Patient Privacy

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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.


Our Legal Duty
We are required by applicable federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this notice at any time, provided that such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all protected healthin formation that we maintain, including medical information we created or received before we made the changes.

You may request a copy of our notice (or any subsequent revised notice) at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.

Uses and Disclosures of Protected Health Information
We will use and disclose your protected health information about you for treatment, payment, and health care operations. Following are examples of the types of uses and disclosures of your protected health care information that may occur. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that maybe made by our office.

Treatment: We will use and disclose your protected health information to provide, coordinate or manage your healthcare and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time to time to another physician or health care provider (e.g., a specialist or laboratory)who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for protected health necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Health Care Operations: We may use or disclose, as needed, your protected health information in order to conduct certain business and operational activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of students, licensing, and conducting or arranging for other business activities.

For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when your doctor is ready to see you. We may use or disclose your protected health information, as necessary, to contact you by telephone or mail to remind you of your appointment.

We will share your protected health information with third party "business associates" that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact us to request that these materials not be sent to you.

Uses and Disclosures Based On Your Written Authorization:Other uses and disclosures of your protected health information will be made only with your authorization,unless otherwise permitted or required by law as described below.

You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Without your written authorization, we will not disclose your health care information except as described in this notice.

Others Involved in Your Health 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. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.

Marketing: We may use your protected health information to contact you with information about treatment alternatives that may be of interest to you. We may disclose your protected health information to a business associate to assist us in these activities. Unless the information is provided to you by a general newsletter or in person or is for products or services of nominal value, you may opt out of receiving further such information by telling us using the contact information listed at the end of this notice.

Research; Death; Organ Donation: We may use or disclose your protected health information for research purposes in limited circumstances. We may disclose the protected health information of a deceased person to a coroner, protected health examiner, funeral director or organ procurement organization for certain purposes.

Public Health and Safety: We may disclose your protected health information to the extent necessary to avert a serious and imminent threat to your health or safety, or the health or safety of others. We may disclose your protected health information to a government agency authorized to oversee the health care system or government programs or its contractors, and to public health authorities for public health purposes.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations; to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Required by Law: We may use or disclose your protected health information when we are required to do so by law. For example, we must disclose your protected health information to the U.S. Department of Health and Human Services upon request for purposes of determining whether we are in compliance with federal privacy laws. We may disclose your protected health information when authorized by workers' compensation or similar laws.

Process and Proceedings: We may disclose your protected health information in response to a court or administrative order, subpoena, discovery request or other lawful process,under certain circumstances. Under limited circumstances,such as a court order, warrant or grand jury subpoena, wemay disclose your protected health information to law enforcement officials.

Law Enforcement: We may disclose limited information to a law enforcement official concerning the protected health information of a suspect, fugitive, material witness, crime victim or missing person. We may disclose the protected health information of an inmate or other person in lawful custody to a law enforcement official or correctional institution under certain circumstances. We may disclose protected health information where necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has escaped from lawful custody.

Patient Rights

  1. Patient has the right to choose another facility for his/her procedure. The patient will be provided a copy of the Patient Rights and Responsibilities prior to the date of the procedure. The provision of this form is delegated to the Medical Practice which shall provide a copy of the signed and dated form to the Center prior to the procedure.

  2. Some or all of the health care professionals performing services in this Center are independent contractors and are not Center agents or employees. Independent contractors are responsible for their own actions and the Center shall not be liable for the acts or omissions of any such independent contractor

  3. The privacy of all patients shall be respected at all times. Patients shall be treated with respect, consideration and dignity.

  4. Patients shall receive assistance in a prompt, courteous, and responsible manner.

  5. Patient disclosures medical records are considered confidential.Except as otherwise required by law, patient records and/or portions of records will not be released to outside entities or individuals without patients’ and/or designated representatives’ express written approval.Patients are given the opportunity to approve or refuse the release of their medical records.

  6. Patients have the right to know the identity and status of individuals providing services to them.

  7. Patients have the right to change providers if they so choose.Patients are informed of the credentials of all staff who will be providing care during the patients’ stay.

  8. Patients, or a legal authorized representative, have the right to thorough, current and understandable information regarding their diagnosis, treatment options and prognosis, if known, and follow-up care. All patients will sign an informed consent form after all information has been provided and their questions answered.

  9. When it is medically inadvisable to give such information to the patient, the information is provided to a person designated by the patient or to a legally authorized person.

  10. Unless participation is medically contraindicated, patients have the right to participate in all decisions involving their healthcare.

  11. Patients have the right to refuse treatment and to be advised of the alternatives and consequences of their decisions.Patients are encouraged to discuss their objectives with their provider.

  12. Patients have the right to refuse participation in experimental treatment and procedures. Should any experimental treatment or procedure be considered, it shall be fully explained to the patient prior to commencement.

  13. Patients have the right to make suggestions or express complaints about the care they have received and to submit such to the Administrative Director or Administrative Director who will complete an “Incident Notification” and bring the issue to the attention of the Medical Director in a timely manner so the grievance may be addressed.

  14. Patients have the right to be provided with information regarding emergency and after-hours care.

  15. Patients have the right to obtain a second opinion regarding the recommended procedure.Responsibility for the expense of the second opinion rests solely with the patient.

  16. Patients have the right to a safe and pleasant environment during their stay.

  17. Patients have the right to have visitors at the Center as long as visitation does not encumber Center operations and the rights of other patients are not infringed.

  18. Patients have the right to have procedures performed in the most painless way possible.

  19. Patients have the right to an interpreter if required.

  20. Patients have the right to be provided informed consent forms as required by the laws of the State of Georgia.

  21. Patients have the right to truthful marketing and/or advertising regarding the competence and capabilities of the Center and its staff.

  22. Patients have the right to have copies of their “Advance Directives” and “Living Wills” in their medical records and to have Center staff honor these wishes to the extent feasible. However, due to the Center’s limited capabilities, in the event of an emergency, the patient will be transferred to the nearest hospital at which attending physician has privileges.Hospital staff will be informed of the existence of the Advance Directives and such will be provided if the Center has copies.

  23. Patients will be provided, upon request, all available information regarding services available at the Center, as well as information about estimated fees and options for payment.

  24. If applicable, patients will be informed of the absence of malpractice insurance coverage.

  25. Patients have the right to approve the release of their medical records to other care providers, legal representatives and other persons authorized by the patient.

  26. Patient has the right to exercise his/her rights without being subject to discrimination or reprisal.

  27. Patient has the right to be free from all forms of abuse or harassment.

     

   Patient Responsibilities

  1. Patients are expected to provide complete and accurate medical histories, to the best of their ability, including providing information on all current medications, over-the counter products and dietary supplements and any allergies or sensitivities.

  2. Patients are responsible for keeping all scheduled pre- and post-procedure appointments and complying with treatment plans to help ensure appropriate care.

  3. Patients are responsible for reviewing and understanding the information provided by their Physician or nurse. Patients are responsible for understanding their insurance coverage and the procedures required for obtaining coverage.

  4. Patients are responsible for providing insurance information at the time of their visit and for notifying the receptionist of any changes in information regarding their insurance or medical information.

  5. Patients are responsible for paying all charges for co-payments, co-insurance and deductibles or for non-covered services at the time of the visit unless other arrangements have been made in advance with the Administrative Director.

  6. Patients are responsible for treating Physicians, Staff and other patients in a courteous and respectful manner.

  7. Patients are responsible for asking questions about their medical care and to seek clarification from their Physician of the services to be provided until they fully understand the care they are to receive.

  8. Patients are responsible for following the advice of their provider and to consider the alternatives and/or likely consequences if they refuse to comply.

  9. Patients are responsible for expressing their opinions, concerns or complaints in a constructive manner to the appropriate personnel at the Center.

  10. Patients are responsible for notifying their health care providers of patient’s Advance Directives, Living Wills, Medical Power of Attorney or any other directives that could affect their care.In the event of an emergency, the patient will be transferred to the appropriate facility.The facility will be notified of the existence of the Advance Directive, if applicable, and will be provided with a copy.

  11. Patients are responsible for having a responsible adult transport them from the Center and remain with the patient for twenty-four (24) hours, if required by the Physician.

  12. The patient will be provided a copy of the Patient Rights and Responsibilities prior to the date of the procedure. The provision of this form is delegated to the Medical Practice which shall provide a copy of the signed and dated form to the Center prior to the procedure.

Questions or Concerns?

You and your family should feel you can always voice your concerns. If you share a concern or complaint, your care will not be affected in any way. The first step is to discuss your concerns with your doctor, nurse, or other caregiver. If you have concerns that are not resolved, please contact the Administrator at (678) 377 8252.

  • The patient/caregiver may contact the Section Head of the Acute Care Section of the Healthcare Facility Regulation Division of the Georgia Department of Community Health at 404-657-5728 or at (800) 878-6442, or at 2 Peachtree Street NW, 31-447, Atlanta, Georgia, 30303, or the Ombudsman at www.cms.hhs.gov/center/ombudsman.asp; or

  • Complaints against physician staff should be made to the Georgia Composite Medical Board, Enforcement Unit, 2 Peachtree Street, N.W., 36th Floor, Atlanta, Georgia 30303, PH: (404) 657-6494 or (404) 656-1725, FAX: (404) 463-6333:

  • < >

    Complaints against nursing staff should be made to the Georgia Board of Nursing at 237 Coliseum Drive, Macon, GA 31217-3858, (478) 207-2440.

  • Complaints against any professional may be submitted online to the Georgia Secretary of State at:

    • < >

      They may also contact their Ombudsman at www.cms.hhs.gov/center/ombudsman.asp; or

    • They may also contact The Accreditation Association for Ambulatory Healthcare (AAAHC) at P: 847.853.6060 F: 847.853.9028 E: [email protected]

      Disclosure of Ownership Interest

      GDC Endoscopy Center, LLC operates an outpatient surgical facility licensed by the State of Georgia. This facility is owned by Dr. Indran Krishnan. This is because of his commitment of providing quality health care and services to his patients at a more affordable cost. You have the right to select  where to receive services, including entities in which your physician does not have a financial relationship.  Reasonable alternative sources of services:

    • Gwinnett Medical Center

      1000 Medical Center Blvd,

      Lawrenceville, GA 30046

      678-312-1000