Notice of Privacy Practices

Federal law requires us to keep your protected health information private, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

Protected health information means information about your health, your care, or payment for your care that could identify you.

There are three purposes for which the law allows us to use and share your information without a separate authorisation.

Treatment. To provide and coordinate your care. If Dr. Jimenez orders an MRI, we give the imaging centre the clinical information they need to perform and read it. If we refer you to another clinician, we send the records relevant to that referral.

Payment. To be paid for the care you receive. This includes billing an insurer where one is involved, verifying coverage, and — where treatment is provided on a lien — providing records and billing to the parties resolving that claim.

Health care operations. To run the practice: quality review, training, licensing, and the administrative work of seeing patients.

We may also use or disclose your information without your authorisation where the law permits or requires it, including: to public health authorities; to report suspected abuse or neglect; for health oversight activities such as audits and investigations; in response to a subpoena, court order or other lawful process; to law enforcement in the limited circumstances the law defines; to coroners and medical examiners; for workers’ compensation claims; to avert a serious and imminent threat to health or safety; and for specialised government functions such as military service.

We may share information with a family member, friend, or other person you involve in your care or payment for your care, limited to what is relevant to their involvement. If you are present and able to decide, we will give you the chance to object first.

Some uses always require your written authorisation, and you may revoke that authorisation at any time in writing. A revocation does not undo anything we already did while it was in effect.

These include psychotherapy notes where any exist, any use of your information for marketing, and any sale of your information.

We do not sell your information, we do not use it for marketing, and we do not use it for fundraising. We do not send promotional communications to patients.

To ask us not to tell your health plan. If you pay for a service in full, out of pocket, you may require us not to disclose that service to your health insurer, and we must agree. This matters here: much of our accident care is self-pay or lien-based, and this right is yours to use.

To ask us to restrict other uses. You may ask us to limit how we use or share your information. We are not required to agree to restrictions beyond the one above, but we will tell you if we cannot.

To be contacted a particular way. You may ask us to reach you at a specific number or address, or to avoid one. We will accommodate reasonable requests without asking why.

To see and copy your records. You may inspect and obtain a copy of your medical and billing records, including an electronic copy where we hold them electronically. We may charge a reasonable, cost-based fee for copies.

To ask us to correct them. If you believe something in your record is wrong or incomplete, you may ask us to amend it. If we decline, we will explain why in writing and you may file a statement of disagreement, which becomes part of the record.

To a list of certain disclosures. You may request an accounting of disclosures we have made, other than those for treatment, payment and operations, for up to six years before the request.

To a paper copy of this notice at any time, even if you agreed to receive it electronically.

To be told about a breach. We will notify you if a breach compromises the privacy or security of your information.

To exercise any of these, contact our Privacy Officer using the details below. We may ask you to put the request in writing.

Our patient records are held in SimplePractice, an electronic health record and practice management system. SimplePractice acts as our business associate and is bound by a written agreement requiring it to protect your information on the same terms we are.

Other business associates — for example billing or IT support — are bound by the same kind of agreement.

We do not participate in a health information exchange. Your records are not contributed to any regional or statewide record-sharing network.

Tell us. Contact our Privacy Officer at the address below. You may also complain directly to the U.S. Department of Health and Human Services, Office for Civil Rights, and you may do both.

We will not retaliate against you for filing a complaint, and doing so will not affect your care.

Some Georgia laws protect certain kinds of health information more strictly than federal law does. Where a stricter law applies, we follow it.

We may change this notice, and any change may apply to information we already hold as well as information we receive afterwards. The current notice is always posted on this page with its effective date, and a copy is available at any of our offices.

This notice takes effect on September 9, 2026.

Dr. Miguel Jimenez, MD is the Privacy Officer for MyOrthoSpineMD, P.C.. Questions about this notice, requests to exercise any right described above, and complaints all go to:

Privacy Officer
MyOrthoSpineMD, P.C.
3280 Pointe Pkwy NW, Suite 2550
Norcross, GA 30092
404-820-2020

This notice applies at all of our offices: Norcross, Lawrenceville, Dalton.