Eastlake Pediatrics, P.C.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU, i.e. YOUR CHILD, AS A PATIENT OF Eastlake Pediatrics, P.C. MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our commitment to your privacy and our legal duty
Your medical information is personal and confidential. We are committed to protecting your medical information and are required by applicable federal and state law to keep it private. In conducting our business at Eastlake Pediatrics, P.C. we are required to create and retain records of the care and services you receive at this office, as well as other offices, if it becomes available to us. We are required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect 4/13/03 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time provided such changes are permitted by applicable law. The new terms of our notice will be effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request. Any revised notice will contain the effective date.
You have the right to a paper copy of this notice at any time. For more information about out privacy practices, or for additional copies of this notice, please contact us.
This Notice of Privacy describes how we may use and disclose your protected health information to carry out treatent, payment or health care operations and for other purposes that are premitted or required by law. It also describes your rights to access and control your protected health inforation. "Protected health inforation" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health services.
How This Office May Use and Disclose Your Protected Health Information
Your protected health information may be used and disclosed by your physicians, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. Additionally, we may disclose your protected health information to others that may assist in your care, such as your spouse, parents or grandparents.
Payment: We may use and disclose your protected health information in order to bill and collect payment from you, an insurance company or a third party for the services and treatments you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits, including immunizations). We may also disclose relevant protected health information to your health plan to obtain approval for a hospital admission.
Healthcare Operation: We may use and disclose, as needed, your protected health inforation in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you.
Appointment Reminders: We may use or disclose your protected health information to contact you with appointment reminders (such as telephone calls, voice mail messages, letters).
Health-Related Benefits and Treatment Options: We may use and disclose your protected health information to inform you of or recommend potential treatment options or alternatives.
Release of Information to Family/Friends: We may use and disclose your protected health information to notify, or assist in the notification of (including identifying or locating) a family ember or another person responsible for your care, of your location, your general condition, or death. In the event of an incapacity, illness, or emerency circumstances, we will disclose only relevant health information to the person who assists in your healthcare. For example, a parent may allow a babysitter to take their child to the Pediatrician for evaluation. The babysitter may then have access to the child's medical information. We will also use our professional judgement and consider your best interest in allowing a person to pick up prescriptions or medical supplies, take for x-rays, or assist in similar forms of health care.
Required By Law: We may use or disclose your protected health information without your consent or authorization in certain situations. These situations include: Required By Law; Public Health; Communicable Disease; Health Oversight; Abuse or Neglect; Food and Drug Administration; Legal Proceedings; Law Enforcement; Coroners, Funeral Directors, and Organ Donation; Research; Criminal Activity; Military or National Security; Workers; Compensation; Inmates, Required Uses and Disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Serious Threats to Health or Safety: We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to health and safety to you, another individual or the public. Under these circumstances, we will only make disclosure to a person or organization able to help prevent the threat.
Your Rights Regarding Your Protected Health Information
Access: You have the right to look at or obtain copies of your health information, with limited exceptions. You must submit a request in writing to obtain access to your health information. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. We may deny your request to inspect and copy in certain very limited circumstances. Under federal law, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.
Amendment: You have the right to request that we amend your health information if you believe it to be incorrect or incomplete for as long as the information is kept by this office. Your request must be in writing and it must explain why the information should be amended. We may deny the request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the health information kept by this office; (c) not part of the health information which you would be permitted to inspect and copy; or (d) not created by our practice. If we deny your request for an amendment you have the right to file a statement of disagreement with us and we will prepare and provide you with a copy of any rebuttal.
Confidential Communication: You have the right to request that we communicate with you about health and related issues in a particular manner or location. For example, you may request that we contact you at home, rather than work, and leave a message on voice mail or in person in reference to appointment reminders, insurance items, clinical care and laboratory results. You must make this request in writing, specifying the method of contact or location desired. We will accommodate all reasonable request.
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your protected health information. You may request that it not be disclosed to faily members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must be in writing and must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information, for purposes other than treatent, payment, healthcare operations and certain other activities. If you request this accounting more that once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. You must submit your request in writing and specify a time period, which may not be longer that six (6) years from the date of disclosure and ay not be prior to April 14, 2003.
Your Authorization: You have the right to provide this office with a written authorization to use and disclose your protected health information for purposes other than identified by this Notice of Privacy Practices. With written authorization we may use and disclose your information to anyone for any purpose. Any authorization you provide to us may be revoked at any time, in writing. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
Complaints: If you believe your privacy rights have been violated you may complain to us or to the Secretary of the Department of Health and Human Services. You may file a written complaint with us by notifying our privacy contact of you complaint. You will not be penalized for filing a complaint.