March 2017



If you have any questions about this notice, please contact Hillside, Privacy Officer, 404-875-4551, extension 294.

Hillside’s Commitment To Your Child Privacy

Hillside is committed to protecting health information about your child.  We create a record of the care and services your child receives from us in order to provide you with quality care and to comply with certain legal requirements.  This notice applies to all the records of your child’s care created or retained by us.

Our notice informs you of the ways in which we may use and disclose identifiable/protected health information.  We also describe certain obligations we have regarding your rights and the use and disclosure of health information.

We are required by law to:

  • Maintain the privacy and confidentiality of health information that identifies you;
  • Provide you with this notice of our legal duties and privacy practices concerning your identifiable/protected health information; and

Hillside requires your authorization to release information (and as required by law). The forms of release of health information are: Written, Verbal and Electronic. Electronic disclosure may be by fax, e-mail, scanning and texting.

Hillside May Use and Disclose Health Information in Several Ways.

The following categories describe the different ways in which we may use and disclose your protected health information.

Treatment.  We may use health information about your child to provide health treatment or services.  We may disclose health information to our doctors, nurses, technicians or other personnel who are involved in taking care of your child or who are arranging for care.  We also may disclose health information about you to people outside our facility who may be involved in your child’s treatment, such as other doctors providing services that are part of your care. For example the Department of Family and Children Services (DFCS), other physicians, and probation officers.

Payment.  We may use and disclose health information so that the treatment and services received from us may be billed to, and payment may be collected from a legal guardian, an insurance company or third party.  For example, we may need to provide your health insurer with information about treatment received from us so your insurer will pay us or reimburse you for the treatment. We may also tell your health insurer about a treatment you are going to receive to obtain prior approval or to determine whether your insurer will cover the treatment. You have the right to restrict disclosure of protected health information to a health plan if you pay “out of pocket” in full for the item or service.

Healthcare Operations.  We may use and disclose health information about you and your child for our facility’s operations. These uses and disclosures are necessary to run our facility and make sure that all of our children receive quality care.  For example, we may use health information to evaluate our performance in caring for your child.

Appointment Reminders.  We may use and disclose health information to contact you and remind you of an appointment with us, with your consent.

Treatment Alternatives.  We may use and disclose your health information to tell you about your child’s recommended possible treatment options or alternatives.

Health-Related Benefits and Services.  We may use and disclose health information to tell you about health-related benefits or services.

Individuals Involved in Your Child’s Care or Payment for Your Child’s Care.  We may use and disclose health information to a friend or family member who is involved in your child’s treatment.  We may also disclose information to someone who helps pay for treatment.

Research Projects.  Hillside is not a research facility. Research projects, however, are subject to a special approval process.  We will always ask for your specific permission if a research project is requested and a researcher will have access to your name, address or other information that reveals who you are.

As Required By Law.  We will disclose health information when required to do so by federal, state or local law.

Serious Threats to Health or Safety.  We may use and disclose health information when necessary to prevent a serious threat to your child’s health and safety or the health and safety of the public of another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

Disclosure Breaches. Hillside may be required to report and notify you when there is a breach in disclosure of protected health information.

Business Associates. Hillside business associates agree to protect you and your child’s protected health information. Business associates are required to comply with HIPAA Privacy and Security rules.

Use and Disclosure of Health Information in Certain Special Circumstances

Organ and Tissue Donation.  If your child is an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military.  If you are a member of the armed forces, we may release health information about you as required by the military command authorities.  We may also release health information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation.  We may release health information about you for workers’ compensation or similar programs.

Public Health Risks.  We may disclose health information about your child for public health activities.  These activities generally include, but are not limited to, the following:

  • Preventing or controlling disease, injury or disability;
  • Reporting births and deaths;
  • Reporting reactions to medications or problems with products;
  • Notifying people of recalls of products they may be using;
  • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • Notifying the appropriate authority if it is believed your child has been the perpetrator or victim of abuse, neglect or domestic violence.

Health Oversight Activities.  We may disclose health information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor treatment systems, government programs, and compliance with civil rights laws.

Lawsuits or Similar Proceeding.  If you are involved in a lawsuit or a similar proceeding, we may disclose health information in response to a court or administrative order.  We also may disclose health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.  We may release health information if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at our offices; and
  • In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Deceased Patients.  We may release health information to a coroner or medical examiner to identify a deceased person or determine the cause of death, and to funeral directors as necessary to carry out their duties.

National Security.  We may release health information about you and your child to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.  We also may disclose health information to authorize federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.

Inmates.  If you or your child are an inmate of a correctional institution or under the custody of a law enforcement official; we may release health information about you to the correctional institution or law enforcement official.  This release would be necessary in order for the institution to provide healthcare, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Education. We may release your child’s immunization records for educational purposes.

Marketing. We are required to request your authorization to use protected health information for marketing purposes and communications.

Sale of Protected Health Information.  We are required to request your authorization to sale protected health information.

Restrictions on Disclosures.  We will comply with an individual’s request to restrict the disclosure of protected health information about the individual to a health plan if:  (a) the disclosure is for purposes of payment or healthcare operations and is not otherwise required by law; and (b) the protected health information relates to an item or service for which the Hillside has been paid in full, either by the individual or by a person (other than the health plan) acting on the individual’s behalf. If the restriction on disclosure applies, we may not disclose protected health information to a health plan or to a Business Associate acting on behalf of the health plan.  Furthermore, once an individual has requested a restriction on disclosure, Hillside may not unilaterally terminate the restriction. Hillside is not required to comply with the restriction if the individual’s payment is dishonored (for example, due to a bounced check).

Genetic Information and Non-Discrimination Act (GINA). There are limitations regulating the use and disclosure of genetic information. There is a prohibition excluding an issuer of a long term care policy from using or disclosing protected health information that is genetic information for underwriting purposes.


You have the following rights regarding the health information we maintain about your child:

Inspection and Copies.  You have the right to inspect and obtain a copy of your health information in hard copy or stored electronically that may be used to make decisions about your child’s care.  This typically includes health and billing records, but does not include psychotherapy notes. We can impose a reasonable, cost-based fee for the supplies used in creating the electronic media if the individual requests that the electronic copy be provided on portable media. To inspect and/or obtain a copy of your health information, you must submit your request in writing to Medical Record Services.  There may be a 30 day response time regardless of where the protected health information is stored. We may deny your request to inspect and/or copy health information.

Amendment.  You may ask us to amend health information if you believe it is incorrect or incomplete.  You may request an amendment for as long as the information is kept by or for our facility.  To request an amendment, your request must be made in writing and submitted to Hillside Privacy Officer.  You must provide us with a reason that supports your request for amendment. Your failure to submit your request (and the reason supporting your request) in writing will result in our denying your request.

Your request also may be denied if we are asked to amend information that

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the health information kept by or for the facility;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Accounting of Disclosures.  You have the right to request a list of disclosures we have made of your health information.

To request this list or accounting of disclosures, you must submit your request in writing to Hillside Privacy Officer.  Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.  The first list you request within a 12-month period will be free, but we may charge you for additional lists.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to opt-out.  You have the right to opt-out of fundraising communications.

Right to Request Restrictions.  You have the right to request a restriction on our use or disclosure of your child’s health information for treatment, payment or healthcare operations.  You also have the right to request that we limit the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except in cases of emergency, when otherwise required by law, or when the information is necessary to provide treatment to your child.  To request restrictions, you must make your request in writing to Hillside Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

You have the right to restrict disclosure of protected health information to a health plan if you pay “out of pocket” in full for the item or service.

Confidential Communications.  You have the right to request that we communicate with you about treatment matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work. To request confidential communications, you must make your request in writing to Hillside Privacy Officer.  We will accommodate reasonable requests; however, your written request must specify how or where you wish to be contacted.

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 copy of this notice.  To obtain a paper copy of this notice, contact Hillside Privacy Officer.

We Reserve the Right to Revise Our Privacy Notice.

We reserve the right to change this notice.  We reserve the right to make the revised notice effective for health 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 in our offices. The notice will contain on the first page the effective date.

Other Uses of Health Information.

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written authorization.  If you authorize us to use or disclose health information about your child, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization.  We are unable to “undo” or take back any disclosures we may have already made with your permission.

After health information is released by Hillside, the health information released is no longer protected by Hillside and may be disclosed.


If you believe your privacy rights have been violated, you may file a complaint with:



Attention: Privacy Officer/Compliance Officer

690 Courtenay Drive, NE

Atlanta, Georgia 30306

404-875-4551,x 294 or 357


Office for Civil Rights 

U.S. Department of Health and Human Services

Sam Nunn Atlanta Federal Center, Suite 16T70

61 Forsyth Street, S.W.

Atlanta, GA 30303-8909


Office for Civil Rights 

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F – HHH Bldg.

Washington, D.C. 20201


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

Revised: 3/2017

Current Version