This notice describes how medical information about you may be used and disclosed, and how to get access to this information. Please review it carefully.

At the Columbus Physicians Group, LLC we keep records of the care and services that you receive at our practice. We keep your health information private, and we are required by law to respect your confidentiality.

This Notice describes the privacy practices of the Columbus Physicians Group, LLC. This Notice applies to all health information that identifies you and the care you receive at the Columbus Physicians Group, LLC. This information may consist of paper, digital records, electronic records, photographs, videos and other electronic transmissions or recordings that are created during your care and treatment. We are legally required to keep your health information private, to notify you of our legal responsibilities and privacy practices that relate to your health information, and to notify you if there is a breach of your unsecured health information. We are also legally required to give you this notice and to follow the terms of the notice currently in effect.

All employees follow the terms of this notice including our doctors, nurse practitioners, counselors, and other staff, may share your health information with each other for reasons of treatment, payment, and health care operations as described below. Your health information may be shared with physicians and other medical providers outside of our practice who are not employed by the Columbus Physicians Group, LLC for the purpose of continuation of care and treatments purposes.

When you become a patient of the Columbus Physicians Group, LLC we will use your health information within our practice and disclose your health information outside of the Columbus Physicians Group, LLC for the reasons described in this notice. The following categories describe some ways that we may use and disclose your health information.

Treatment

We may disclose your health information to doctors, nurses, technicians, medical or nursing students, or other persons not affiliated with the Columbus Physicians Group, LLC who need the information to provide care for you, or to assist our staff in providing care for you. This may involve talking to other medical professionals, home care providers, pharmacies, drug or medical device representatives, and imaging facilities, etc.

Payment

We may use and disclose your health information so that the health care you receive can be billed and paid for by you, your insurance company, or another third party. For example, we may give information about treatment you had here to your health plan so it will pay us for the treatment provided to you by our Doctor or Nurse Practitioners. We may also tell your health plan about a treatment you are going to receive so we can get prior authorization or a pre-determination so we may determine if your plan will pay for the treatment.

Contacting You

We may use and disclose health information to reach you about appointments and other matters. We may contact you by mail, email, telephone, text, or by the patient portal. We may leave voice messages at the telephone number you provide us with, and we may respond to your email address.

Health Information Exchanges

We may participate in certain health information exchanges whereby we may disclose your health information, as permitted by law, to other health care providers or entities for treatment, payment, or health care operations purposes.

Health-Related Services

We may use and disclose health information about you to send you mailings about health-related products and services available at the Columbus Physicians Group, LLC.

Legal Matters

We will disclose health information about you outside the Columbus Physicians Group, LLC when required to do so by federal, state, or local law, or by the court process. We may disclose health information about you for public health reasons, like reporting abuse or neglect, reactions to medications or problems with medical products. We may release health information in an effort to notify authorities when your health or safety may be threatened. We may disclose health information to a health oversight agency for activities authorized by law, such as for audits, investigations, inspections, and licensure.

Authorizations for other uses and disclosures

As described above, the Columbus Physicians Group, LLC will use your health information and disclose it outside of the Columbus Physicians Group, LLC for treatment, payment, health care operations, and when required or permitted by law. We will not use or disclose your health information for other reasons without your written authorization. You may revoke the authorization in writing at any time. Revocation will not be retroactive as we cannot take back any uses or disclosures of your health information already made with your authorization.

Ohio law requires that we obtain your consent for certain disclosures of health information about the following: the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition, drug or alcohol treatment that you have received as part of a drug or alcohol treatment program, or mental health

services that you have received.

Right to Accounting

You may request an accounting, which is a listing of the entities or persons (other than yourself) to whom the Columbus Physicians Group, LLC has disclosed your health information without your written authorization. The accounting would not include disclosures for treatment, payment, health care operations, and certain other disclosures exempted by law. Your request for an accounting of disclosures must be in writing, signed, and dated. It must identify the time period of the disclosures. We will not list disclosures made earlier than six (6) years before your request. Your request should indicate the form in which you want the list (for example, on paper or electronically). You must submit your written request to the medical records department of the Columbus Physicians Group, LLC, located at 4995 Bradenton Ave, Suite 110, Dublin, Ohio 43017. We will respond to you within 60 days.

Right to Amend

If you feel that health information we have about you is incorrect or incomplete, you have the right to ask us to amend your medical records. Your request for an amendment must be in writing, signed, and dated. It must specify the records you wish to amend and give the reason for your request. You must address your request to the Columbus Physicians Group, LLC, Attn: Medical Records Department, located at 4995 Bradenton Ave, Suite 110, Dublin, Ohio 43017. We may deny your request; if we do, we will tell you why and explain your options.

Right to Inspect and Obtain Copy

You have the right to inspect and obtain a copy of your completed health records unless your doctor believes that disclosure of that information to you could harm you. You may not see or get a copy of information gathered for a legal proceeding. Your request to inspect or obtain a copy of the records must be submitted in

writing, signed and dated, to the medical records department of the Columbus Physicians Group, LLC. (Requests for billing records should be sent to the billing departments.) We may charge a fee for processing your request. Please mail your request to Columbus Physicians Group, LLC, Attn: Medical Records Requests, 4995 Bradenton Ave, Suite 110, Dublin, Ohio 43017.

Right to Request Restrictions

You have the right to ask us to restrict the uses or disclosures we make of your health information for treatment, payment, or health care operations, but we do not have to agree. You also may ask us to limit the health information that we use or disclose about you to someone who is involved in your care or the payment for your

care, such as a family member or friend. 

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request for confidential communications must be in writing, signed, and dated. It must specify how or where you wish to be contacted. You need not tell us the reason for your request, and we will not ask. You must send your written request to the medical records department of the Columbus Physicians Group, LLC located at 4995 Bradenton Ave, Suite 110, Dublin, Ohio 43017. We will accommodate all 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. You also can view this notice at our website, https://www.columbusphysiciansgroup.com/

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services.  You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. To file a complaint with the Columbus Physicians Group, LLC, you must submit your complaint in writing to the Columbus Physicians Group, LLC, Attn: Patient Complaints, 84995 Bradenton Ave, Suite 110, Dublin, Ohio 43017. You will not be penalized for filing a complaint.

Changes to this Notice

The Columbus Physicians Group, LLC may change this Notice at any time. Any change in the Notice could apply to 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 at our medical practice and on our website,

https://www.columbusphysiciansgroup.com 

Non-Discrimination Notice

The Columbus Physicians Group, LLC complies with applicable Federal civil rights laws and do not discriminate based on race, color, national origin, age, disability, or sex. The Columbus Physicians Group, LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.