consent and/or authorization to do so. Business Associates perform various activities such as billing services, transcription services, etc...We will request your consent and /or authorization to release information at your first visit. With your consent, Southern Women's Health, P.L.L.C. will release information as required for treatment, payment and health care operations only, with certain restrictions. With your authorization, we will release the information that you have approved for release.

All of your rights may be exercised by contacting the Privacy Liaison or Privacy Officer of Southern Women's Health, P.L.L.C.

The Patient Notice, which you are now reviewing, is part of your patient rights. You have the right to receive and read this Notice.

You have a right to request restrictions regarding how we use and disclose your protected health information regarding treatment, payment, health care operations, however, we are not required to agree to your restrictions. If we do agree to your requested restriction we will follow your request, unless you are in need of emergency treatment, and the information is needed to provide emergency care. However, your restriction (if agreed to) will not prevent us from releasing information as required by other state and federal laws. [see WHEN YOUR CONSENT/AUTHORIZATION IS NOT REQUIRED]. Finally, if we accept your restrictions, we have the right to terminate them by notifying you of such.

You have a right to request that we communicate about your treatment and/or protected health information by alternative means or at alternative locations. We are required to accept reasonable requests. We require that you make this request in writing.

You have the right to ask questions and to receive answers.

You do not have to sign a consent form. However, if you chose not to allow access to your medical records, we may be unable to provide health care.

Your refusal to sign an authorization form will not be held against you.

You may change your mind and revoke your authorization, except in as much as we have relied on the authorization until that point or if the authorization was obtained as a condition of obtaining insurance coverage.

You have the right to inspect and copy your protected health information, as permitted by law.

You have the right to request amendments to your protected health information. We require that all requests for amendments be in writing and provide a reason to support the requested amendment. An amendment to your medical record will be made in the form of an addendum as is common practice in the medical field. Additionally, under federal law, we may deny the amendment, please contact the Privacy Liaison or Officer of Southern Women's Health, P.L.L.C. for details and to exercise your rights.

You have the right to an accounting of all entities that obtained information unrelated to treatment, payment or healthcare operations that you do not approve by completing an authorization.

American College of Obstetrics and Gynecology	District VII ACOG
Mississippi Section of ACOG	Winfred Winser Society
Mississippi State Medical Association	Central Medical Society
American Medical Association	Jackson Gynecic Society
American Academy of Pain Management	Canadian Pain Society
International Society for the Study of Vulvovaginal Disease	International Pelvic Pain Society