PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact the Facility Privacy Official by dialing the clinic number.

 

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care of treatment, and billing-related information. This notice applies to all of the records of your care generated by this clinic, whether made by personnel, or your doctor.

 

Our Responsibilities

 

Premier Pediatrics is required by law to maintain the privacy of your health information and provide you a description of your privacy practices. We will abide by the terms of this notice.

Uses and Disclosures

The following categories describe examples of the way we use and disclose health information:

 For Treatment: We may use health information about you to provide them with treatment or services. We may disclose health information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you. For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your records and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide subsequent health care providers with copies of various reports that should assist him or her in treating your child once they are discharged from the hospital.

 

For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example: we may need to give your insurance company information about your hospital stay so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether yoru plan will cover it.

 

 

For Health Care Operations:

Members of Premier Pediatrics may use information in your health record to assess the care and outcomes in your case and other like it. The results will then be used to continually improve the quality of care for all patients we serve. For Example: Members of the medical staff or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

When disclosing information, primarily appointment reminders and billing/collections efforts, we may leave messages on your answering machine/voice mail.

Business Associates:

There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, collection agencies, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your child’s health information in our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:

 *Health Oversight Activities: We may disclose your health information to health agencies during the course of audit, investigations, inspections, licensure and other proceedings.

*Judicial and Administrative Proceedings: We may disclose your health information in the course of any administrative or judicial proceeding.

*Public Safety: We may disclose your health information to appropriate persons in order to prevent or lessen a serious or imminent threat to the health or safety of a particular person or the general public.

*Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

*Law Enforcement: We may disclose certain health information for law enforcement purposes as required by law or in response to a valid subpoena.

*Change of Ownership: In the event that this organization is sold or merged with another organization, your health information will become the property of the new owner.

Your Health Information Rights

Although your health record is the physical property of the practitioner or facility that compiled it, you have the right to:

*Inspect and Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. A licensed health care professional will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

*Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by this facility. We may deny your request for an amendment and if this occurs, you will be notified of the reason for denial.

 *An Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of certain disclosures we make of your health information for purposes other than treatment, payment of health care operations where an authorization was not required.

 *Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on 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.

*Request Confidential Communication: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example: you may ask that we contact you at work instead of your home. The facility will grant reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

*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.

To exercise any of your rights, please obtain the required forms from the Privacy Official and submit your request in writing.

We are not required to agree to your request.

If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

 

 

 

 

 

 

 

CHANGES TO THIS NOTICE

 

 

Premier Pediatrics reserves the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted and include the effective date.

COMPLAINTS

You will not be penalized for filing a complaint.

 OTHER USES OF HEALTH IFORMATION

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 permission. If you provided us permission to use or disclose health information about you, 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. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records for the care that we provide to you.

 

Privacy Official

Premier Pediatrics

 

 

 

 

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer. All complaints must be submitted in writing.

 

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