Notice of Privacy Practices

Gastroenterology Associates of Cleveland, Incorporate (GAC) presents this Notice to our patients describing how your medical information may be used or disclosed and how you can get access to this information. Please review it carefully. You have the right to obtain a paper copy of this Notice upon request.

Patient Health Information

Under Federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment and related medical information. Your health information also includes payment, billing and insurance information.

How We Use Your Patient Health Information

GAC uses health information about you for treatment, analyzing procedures and lab results. We use information to obtain payment and for health care operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances where the law applies, we may be required to use or disclose the information without your permission.

Examples of Treatment, Payment, and Health Care Operations

Treatment: GAC will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians and other members of your treatment team will record information in your medical record and use it to determine the most appropriate course of care. GAC may also disclose this information by fax, in person, or via telecommunication. We may communicate to other health care providers who are participating in your treatment, to pharmacists who are filling and refilling your prescriptions, and to family members who are helping with your care.

Payment: GAC will use and disclose your health information for payment purposes. For example, GAC may need to obtain authorization from your insurance company before providing certain types of treatment. GAC will submit bills and maintain records of payments from your health plan.

Health Care Operations:
 GAC will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, and to assess the care and outcomes of your case and others like it.

Release of Information to Family or Friends

GAC knows that family or friends are an integral part of a patient’s care. If you wish to authorize a family member or friend to speak with us regarding your care or test results, please write their name and contact information on the ‘Notice of Privacy Practices Acknowledgement’ form. GAC will not release your information to any friend or family without your written consent.

Special Uses

GAC may use your information to contact you with appointment reminders by phone or mail. GAC may also contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. This communication may be sent to you via the methods listed above. If you have granted written permission, the above information may also be sent to you via email. If you wish to authorize the use of email as a method for GAC to communicate with you, sign the proper section on the ‘Notice of Privacy Practices Acknowledgement’ form.

Other Uses and Disclosures

GAC may use or disclose identifiable health information about you for other reasons, even without your consent. Subject to certain requirements, GAC is permitted to give out health information without your permission for the following purposes:

  • Required by Law: GAC may be required by law to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
  • Research: GAC may use or disclose information for approved medical research.
  • Public Health Activities: As required by law, GAC may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
  • Health Oversight: GAC may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
  • Judicial and Administrative Proceedings: GAC may disclose information in response to an appropriate subpoena or court order.
  • Law Enforcement Purposes: Subject to certain restrictions, GAC may disclose information required by law enforcement officials.
  • Deaths: We may report information regarding deaths to coroners, medical examiners, funeral and organ donation agencies.
  • Serious Threat to Health or Safety: GAC may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • Military and Special Government Functions: If you are a member of the armed forces, GAC may release information as required by military command authorities. GAC may also disclose information to correctional institutions or for national security purposes.
  • Workers’ Compensation: GAC may release information about you for workers’ compensation or similar programs providing benefits for work-related injuries or illness. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

Individual Rights

You have the following rights with regard to your health information. Submit any concerns in writing to GAC’s compliance officer (see below).

  • Request Restrictions: You may request restrictions on certain uses and disclosures of your health information. GAC is not required to agree to such restrictions, but if we do agree, GAC must abide by those restrictions.
  • Confidential Communications: You may ask us to communicate with you confidentially. Please ask to see the practice administrator to initiate and document this request.
  • Inspect and Obtain Copies: You have the right to see or receive a copy of your health information. There may be a small charge dictated by Ohio Law for these copies.
  • Amend Information: If you believe information in your record is incorrect, you have the right to request that GAC correct or amend the existing information. Your GAC physician has the right to refuse your request. Regardless, a letter concerning your request will be sent within 30 days of said request.
  • Accounting of Disclosures: You may request a list of instances where we have disclosed health information about you for reasons other than treatment, payment, or health care operations.

Our Legal Duty

We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.

Changes in Privacy Practices

We may change our policies at any time. A current version of our Notice is available in each waiting area at all times. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below


If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.

For additional information, please contact:

Gastroenterology Associates of Cleveland, Incorporated
Attn: Privacy Officer
3700 Park East Drive, STE 100
Beachwood, Ohio 44122