Effective Date: 01/01/2026
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.
Atlanta Neuroscience Institute, Inc. (“ANI,” “we,” “our,” or “us”) is committed to protecting the privacy and
security of your health information. This Notice describes how we may use and disclose your Protected Health
Information (“PHI”), explains your rights concerning your PHI, and describes our legal responsibilities regarding
your health information.
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some
of our responsibilities to help you exercise those rights.
Get an Electronic or Paper Copy of Your Medical Record
You may ask to inspect or obtain an electronic or paper copy of your medical record and other health
information we maintain about you. We will provide access within the time required by applicable law and may
charge a reasonable, cost-based fee as permitted by law. In limited circumstances, we may deny access; if so,
you may have a right to request review of the denial.
Ask Us to Correct Your Medical Record
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the
request, but we will provide a written explanation when required by law, and you may have the right to submit a statement of disagreement.
Request Confidential Communications
You may ask us to contact you in a specific way or at a specific location, such as only at a particular telephone
number or mailing address. We will accommodate reasonable requests as required by law.
Ask Us to Limit What We Use or Share
You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We
generally are not required to agree. If we agree, we will comply as required by law. If you pay for a health care
item or service in full out-of-pocket, you may request that we not disclose information about that item or
service to your health plan for payment or health care operations. We will honor the request when required by
law unless the disclosure is otherwise required by law.
Get a List of Certain Disclosures
You may request an accounting of certain disclosures of your PHI. The accounting generally covers the six
years before your request, subject to legal exceptions. It generally does not include disclosures for treatment,
payment, health care operations, and certain other disclosures excluded by law. One accounting in a 12-
month period is provided without charge; a reasonable cost-based fee may apply to additional requests after
notice to you.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically. The
current Notice is also available at www.atlneuroinstitute.org.
Choose Someone to Act for You
If someone has legal authority to act for you, such as a health care agent or legal guardian, that person may
exercise your rights to the extent permitted by law. We may verify the person’s authority before taking action.
File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with ANI’s Privacy Officer or with
the U.S. Department of Health and Human Services, Office for Civil Rights. ANI will not retaliate against you for
filing a complaint or exercising your privacy rights.
YOUR CHOICES
For certain health information, you may tell us your preferences about what we disclose. We will follow your
instructions as required by law.
Family, Friends, and Others Involved in Your Care
Unless you object, we may disclose relevant information to a family member, close friend, caregiver, or other
person involved in your care or payment for your care when permitted by law. If you are unable to tell us your
preference, we may disclose information when, using professional judgment, we determine that the disclosure
is in your best interest and is permitted by law.
Disaster Relief
We may disclose relevant information to an organization assisting with disaster-relief efforts so that family
members or others responsible for your care may be notified about your location, general condition, or death,
as permitted by law.
Fundraising
ANI may contact you about fundraising activities as permitted by law. You have the right to opt out of future
fundraising communications. Your decision will not affect your treatment or payment for your care.
Marketing and Sale of Health Information
We will obtain your written authorization before using or disclosing PHI for marketing or selling PHI when
authorization is required by law.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your health information without your written authorization when HIPAA or another
applicable law permits or requires it, including for the following purposes:
Treatment
We may use and disclose PHI to provide, coordinate, and manage your care. For example, we may share
relevant information with physicians, hospitals, pharmacies, laboratories, imaging facilities, therapists, or
other health care professionals involved in your care.
Payment
We may use and disclose PHI to bill and obtain payment for services. For example, we may provide information
about an office visit, MRI, EEG, infusion, procedure, or other service to your health plan so it can determine
coverage or make payment.
Health Care Operations
We may use and disclose PHI to operate our practice, improve quality, train staff, credential professionals,
conduct compliance and audit activities, manage risk, improve patient safety, and perform business planning
and administration.
OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
Public Health and Safety
We may disclose PHI for public-health activities authorized by law, including disease prevention or control,
certain reports involving medications or devices, recalls, communicable diseases, and preventing or reducing
a serious threat to health or safety.
Abuse, Neglect, or Domestic Violence
We may disclose PHI to an appropriate authority regarding suspected abuse, neglect, or domestic violence
when authorized or required by law.
Health Oversight
We may disclose PHI to health oversight agencies for authorized audits, investigations, inspections, licensure,
and disciplinary activities.
Legal Proceedings
We may disclose PHI in response to certain court or administrative orders, subpoenas, discovery requests, or
other lawful processes when applicable legal requirements are satisfied.
Law Enforcement
We may disclose PHI for certain law-enforcement purposes when permitted or required by law.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI to coroners, medical examiners, and funeral directors when permitted by law.
Organ and Tissue Donation
We may disclose PHI to organizations involved in organ, eye, or tissue donation and transplantation when
applicable.
Workers’ Compensation
We may disclose PHI as authorized by and to the extent necessary to comply with workers’ compensation and
similar programs.
Specialized Government Functions
We may disclose PHI for certain military, veterans, national security, protective services, correctional, and
other specialized government functions as permitted by law.
Research
We may use or disclose PHI for research when permitted by law, including when an Institutional Review Board
or Privacy Board has approved a waiver of authorization or another legal permission applies. We will obtain
your written authorization when required.
Required by Law
We may use or disclose PHI when federal, state, or other applicable law requires us to do so.
SUBSTANCE USE DISORDER RECORDS
Certain records relating to substance use disorder (“SUD”) treatment may receive additional confidentiality
protections under federal law, including 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2. If ANI receives or maintains
records protected by Part 2, those records will be used and disclosed in accordance with applicable law. Part 2
records, or testimony describing information contained in those records, generally may not be used or
disclosed in civil, criminal, administrative, or legislative proceedings against the patient unless the patient
provides the consent required by law or a court order authorizes the use or disclosure after applicable
requirements have been satisfied.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Uses and disclosures of PHI that are not otherwise permitted or required by law generally will be made only
with your written authorization. This includes certain marketing communications, sales of PHI, uses and
disclosures of psychotherapy notes when applicable, and other uses or disclosures for which authorization is
required. You may revoke an authorization in writing at any time. Revocation applies to future uses and
disclosures and does not affect actions already taken in reliance on the authorization.
SPECIAL PROTECTIONS UNDER OTHER LAWS
Some health information may receive additional protection under federal or state law. ANI will comply with
applicable laws that provide greater privacy protection than HIPAA, including laws governing certain substance use disorder records, mental health information, genetic information, HIV/AIDS-related information, and other specially protected information when applicable.
OUR RESPONSIBILITIES
• Maintain the privacy and security of your PHI.
• Provide you with this Notice describing our legal duties and privacy practices.
• Follow the terms of the Notice currently in effect.
• Notify affected individuals following a breach of unsecured PHI when notification is required by law.
• Comply with applicable federal and state privacy laws.
We will not use or disclose your health information other than as described in this Notice unless you authorize
us in writing or another use or disclosure is permitted or required by law.
ELECTRONIC COMMUNICATIONS AND PATIENT PORTAL
ANI may communicate with you about your care through methods permitted by law, including telephone,
voicemail, mail, secure patient portal, electronic communications, or other communication methods. You may
request reasonable confidential communications or ask us to communicate with you through a particular
method or at a particular location. Please notify ANI if your contact information or communication preferences
change.
CHANGES TO THIS NOTICE
ANI reserves the right to change the terms of this Notice and its privacy practices. Changes may apply to all PHI
ANI maintains, including information created or received before the change. When a material change is made,
the revised Notice will be made available as required by law, including at our office, upon request, and on our
website.
QUESTIONS, REQUESTS, OR COMPLAINTS
To ask questions about this Notice, exercise your privacy rights, request restrictions or confidential
communications, obtain records, or file a privacy complaint, contact:
Atlanta Neuroscience Institute, Inc.
Privacy Officer
3200 Downwood Circle, Suite 550
Atlanta, Georgia 30327
Telephone: 404-609-5406
Email: info@atlneuroinstitute.org
Website: www.atlneuroinstitute.org
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights,
200 Independence Avenue, S.W., Washington, D.C. 20201; telephone 1-877-696-6775; or through the Office
for Civil Rights complaint process at www.hhs.gov/ocr/privacy/hipaa/complaints/.
ANI will not retaliate against you for exercising your privacy rights or filing a complaint.
Effective Date of this Notice: 01/01/2026