Notice of Privacy Practices

OUR OBLIGATIONS
We are required by law to:
• Maintain the privacy of protected health information
• Give you this notice of our legal duties and privacy practices regarding health information about you
• Follow the terms of our notice that is currently in effect

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
The following describes the ways we may use and disclose health information that identifies you (“Health
Information”). Except for the purposes described below, we will use and disclose Health Information only with your
written permission. You may revoke such permission at any time by writing to our practice Privacy Officer.
For Treatment: We may use and disclose Health Information for your treatment and to provide you with treatmentrelated
health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or
other personnel, including people outside our office, who are involved in your medical care and need the information
to provide you with medical care.
For Payment: We may use and disclose Health Information so that we or others may bill and receive payment from
you, an insurance company or a third party for the treatment and services you received. For example, we may give
your health plan information about you so that they will pay for your treatment.
For Healthcare Operations: We may use and disclose Health Information for health care operations purposes.
These uses and disclosures are necessary to make sure all of our patients receive quality care and to operate and
manage our office. For example, we may use and disclose information to ensure the home care, medical equipment
and medications you receive are of the highest quality. We also may share information with other entities that have a
relationship with you (for example, your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services: We may use and
disclose Health Information to contact you to remind you that you have an appointment with us. We also may use
and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that
may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care: When appropriate, we may share Health
Information with a person who is involved in your medical care or payment for your care, such as your family or a
close friend. We also may notify your family about your location or general condition or disclose such information to
an entity assisting in a disaster relief effort.
SPECIAL SITUATIONS
As Required by Law: We will disclose Health Information when required to do so by international, federal, state or
local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose Health Information when necessary to
prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures,
however, will be made only to someone who may be able to help prevent the threat.
Business Associates: We may disclose Health Information to our business associates that perform functions on our
behalf or provide us with services if the information is necessary for such functions or services. For example, we may
use another company to perform billing services on our behalf. All of our business associates are obligated to protect
the privacy of your information and are not allowed to use or disclose any information other than as specified in our
contract.
Military and Veterans: If you are a member of the armed forces, we may release Health Information as required by
military command authorities. We also may release Health Information to the appropriate foreign military authority if
you are a member of a foreign military.
Workers’ Compensation: We may release Health Information for workers’ compensation or similar programs. These
programs provide benefits for work-related injuries or illness.
Health Oversight Activities: We may disclose Health Information to a health oversight agency for activities authorized
by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system, government programs, and compliance
with civil rights laws.
Data Breach Notification Purposes: We may use or disclose your Protected Health Information to provide legally
required notices of unauthorized access to or disclosure of your health information.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose Health Information in response
to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery
request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information requested.
Law Enforcement: We may release Health Information if asked by a law enforcement official if the information is: (1)
in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or
locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very
limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of
criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of
the crime or victims, or the identity, description or location of the person who committed the crime.
Inmates or Individuals in Custody: If you are an inmate of a correctional institution or under the custody of a law
enforcement official, we may release Health Information to the correctional institution or law enforcement official. This
release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety
or the health and safety of others; or (3) the safety and security of the correctional institution.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT
OUT
Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may disclose to a member of
your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly
relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we
may disclose such information as necessary if we determine that it is in your best interest based on our professional
judgment.
Disaster Relief: We may disclose your Protected Health Information to disaster relief organizations that seek your
Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a
disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do
so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health Information will be made only with your written
authorization:
• Uses and disclosures of Protected Health Information for marketing purposes; and
• Disclosures that constitute a sale of your Protected Health Information
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will
be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by
submitting a written revocation to our Compliance Director and we will no longer disclose Protected Health
Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked
it will not be affected by the revocation.

YOUR RIGHTS
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy: You have a right to inspect and copy Health Information that may be used to make
decisions about your care or payment for your care. This includes medical and billing records, other than
psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to
Compliance Director, PO Box 1187, Valdosta, GA 31603. We have up to 30 days to make your Protected Health
Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other
supplies associated with your request. We may not charge you a fee if you need the information for a claim for
benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your
request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by
a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply
with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records: If your Protected Health Information is maintained in
an electronic format (known as an electronic medical record or an electronic health record), you have the right to
request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will
make every effort to provide access to your Protected Health Information in the form or format you request, if it is
readily producible in such form or format. If the Protected Health Information is not readily producible in the form or
format you request your record will be provided in either our standard electronic format or if you do not want this form
or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with
transmitting the electronic medical record. Right to Get Notice of a Breach. You have the right to be notified upon a
breach of any of your unsecured Protected Health Information.
Right to Amend: If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the
information. You have the right to request an amendment for as long as the information is kept by or for our office. To
request an amendment, you must make your request, in writing, to: Compliance Director, PO Box 1187, Valdosta, GA
31603.
Right to an Accounting of Disclosure: You have the right to request a list of certain disclosures we made of Health
Information for purposes other than treatment, payment and health care operations or for which you provided
written authorization. To request an accounting of disclosures, you must make your request, in writing, to: Compliance
Director, PO Box 1187, Valdosta, GA 31603.
Right to Request Restrictions: You have the right to request a restriction or limitation on the Health Information we
use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the
Health Information we disclose to someone involved in your care or the payment for your care, like a family member
or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your
spouse.
To request a restriction, you must make your request, in writing, to: Compliance Director, PO Box 1187, Valdosta, GA
31603. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your
Protected Health Information to a health plan for payment or health care operation purposes and such information you
wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we
agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Out-of-Pocket-Payments: If you paid out-of-pocket (or in other words, you have requested that we not bill your
health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with
respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and
we will honor that request.
Right to Request Confidential Communications: You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or
at work. To request confidential communications, you must make your request, in writing, to: Compliance Director,
PO Box 1187, Valdosta, GA 31603. Your request must specify how or where you wish to be contacted. We will
accommodate reasonable requests.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you
a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a
paper copy of this notice. You may obtain a copy of this notice at our web site, www.barneshc.com. To obtain a paper
copy of this notice, contact our Compliance Hotline at 229-245-5750.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well
as any information we receive in the future. We will post a copy of our current notice at our office. The notice will
contain the effective date on the first page, in the top right-hand corner.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of
the Department of Health and Human Services. To file a complaint with our office, contact our Compliance Hotline at
229-245-5750. You will not be penalized for filing a complaint.