Effective Date: May 6, 2026

Contact: Diane Blazer, Program Administrator — dianeblazer@chathamhospitalists.com — (912) 819‑8974 — 5354 Reynolds Street, Suite 222, Savannah, GA 31405 

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Note: This notice covers PHI and patient rights. For information about how this website collects non‑medical data (cookies, analytics, contact forms), see our Website Privacy Statement. 

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. You have the right to access, amend, and control your health information.

This Notice of Privacy Practices describes how Chatham Hospitalists may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes permitted or required by law.

We are required by law to maintain the privacy of your PHI, provide you with this notice, and abide by the terms of this notice. We will notify you if a breach occurs that may have compromised the privacy or security of your information.

We may use and disclose your PHI for the following purposes:

To provide, coordinate, or manage your health care and related services.

To obtain payment for your health care services.

For quality assessment, training, licensing, and other operational purposes.

To report health information for public health activities such as disease control.

Under certain circumstances, we may use and share PHI for research purposes.

To comply with legal requirements or court orders.

As required by law, including for workers' compensation, health oversight, and national security.

We will not use or disclose your PHI for marketing purposes, the sale of PHI, or most sharing of psychotherapy notes without your written authorization. You may revoke your authorization at any time in writing.

You have the right to:

• Inspect and copy your PHI. 
• Request an amendment to your PHI. 
• Receive an accounting of disclosures. 
• Request restrictions on certain uses or disclosures. 
• Request confidential communications. 
• Receive a paper copy of this notice, even if you agreed to receive it electronically. 

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

For questions or to file a complaint, contact:

Diane Blazer, Program Administrator
Email: dianeblazer@chathamhospitalists.com
Phone: (912) 819-8974
Address: 5354 Reynolds Street, Suite 222, Savannah, GA 31405

This notice is effective as of May 6, 2026. We reserve the right to change our privacy practices and this notice. Any changes will apply to all PHI we maintain. The revised notice will be available upon request and posted on our website.

Patient Name: _____________________________________

Signature: _________________________________________

Date: ___________________