Notices of Privacy Practices


This notice describes how medical information about your child or other members of your family may be used and disclosed and how you may obtain this information.  Please review it carefully.

A federal regulation, known as the HIPAA Privacy Rule, requires that we provide detailed notice in writing of our privacy practices. We apologize for the length of this notice but the HIPAA Privacy Rule requires us to address many issues in this notice.

I. Our commitment to protecting health information about your child, you, and your family.

-- HIPAA Privacy Rule requires that we protect health information which identifies a patient or family, information which is called Protected Health Information or PHI.
-- we will maintain the privacy of all PHI.
-- we give you this notice of our legal duties and privacy practices.
-- we reserve the right to change this notice in accordance with current law, and post a copy of such changes in our office in a prominent location, and provide you with a copy of the revised notice upon your request.

II. How we may use and disclose Protected Health Information (PHI) without your written authorization or opportunity to agree or object.
-- for treatment: We may use and disclose PHI to provide, coordinate, and manage your child's health care and related services. Examples include disclosure of PHI when your child requires referral to another physician, health care professional, or hospital, a prescription drug or device, laboratory tests, imaging tests, or other specialized testing or therapy.
-- for payment: We may use and disclose PHI in order to verify your coverage for particular treatment and services and to collect payment for your child's treatment and other services from third party payers including your health plan, their paid reviewers, and other insurance companies providing you with additional coverage.
-- for health care operations: We may use and disclose PHI in order to help improve the quality of your child's care and reduce its cost. This includes providing training to other health care providers, cooperating with outside organizations which certify the quality of providers or institutions, providing information to professionals who help us improve and maintain the quality and efficiency of the services we provide to you child and to others, resolving grievances which occur within our practice, and converting PHI to de-identified health information, data which cannot be associated with your child or with other members of your family.
-- for communication from our office to you: We may use and disclose PHI to remind you of appointments and to provide you with information about alternative therapies.
-- for involvement of non-family members in your child's care: We may use and disclose PHI to enlist the help in your child's care of your family member, close friend, or any other person identified by you. In these situations, we will use your direct instructions as well as our best professional judgements to make reasonable decisions about your child's best interests in allowing someone other than a parent to act on the behalf of your child to perform such functions as picking up and delivering prescriptions, x-rays, medical supplies or other items which contain direct or indirect PHI about your child and family.
-- for compliance with law: We may use and disclose PHI to comply with applicable federal, state, or local laws including worker's compensation and Medicare laws.
-- for compliance with public health directives: We may use and disclose PHI to assist public health and other authorities in their efforts to prevent or control communicable diseases, general or school-based injuries, disabilities, and injuries or complications from FDA-regulated medications or devices.
-- for prevention and control of abuse, neglect, or domestic violence: We may use and disclose PHI to properly constituted government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse, or neglect.
-- for health oversight activities: We may use and disclose PHI to a health oversight agency for audits, investigations, inspections, licensure and disciplinary activities, and other activities necessary to monitor the health care system including government health care programs.
-- for support of legal proceedings: We may use and disclose PHI when ordered by a court order, subpoena, or discovery requests.
-- for support of law enforcement: We may use and disclose PHI to law enforcement authorities if the patient is a suspected crime victim, if law enforcement authorities indicate that it is necessary to locate a suspect, fugitive, material witness, or a missing person, if it relates to a crime or suspected crime committed in this office, if it is in response to a medical emergency not occurring in the office, and if it is necessary to report a crime and its nature, location, and the identity of those who committed the crime.
-- for post-mortem matters: We may use and disclose PHI to a coroner or medical examiner and, if authorized by law, a funeral director, to allow them to carry out their jobs.
-- for selected research activities allowed or required by the HIPAA Privacy Act: We may use and disclose PHI to governmental agencies for certain research or oversight of our practice and others and to you should you desire it.
-- for prevention of a serious threat to health or safety: We may use and disclose PHI to an appropriate person about your child or family in limited circumstances to prevent a threat to the health or safety of another person or to the public.
-- for support of certain specialized government activities: We may use and disclose PHI to support certain activities including military maneuvers, executive protection, national security, intelligence gathering, and protection of the health of persons in custody.


III. Your rights regarding Protected Health Information about your child and family.

-- right to request restrictions: You have the right to request restrictions on the PHI that we may use for treatment, payment, and health care operations. To request restrictions, you must make your request in writing to our Privacy Officer using the request form we provide. We are not required to comply with your request if we feel that it is in violation of the above-noted legal directives. In such a case, we will provide you with a written notice of denial.
-- right to receive confidential communications: You have the right to request that you receive communications containing PHI in a certain manner or at a certain location. You must make your request in writing to our Privacy Officer specifying how and where you would like to be contacted. We are required to accommodate reasonable requests.
-- right to inspect and copy: You have the right to copy or inspect PHI about you. This does not include PHI gathered for a civil, criminal, or administrative proceeding. We may deny your request only in limited circumstances. You must make your requests to inspect and copy in writing to our Privacy Officer, and we may charge you a reasonable fee for copying, postage, labor, and supplies used to meet your request.
-- right to amend: You have the right to amend your PHI about your child or family as long as such information is kept by or for our office. This request must be made in writing to our Privacy Officer, and you must include a reason for the request.
-- right to receive an accounting of disclosures: You have the right to request an accounting of certain disclosures of your PHI. This request, in writing to our Privacy Officer, must be for a list of disclosures other than those specified in Section I above made during a time period up to six years.

IV. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, please contact our Privacy Officer. We will not retaliate or take action against you for filing a complaint.

IV. Privacy Officer Contact Information

You may contact our Privacy Officer Judy Smith at the address and phone number below.

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Thank you for reviewing this HIPAA privacy notice. It is part of the federal law that you sign a form acknowledging that you have read and accept these privacy rules and that you consent to their application. Please click on the following link to reach the form which you may print, sign, and either bring in at your child’s next visit or fax to our office: Acknowledgement and Consent Form