Cedar Creek Pediatrics, P.C. 114 Plantation Ave., Cedartown, GA 30125 1 May 2009
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
If you have questions about this notice, please ask one of the staff.
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information (PHI), and with whom that information may be shared. This notice also describes your rights under this law. We pledge to you that we will keep your information private to the best of our ability. This Notice applies to all the records we receive and create on your child. The records are the property of Cedar Creek Pediatrics, P.C.
1. ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE: You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information (PHI) and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information (PHI) for treatment, payment, and health care operations when necessary.
2. WHO WILL FOLLOW THIS NOTICE: The entire staff of Cedar Creek Pediatrics, P.C. will follow these practices.
3. OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION: “Protected health information” (PHI) consists of those pieces of information which are individually, personally identifiable to a given patient. This information includes, for example, age, addresses, phone numbers, and information concerning your past medical history, current condition, and related health care services. The staff of Cedar Creek Pediatrics, P.C. is required by law to: • Make sure that your protected health information (PHI) is kept private. • Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information (PHI). • Follow the terms of the notice currently in effect. • Communicate any changes in the notice to you. The most current Notice will be posted in the office and examination rooms. Cedar Creek Pediatrics, P.C. reserves the right to change this notice. Its effective date is at the top of the first page and on every page thereafter. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a copy of the current Notice of Privacy Practices by coming by the office and requesting one. Note that the protected health information (PHI) we are trying to protect refers primarily to that information concerning your child. When you provide us with this information about the child, you may also be providing information about yourself and family members (for example, family history or social history) that may be needed to care for your child. All of this information will be kept in the medical record and will be safeguarded in a like manner, but all of it may be used or disclosed in the manner discussed in Section 4.
4. HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI): The following are examples of permitted uses and disclosures of your protected health information (PHI), but there may be others not listed here. We will only use or disclose the minimum necessary information to accomplish the task at hand. •REQUIRED USES AND DISCLOSURES: By law, we must disclose your PHI to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your PHI. •TREATMENT: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of you health care with a third party. For example, we would disclose information to another physician (specialist or on call physician), or clinic (such as Urgent Care or the Emergency Department), and to service providers, such as Laboratories, X-ray Departments, Pharmacies, and Specialty Clinics such as Physical therapy, Speech Therapy, or Occupational Therapy, who at the request of Cedar Creek Pediatrics, P.C., P.C. become involved with your care by providing assistance with you health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, we will use and disclose your PHI to provide the required treatment. •PAYMENT Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities our office might undertake as it seeks to confirm your coverage and eligibility with health insurance plans, coverage limits, co-payments, utilization review activities, deductibles, precertifications, preauthorizations for care/hospitalization/procedures, and determinations of medical necessity. •HEALTH CARE OPERATIONS We may use or disclose, as needed, your PHI to support the daily activities related to health care. These activities include, but are not limited to, quality assessment activities, investigation, oversight or staff performance reviews, training of medical students, students in a health profession training program, training of resident physicians in Family Practice and Pediatrics, licensing, communications about a product or service, activities related to the investigation and defense of a claim/lawsuit, defense of medical professional liability claims asserted by or on behalf of a patient, and conducting or arranging for other health care related activities. Some forms of medical records such as immunization log books, laboratory and diagnostic procedure log books (among others yet to be required) are kept outside the medical record, but contain enough personal information to connect it back to the patient. These log books are frequently inspected by government and insurance agents. Their access to these logbooks is considered routine and is covered by your consent for care. For example, we may disclose your PHI to students in training in the office. We may call you by name in the waiting room when preparing you for your appointment. We may use your PHI, as necessary, to contact you to remind you of your appointment. We will share your PHI with third-party “Business Associates” who may perform various activities (for example, billing services, transcription services, paging services) for this practice. Business Associates will also be required to protect your PHI. We may use or disclose your protected health information, as necessary, to contact you by mail or phone. Except in the case of the retirement of Cedar Creek Pediatrics, P.C., and the sale of the entire practice to another physician, we will not sell your PHI to anyone. •REQUIRED BY LAW: We may use or disclose your PHI if required by law or regulation. •PUBLIC HEALTH: We may use or disclose your PHI to a public health authority who is permitted by law to collect or receive the information. The disclosure may be related to any of the following: a. Prevent or control disease, injury, or disability. b. Report births and deaths. c. Report Child abuse, Child Sexual Abuse, or Child Neglect. d. Report reactions to Medications or complications of medical devices. e. Notify a person who may have been exposed to a disease, or may be at risk of contracting or spreading a disease. f. Notify an appropriate agency if we believe a patient or family member has been the victim of abuse, neglect or domestic violence. •HEALTH OVERSIGHT: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws. •FOOD AND DRUG ADMINISTRATION: We may disclose your PHI to a person or company required by the food and Drug Administration to do the following: a. Report adverse events, products defects, or problems and biologic product deviations. b. Track products. c. Enable product recalls. d. Make repairs or replacements. e. Conduct post marketing surveillance as required. •LEGAL PROCEEDINGS: We may disclose PHI during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process. •LAW ENFORCEMENT: We may disclose PHI for law enforcement purposes, including the following: a. Responses to legal proceedings. b. Information requests for identification and location. c. Circumstances pertaining to the victims of a crime. d. Deaths from suspected criminal conduct. e. Crimes occurring in the clinic or environs. f Medical emergencies believed to result from criminal conduct. •CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATIONS: We may disclose PHI to coroners or medical examiners for identification to determine cause of death or for the performance of other duties authorized by law. We may also disclose PHI to funeral directors as authorized by law. PHI may also be used and disclosed for cadaveric organ, eye, or tissue donations. •We may disclose your PHI to researchers when authorized by law. For example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI. •CRIMINAL ACTIVITY: Under applicable Federal and State laws, we may disclose your PHI if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual. •MILITARY ACTIVITY AND NATIONAL SECURITY: When appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces Personnel (1) for activities believed necessary by appropriate military command authorities to ensure the proper execution of the military mission including determination of fitness for duty; (2) for determination by the Department of Veterans Affairs of eligibility for benefits; or (3) or to a foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or others. •WORKERS’ COMPENSATION: We may disclose your PHI to comply with workers’ compensation laws and other similar legally established programs. •INMATES We may disclose PHI if you are an inmate of a correctional facility, and the medical information is needed: (1) to provide care to you; (2) for your health and safety, or to the health and safety of others, or (3) for the safety and security of the correctional institution. •DISCLOSURE TO A HEALTH PLAN: Examples of these disclosures include verifying your eligibility for health care and for enrollment in various health plans, and in coordinating benefits for those who have more than one health insurance, or who are eligible for government benefit programs. •PARENTAL ACCESS: Some state laws concerning minors permit or require disclosure of PHI to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the State of Georgia and will make disclosures following such laws.
5. USES AND DISCLOSURES OF PHI REQUIRING YOUR PERMISSION: In some circumstances, you have the opportunity to agree or object to the use and disclosure of all or part of your PHI. Some examples follow: •Unless you object, we may disclose to a member of the family, a relative, a close friend, or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose PHI to notify a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.
6. YOUR RIGHTS REGARDING YOUR PHI: You may exercise the following rights by submitting a written request to Cedar Creek Pediatrics, P.C. We may deny your request; however, you may seek a review of the denial. •RIGHT TO INSPECT AND COPY THE RECORD: You may inspect and obtain a copy of your PHI for as long as we maintain the PHI. Your records generally fall into two categories: billing information and the clinical information which is used for making decisions about you. If approved, you may inspect the record under supervision at the office. It is our policy to provide for you, at no charge, a copy of the medical record if you request it to be transferred to another physician either for consultation or in conjunction with a change in physician. You may request a copy of the record for any other purpose, but a charge will be applied for the cost of retrieving and copying the record. These charges are not routinely covered by insurance and will be paid for before the copy is prepared. A fee schedule is available on request. This right does not include inspection and copying of the following records: (1) psychotherapy notes; (2) information compiled in reasonable anticipation of, or use in a civil, criminal, or administrative action or proceeding: and (3) PHI that is subject to law that prohibits access to PHI. •RIGHT TO REQUEST RESTRICTIONS: You may ask us not to use or disclose any part of your PHI for treatment, payment, or health care operations. Your request must be in writing to Cedar Creek Pediatrics, P.C. In your request, you must tell us: (1) what information you wish restricted: (2) whether you want us to restrict our use, disclosure or both; (3) to whom you want the restriction to apply, for example, disclosures to another relative, noncustodial parent, etc.; and (4) an expiration date. If Cedar Creek Pediatrics, P.C. doesn’t feel that the request is in the best interest of either one of us, or if Cedar Creek Pediatrics, P.C. cannot reasonably comply with the request, then there is no requirement for Cedar Creek Pediatrics, P.C. to agree to the request. If the restriction is mutually agreed upon, then we will not use or disclose your PHI in violation of that restriction, unless it is needed to provide emergency treatment. •RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for the request. We will accommodate reasonable requests, when possible. •RIGHT TO REQUEST AMENDMENT: If you believe the information we have about you is incorrect or incomplete, you may request an amendment to your PHI for as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment. Documents in the record will not be removed or corrected. Amendments correcting the information will be added only. •RIGHT TO AN ACCOUNTING OF DISCLOSURES: You may request that we provide you with an accounting of the disclosures we have made of your PHI. This right applies to disclosures made for purposes other than Treatment, Payment, or Healthcare Operations. as described in this Notice. The disclosure must have been made after 1 July 2003, and no more than 6 years from the date of request. This right excludes disclosures made to you, to family members or friends involved in your care, or for notification. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice. •RIGHT TO OBTAIN A COPY OF THIS NOTICE: You may obtain a copy of this notice by coming by the office during regular office hours and applying for it in person. •RIGHT TO AUTHORIZE ALL OTHER DISCLOSURES AND USES: We will obtain your written authorization for uses and disclosures which are not identified by this notice and are not permitted by law. •RIGHT TO FILE A COMPLAINT: If you believe your rights have been violated, you may file a written complaint with Cedar Creek Pediatrics, P.C., P.C. or the Department of Health and Human Services within 180 days of the incident. No retaliation will occur against you for filing a complaint. Cedar Creek Pediatrics, P.C., P.C. will investigate your complaint, take action if necessary and will report to you his findings and actions
7. FEDERAL PRIVACY LAWS Other Federal privacy laws such as the Freedom of Information Act, the Privacy Act, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act have not been superseded by HIPAA. Some aspects of these laws were considered in formulating our policies and this Notice.