As Required by the Privacy Regulations Created as a Result of the Health

Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU

(AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED,

AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY

IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually

identifiable health information (IIHI). In conducting our business, we will

create records regarding you and the treatment and services we provide to

you. We are required by law to maintain the confidentiality of health

information that identifies you. We also are required by law to provide you

with this notice of our legal duties and the privacy practices that we

maintain in our practice concerning your IIHI. By federal and state law, we

must follow the terms of the notice of privacy practices that we have in

effect at the time.

We realize that these laws are complicated, but we must provide you with the

following important information:

-- How we may use and disclose your IIHI

-- Your privacy rights in your IIHI

-- Our obligations concerning the use and disclosure of your IIHI

The terms of this notice apply to all records containing your IIHI that are

created or retained by our practice. We reserve the right to revise or amend

this Notice of Privacy Practices. Any revision or amendment to this notice

will be effective for all of your records that our practice has created or

maintained in the past, and for any of your records that we may create or

maintain in the future. Our practice will post a copy of our current Notice

in our offices in a visible location at all times, and you may request a copy

of our most current Notice at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Office Manager, IFPSM, 285 Boulevard Ave, Suite 640, Atlanta, GA 30312,

404-577-5800

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

(IIHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and

disclose your IIHI.

1. Treatment. Our practice may use your IIHI to treat you. For example, we

may ask you to have laboratory tests (such as blood or urine tests), and we

may use the results to help us reach a diagnosis. We might use your IIHI in

order to write a prescription for you, or we might disclose your IIHI to a

pharmacy when we order a prescription for you. Many of the people who work

for our practice - including, but not limited to, our doctors and nurses -

may use or disclose your IIHI in order to treat you or to assist others in

your treatment. Additionally, we may disclose your IIHI to others who may

assist in your care, such as your spouse, children or parents.

Finally, we may also disclose your IIHI to other health care providers for

purposes related to your treatment.

2. Payment. Our practice may use and disclose your IIHI in order to bill

and collect payment for the services and items you may receive from us. For

example, we may contact your health insurer to certify that you are eligible

for benefits (and for what range of benefits), and we may provide your

insurer with details regarding your treatment to determine if your insurer

will cover, or pay for, your treatment. We also may use and disclose your

IIHI to obtain payment from third parties that may be responsible for such

costs, such as family members. Also, we may use your IIHI to bill you

directly for services and items. We may disclose your IIHI to other health

care providers and entities to assist in their billing and collection

efforts.

3. Health Care Operations. Our practice may use and disclose your IIHI to

operate our business. As examples of the ways in which we may use and

disclose your information for our operations, our practice may use your IIHI

to evaluate the quality of care you received from us, or to conduct

cost-management and business planning activities for our practice. We may

disclose your IIHI to other health care providers and entities to assist in

their health care operations.

4. Appointment Reminders. Our practice may use and disclose your IIHI to

contact you and remind you of an appointment.

5. Treatment Options. Our practice may use and disclose your IIHI to inform

you of potential treatment options or alternatives.

6. Health-Related Benefits and Services. Our practice may use and disclose

your IIHI to inform you of health-related benefits or services that may be of

interest to you.

7. Release of Information to Family/Friends. Our practice may release your

IIHI to a friend or family member that is involved in your care, or who

assists in taking care of you. For example, a parent or guardian may ask

that a babysitter take their child to the pediatrician's office for treatment

of a cold. In this example, the babysitter may have access to this child's

medical information.

8. Disclosures Required By Law. Our practice will use and disclose your

IIHI when we are required to do so by federal, state or local law.

D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or

disclose your identifiable health information:

1. Public Health Risks. Our practice may disclose your IIHI to public

health authorities that are authorized by law to collect information for the

purpose of:

-- maintaining vital records, such as births and deaths

-- reporting child abuse or neglect

-- preventing or controlling disease, injury or disability

-- notifying a person regarding potential exposure to a communicable disease

-- notifying a person regarding a potential risk for spreading or

contracting a disease or condition

-- reporting reactions to drugs or problems with products or devices

-- notifying individuals if a product or device they may be using has been

recalled

-- notifying appropriate government agency(ies) and authority(ies) regarding

the potential abuse or neglect of an adult patient (including domestic

violence); however, we will only disclose this information if the patient

agrees or we are required or authorized by law to disclose this information

-- notifying your employer under limited circumstances related primarily to

workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our practice may disclose your IIHI to a

health oversight agency for activities authorized by law. Oversight

activities can include, for example, investigations, inspections, audits,

surveys, licensure and disciplinary actions; civil, administrative, and

criminal procedures or actions; or other activities necessary for the

government to monitor government programs, compliance with civil rights laws

and the health care system in general.

3. Lawsuits and Similar Proceedings. Our practice may use and disclose your

IIHI in response to a court or administrative order, if you are involved in a

lawsuit or similar proceeding. We also may disclose your IIHI in response to

a discovery request, subpoena, or other lawful process by another party

involved in the dispute, but only if we have made an effort to inform you of

the request or to obtain an order protecting the information the party has

requested.

4. Law Enforcement. We may release IIHI if asked to do so by a law

enforcement official:

-- Regarding a crime victim in certain situations, if we are unable to

obtain the person's agreement

-- Concerning a death we believe has resulted from criminal conduct

-- Regarding criminal conduct at our offices

-- In response to a warrant, summons, court order, subpoena or similar legal

process

-- To identify/locate a suspect, material witness, fugitive or missing

person

-- In an emergency, to report a crime (including the location or victim(s)

of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients. Our practice may release IIHI to a medical examiner

or coroner to identify a deceased individual or to identify the cause of

death. If necessary, we also may release information in order for funeral

directors to perform their jobs.

6. Organ and Tissue Donation. Our practice may release your IIHI to

organizations that handle organ, eye or tissue procurement or

transplantation, including organ donation banks, as necessary to facilitate

organ or tissue donation and transplantation if you are an organ donor.

7. Research. Our practice may use and disclose your IIHI for research

purposes in certain limited circumstances. We will obtain your written

authorization to use your IIHI for research purposes except when an Internal

Review Board or Privacy Board has determined that the waiver of your

authorization satisfies the following: (i) the use or disclosure involves no

more than a minimal risk to your privacy based on the following: (A) an

adequate plan to protect the identifiers from improper use and disclosure;

(B) an adequate plan to destroy the identifiers at the earliest opportunity

consistent with the research (unless there is a health or research

justification for retaining the identifiers or such retention is otherwise

required by law); and (C) adequate written assurances that the PHI will not

be re-used or disclosed to any other person or entity (except as required by

law) for authorized oversight of the research study, or for other research

for which the use or disclosure would otherwise be permitted; (ii) the

research could not practicably be conducted without the waiver; and (iii) the

research could not practicably be conducted without access to and use of the

PHI.

8. Serious Threats to Health or Safety. Our practice may use and disclose

your IIHI when necessary to reduce or prevent a serious threat to your health

and safety or the health and safety of another individual or the public.

Under these circumstances, we will only make disclosures to a person or

organization able to help prevent the threat.

9. Military. Our practice may disclose your IIHI if you are a member of

U.S. or foreign military forces (including veterans) and if required by the

appropriate authorities.

10. National Security. Our practice may disclose your IIHI to federal

officials for intelligence and national security activities authorized by

law. We also may disclose your IIHI to federal officials in order to protect

the President, other officials or foreign heads of state, or to conduct

investigations.

11. Inmates. Our practice may disclose your IIHI to correctional

institutions or law enforcement officials if you are an inmate or under the

custody of a law enforcement official. Disclosure for these purposes would

be necessary: (a) for the institution to provide health care services to you,

(b) for the safety and security of the institution, and/or (c) to protect

your health and safety or the health and safety of other individuals.

12. Workers' Compensation. Our practice may release your IIHI for workers'

compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR IIHI

You have the following rights regarding the IIHI that we maintain about you:

1. Confidential Communications. You have the right to request that our

practice communicate with you about your health and related issues in a

particular manner or at a certain location. For instance, you may ask that

we contact you at home, rather than work. In order to request a type of

confidential communication, you must make a written request to the Office

Manager, 404-577-5800, specifying the requested method of contact, or the

location where you wish to be contacted. Our practice will accommodate

reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in

our use or disclosure of your IIHI for treatment, payment or health care

operations. Additionally, you have the right to request that we restrict our

disclosure of your IIHI to only certain individuals involved in your care or

the payment for your care, such as family members and friends. We are not

required to agree to your request; however, if we do agree, we are bound by

our agreement except when otherwise required by law, in emergencies, or when

the information is necessary to treat you. In order to request a restriction

in our use or disclosure of your IIHI, you must make your request in writing

to the Office Manager, 404-577-5800. Your request must describe in a clear

and concise fashion:

(a) the information you wish restricted;

(b) whether you are requesting to limit our practice's use, disclosure or

both; and

(c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy

of the IIHI that may be used to make decisions about you, including patient

medical records and billing records, but not including psychotherapy notes.

You must submit your request in writing to [insert name, or title, and

telephone number of a person or office to contact for further information] in

order to inspect and/or obtain a copy of your IIHI. Our practice may charge

a fee for the costs of copying, mailing, labor and supplies associated with

your request. Our practice may deny your request to inspect and/or copy in

certain limited circumstances; however, you may request a review of our

denial. Another licensed health care professional chosen by us will conduct

reviews.

4. Amendment. You may ask us to amend your health information if you

believe it is incorrect or incomplete, and you may request an amendment for

as long as the information is kept by or for our practice. To request an

amendment, your request must be made in writing and submitted to the Office

Manager, 404-577-5800. You must provide us with a reason that supports your

request for amendment. Our practice will deny your request if you fail to

submit your request (and the reason supporting your request) in writing.

Also, we may deny your request if you ask us to amend information that is in

our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or

for the practice; (c) not part of the IIHI which you would be permitted to

inspect and copy; or (d) not created by our practice, unless the individual

or entity that created the information is not available to amend the

information.

5. Accounting of Disclosures. All of our patients have the right to request

an "accounting of disclosures." An "accounting of disclosures" is a list of

certain non-routine disclosures our practice has made of your IIHI for

non-treatment, non-payment or non-operations purposes. Use of your IIHI as

part of the routine patient care in our practice is not required to be

documented. For example, the doctor sharing information with the nurse; or

the billing department using your information to file your insurance claim.

In order to obtain an accounting of disclosures, you must submit your request

in writing to the Office Manager, 404-577-5800. All requests for an

"accounting of disclosures" must state a time period, which may not be longer

than six (6) years from the date of disclosure and may not include dates bef ore April 14, 2003. The first list you request within a 12-month period is

free of charge, but our practice may charge you for additional lists within

the same 12-month period. Our practice will notify you of the costs involved

with additional requests, and you may withdraw your request before you incur

any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a

paper copy of our notice of privacy practices. You may ask us to give you a

copy of this notice at any time. To obtain a paper copy of this notice,

contact the Office Manager, 404-577-5800.

7. Right to File a Complaint. If you believe your privacy rights have been

violated, you may file a complaint with our practice or with the Secretary of

the Department of Health and Human Services. To file a complaint with our

practice, contact the Office Manager, 404-577-5800. All complaints must be

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

8. Right to Provide an Authorization for Other Uses and Disclosures. Our

practice will obtain your written authorization for uses and disclosures that

are not identified by this notice or permitted by applicable law. Any

authorization you provide to us regarding the use and disclosure of your IIHI

may be revoked at any time in writing. After you revoke your authorization,

we will no longer use or disclose your IIHI for the reasons described in the

authorization. Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health

information privacy policies, please contact the Office Manager,

404-577-5800.