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Wellroot Family Services understands that medical information about you is personal. We are committed to maintaining the privacy of your protected health information, which includes both your medical and mental health information, as well as information concerning the care and treatment you receive at Wellroot. This notice tells you how Wellroot Family Services may use and disclose your protected health information.


Wellroot Family Services creates a record of the services you receive at Wellroot.  This notice outlines how the information included in your record may be disclosed to third parties to coordinate the services you need, conduct day-to-day business activities, and for other purposes either permitted or required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).


We are required to abide by the terms of this Privacy Notice, which may be amended or updated from time to time. Should that happen, the new notice will be effective for all protected health information at that time. Upon your request, Wellroot will provide you with any revised Privacy Notice practices by accessing our website at or calling the agency’s Privacy Officer at 404.327.5820.


How We May Use Or Disclose Your Protected Health Information

Your protected health information may be used and shared by appropriate Wellroot administrative, supervisory, or treatment team members that are involved in your care for the purpose of providing services to you. The following are examples of the ways in which sharing your information may occur. The examples are not meant to include all possibilities.


  1. Treatment – In order to provide for your care, Wellroot will sometimes need to disclose pertinent medical or psychological information about you to other professionals directly involved in your care, whether they are on our staff or not, so they may understand your medical and/or mental health condition and provide treatment or advice.  For example, a psychologist from the community treating you for a condition such as depression may need to know what medications have been prescribed for you by other healthcare providers who consult with Wellroot.
  2. Payment—Wellroot may use your protected health information, if needed, to either obtain reimbursement or avoid being billed for services provided to you. For example, Wellroot may disclose information to health care providers to ensure that Georgia Medicaid, and not Wellroot Family Services, is billed for the health services you receive.
  3. Health Care Operations – We may use or disclose your information in order to support the business activities of Wellroot as required by law and continue the quality of the care provided to you.  For example, members of our Quality Assurance Committee may use information in your record to assess the care you receive at Wellroot in an effort to improve the employee training program.

Other Uses Or Disclosures For Which Authorization Is Not Required

In addition to using or disclosing protected health information for treatment, payment-related issues, and ongoing healthcare operations, Wellroot Family Services may use and/or share your information, without written authorization from you, in the following instances:

  1. Personal Representative – Wellroot may disclose information about you to a person who, by law, has the authority to represent you in making health care decisions.
  2. Public Health Activities – Such activities may include information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability.  An example might be a report of child abuse or neglect made to a representative of local Child Protective Services if Wellroot believes that you have been victimized.
  3. Avoid a Serious Threat to Another’s Health or Safety – Wellroot may use and disclose protected health information if it believes that sharing the information is necessary to prevent or lessen a serious and likely threat to the health or safety of an individual or the public at large.  In an instance such as this, the disclosure will be made to a person who is considered to be reasonably able to prevent or lessen the threat.
  4. Health Oversight Activities –  Wellroot may disclose protected health information to government authorities, as required by law, for oversight activities such as audits, inspections, and other proceedings necessary for monitoring the health care system, government programs, and compliance with civil rights laws.
  5. As Required By Law and Law Enforcement – Wellroot will disclose information about you when required to do so by federal, state, or local law.  For example, Wellroot will comply with requests to disclose information in a judicial or administrative proceeding, to identify or locate a suspect, fugitive, or material witness in a criminal investigation, to report a missing person or a crime, and to assist a coroner, medical examiner or funeral director who may require medical information about you as permitted by law and as necessary to carry out their duties.
  6. Specialized Government Functions – Wellroot may disclose information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities or for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.  In addition, the agency may also share your information with authorized federal officials who are conducting national security and intelligence activities and for the provision of protective services to the President or other authorized individuals.
  7. Inmates – Wellroot may share your protected health information with a correctional institution if you are an inmate of that facility and your information is necessary to provide care and treatment to you or is necessary for the health and safety of other inmates.
  8. Emergencies—Wellroot may use or share your information in an emergency treatment situation if treatment is required by law and the health care provider has not succeeded in obtaining your consent.
  9. Research – Wellroot may disclose information about you for a research project that a review board has approved.  The review board must review the research project and its rules to ensure the privacy of your information.
  10. Business Associates – A business associate is someone Wellroot contracts with to provide you or the agency with a service.  Whenever a business associate arrangement involves the use or disclosure of your health information, Wellroot will have written assurance that the associate will maintain the same standards of safeguarding your privacy that we require of our own employees.
  11. De-Identified Information—Wellroot may disclose information about you in public relations presentations or publications, but only when the information has been changed so that it does not identify you.


Your Rights Regarding Your Protected Health Information

  1. Uses and disclosures other than those described above will be made only with your written authorization. With some limitations, you have the right to cancel the authorization at any time.   To request cancellation, you must submit a written request to Wellroot’s Privacy Officer.
  2. You have the right to request that Wellroot restrict the use or disclosure of your protected health information to carry out treatment, payment, and health care operations or communications with family members or friends.  To request restrictions, you must submit a written request to Wellroot’s Privacy Officer and be specific about what information you want to limit and to whom you want the limits to apply. Wellroot is not required to agree to your request.
  3. You have the right to request that Wellroot send communications that contain your protected health information by alternative means or to alternative locations.  For example, you can request that Wellroot contact you by e-mail or by fax.  You must make your request in writing to Wellroot’s Privacy Officer.  By law, the agency must accommodate all reasonable requests if you state in writing that the disclosure of the information through normal channels could endanger you.
  4. You have the right to inspect and copy health information that Wellroot maintains about you.   To do so, you must submit a written request to the agency’s Privacy Officer.  Wellroot, by law, can charge you a fee for the costs related to copying, labor, and postage.  In certain situations, Wellroot may deny your request, but you will have the right to have the denial reviewed.
  5. You have the right to have Wellroot amend your protected health information for as long as the agency maintains such information.  Your written request toWellroot’s Privacy Officer must include the reason that supports your request.  Wellroot may deny your request for an amendment if it is determined that Wellroot did not originally create the record, the information is not available for inspection as specified by law, or is accurate and complete.
  6. You have the right to receive an accounting of who your protected health information has been shared with, what was shared and when it was shared in the six years prior to the date such an accounting is requested.  This right applies to those purposes other than treatment, payment or business activities as described in this Notice.  This right does not include those times that information was shared with you for notification purposes or those times that disclosures were made prior to the HIPAA compliance date of April 14, 2003.  The request should be in writing to Wellroot’s Privacy Officer and should indicate in what form you want the list. There will be no charge for the first list you request within a twelve (12) month period, but Wellroot may charge you for the cost of providing additional lists.
  7. You have the right to obtain a paper copy of this Notice at any time by requesting a copy, in writing, from Wellroot’s Privacy Officer.


How To File a Complaint If You Believe Your Privacy Rights Have Been Violated

If you believe that your privacy rights with respect to your protected health information have been violated, you may complain, either in writing or by phone call, to:

Wellroot Family Services
Attention:  Privacy Officer
1967 Lakeside Parkway, Suite 400
Tuycker, Georgia  30084

You may also file a complaint with the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, SW, Washington, D.C.  20201.  You will not be retaliated against for filing a complaint.