Patient Information Privacy Policy

It is the policy of Fusion Sleep that all physicians and staff preserve the integrity and the confidentiality of protected health information (PHI) pertaining to our patients. This policy describes how medical information about you may be used and disclosed and, how you can get access to this information and what obligations Fusion Sleep has regarding the use and disclosure of medical information. The purpose of this policy is to ensure that we have the necessary medical information and PHI in order to provide high quality medical care while protecting the confidentiality and privacy of the PHI of our patients. Patients should not be afraid to provide information to our organization for purposes of treatment, payment and healthcare operations

Definitions

Health Information: Any information, whether oral or recorded in any form, that is created or received by a health care provider that relates to an individual's past, present, or future physical or mental health, or to the payment for such health care.

Individual Identifiable Information: Health information that is created or received by Fusion Sleep and relates to the past, present, future physical or mental health or condition of an individual or payment for the provision of care to the patient, the provision of health care to the patient, and identifies the patient or that there is a reasonable basis to believe the information can be used to identify the patient.

Protected Health Information (PHI): Is Individual Identifiable Information that is transmitted by electronic media or transmitted or maintained in any other form or medium.

Legal Requirements

Fusion Sleep is required by law to: 

• Make sure that medical information that identifies you is kept private; 
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; 
• Follow the terms of the notice that currently is in effect; 
• Change the notice only in accordance with federal rules; 
• Provide our internal complaint process for privacy issues to you.

Who will follow our privacy practices

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. All Fusion Sleep staff and associated physicians adhere to this policy. Violation of this policy is grounds for disciplinary action, up to and including termination of employment in accordance with personnel policies. Additionally, criminal or professional sanctions may apply. This notice applies to all of the records of your care we generate. This notice also applies to other health information about you; such as information collected with your authorization during research studies that do not involve treatment. Your personal doctor and other entities providing products or services to you may have different policies or notices regarding their use and disclosure of your medical information.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

RIGHT TO INSPECT AND COPY: You have the right to request a copy of your personal medical information. Usually, this includes medical and billing records.

If we deny your request, then we must inform you of your right to request a review of our denial. Depending on the reason for denial, another licensed health care professional chosen by us will review the request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. To receive a copy of your medical information, you must submit your request in writing to Fusion Sleep. A fee for the costs of copying, mailing, or other supplies associated with your request will be assessed.

RIGHT TO AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request the amendment for as long as the information is kept by us or for us. To request an amendment, your request must be made in writing to Fusion Sleep. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for us;
• Is not part of the information which you would be permitted to inspect or copy;
• Is accurate and complete.

RIGHT TO AN ACCOUNTING OF DISCLOSURE: You have the right to request an "accounting of disclosures." This accounting is a list of the disclosures we made of medical information about you, except disclosures made for treatment, payment and Fusion Sleep’s operations. To request this list or accounting of disclosures, you must submit your request in writing to Fusion Sleep. Your request must state a time period, which may not be longer that three years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional list, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation of the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do not agree, we will comply with your request unless the information is needed to provide your emergency treatment. To request restrictions, you must make your request in writing to Fusion Sleep. In your request, you must tell (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

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 at work or by mail. To request confidential communications, you must make your request in writing to Fusion Sleep. We will not ask you for the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

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 entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact Fusion Sleep.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we are permitted to use and disclose medical information as a health care provider For each category of uses or disclosures will be listed. However, all of the ways we are permitted or required to use and disclose information will fall within one of the categories.

FOR TREATMENT: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to physicians, nurses, and their office personnel, medical technicians, labs, hospitals, and other facilities and their staff. For example, your health care provider may disclose your medical information for treatment purposes when referring you to another health care provider. We also may disclose medical information about you to people who may be involved in your medical care after you have received our products and services, such as social workers or home health agencies.

FOR PAYMENT: We may use and disclose medical information about you so that the treatment and services we provide you may be billed to and payment may be collected from you, an insurance company, or third party. For example, we may need to give your health plan information about products and services we provided to you so your health plan will pay us or reimburse you for the products and services. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

FOR HEALTH CARE OPERATIONS: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, marketing and conducting or arranging for business activities. For example, we may discuss your protected health information to medical residents that see patients at our office. In addition, we may use a sign in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you.

APPOINTMENT REMINDERS: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or services.

TREATMENT ALTERNATIVES: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

HEALTH-RELATED BENEFITS AND SERVICES: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your location and condition and that you are receiving products and services from us. In addition, we may disclose medical information about you to any entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

RESEARCH: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one product or service to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with the patient's need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave our premises. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.

AS REQUIRED BY LAW: We will disclose medical information about you when required to do so by federal, state, and local law.

TO AVERT A SERIOUS THREAT TO HEALTH AND SAFETY: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

MILITARY AND VETERANS: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

WORKER'S COMPENSATION: We may release information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

PUBLIC HEALTH ACTIVITES: We may disclose medical information about you for public health activities. These activities include the following:

• To prevent or control disease, injury, or disability; 
• To report birth and deaths;
• To report child abuse or neglect;
• To report reactions to medications, or problems with products;
• To notify people of recalls of products they may be using;
• To notify a person who may have been exposed to a disease or may be at risk fir contracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

HEALTH OVERSITE ACTIVITES: We may disclose medical 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.

LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you 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 medical information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if under certain limited circumstances, we are unable to obtain the person's agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct occurring on our premises;
• In emergency circumstances to report a crime; the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: We may release medical information to a coroner, or medical examiner. This may be necessary for example, to identify a deceased person or determine the cause of death. We may also release medical information about our patients to funeral directors as necessary to carry out their duties.

NATIONAL SECURITY FOR THE PRESIDENT AND OTHERS: We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations. INMATES: If you are an inmate of a correctional institution or under the custody of a law enforcement officials, we may release medical information about you to the correctional institution or law enforcement official. This release would be 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) for the safety and security of the correctional institution.

ORGAN AND TISSUE DONATION: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary you facilitate organ or tissue donation and transplantation.

SALE OF BUSINESS ASSETS: We reserve the right to transfer medical information about you to a third party in conjunction with the sale of our company or certain assets belonging to our company.

OTHER USES FOR MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided you.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please write to:

Fusion Sleep - Center for Sleep Disorders
Data Privacy and Security Officer
4265 Johns Creek Pkwy, Suite A
Suwanee, GA 30024

All complaints must be submitted in writing. You will not be penalized for filing a complaint.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office where you are being treated. We will let you know that the policy has changed by changing the effective date at the bottom of this notice. If we do change this notice, we will re-post a copy of the current notice on our corporate website and in our office, but we will not redistribute this notice to you.

Effective Date: January 20th 2006