HIPPA Privacy Notice HIPPA Privacy Notice
 

NOTICE OF PRIVACY PRACTICES

 

Effective date: 4/14/2003

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

 

If you have any questions regarding this notice, you may contact our privacy officer at:

 

Warren Pediatric Associates, Attn: Privacy Officer

145 Pleasant Dr., Warren PA 16465

814-723-8023

Fax: 814-723-8025

 

  1. YOUR PROTECTED HEALTH INFORMATION

 Warren Pediatric Associates is required by the federal privacy rule to maintain the privacy of your child's health information that is protected by the rule, and to provide you with notice of our legal duties and privacy practices with respect to your child's protected health care information. We are required to abide by the terms of the notice currently in effect.

Generally speaking, your child's protected health information is any information that relates to your child's past, present or future physical or mental health or condition, the provision of health care to your child, or payment for health care provided to your child and individually identifies your child or reasonably can be used to identify your child.

Your child's medical and billing records at our practice are examples of information that usually will be regarded as your protected health information.

 

  1. USES AND DISCLOSURES OF HEALTH INFORMATION

 

  1. Treatment, payment and health care operations

 

  1. Treatment: We may use and disclose your child's protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision, coordination or management of health care to your child by one of more health care providers. Some examples of treatment uses and disclosures include:

 

During an office visit, practice physicians and other staff (including students) involved in your child's care may review your child's medical record and share and discuss your child's medical information with each other.

We may share and discuss your child's medical information with an outside physician to whom we have referred your child's care or with whom we are consulting regarding your child's care.

We may share and discuss your child's medical information with an outside laboratory, radiology department, or other health care facility where we have referred your child for testing.

We may share and discuss your child's medical information with an outside home health agency, durable medical equipment agency or other health care provider to whom we have referred your child for health care services and products.

We may share and discuss your child's medical information with a hospital or other health care facility where we are admitting or treating your child.

We may share and discuss your child's medical information with another health care provider who seeks this information for the purpose of treating your child.

We may page patients in the waiting room when it is time for them to go to an examining room. 

We may contact you to provide appointment reminders.

 

  1. Payment: We may use and disclose your child's protected health information for our payment purposes as well as the payment purposes of other healthcare providers and health plans. Payment uses and disclosure include activities conducted to obtain payment for the care provide to your child or so that you can obtain reimbursement for that care, for example, from your health insurer. Some examples of payment uses and disclosures include:

  

Sharing information with your health insurer to determine whether your child is eligible for coverage or whether proposed treatment is a covered service.

 Submission of a claim form to your health insurer.

Providing supplemental information to your health insurer so that your health insurer can obtain reimbursement from another health plan under a coordination of benefits clause in your subscriber agreement.

 Sharing your address with other health care providers who seek this information to obtain payment for health care services provided to your child.

 Providing medical records and other documentation to your health insurer to support the medical necessity of a health service.

 Allowing your health insurer access to your child's medical record for a medical necessity or quality review audit.

 Providing information to a collection agency or our attorney for purposes of securing payment of a delinquent account.

 Disclosing information in a legal action for purposes of securing payment of a delinquent account.

 

  1. Health care operations: We may use and disclose your child's protected health information for our health care operation purposes as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:

 

Quality assessment and improvement activities.

 Reviewing the competence or qualifications of healthcare professionals.

 Evaluating practitioner and provider performance.

 Conducting training programs, accreditation, certification, licensing or credentialing activities.

 

  1. Uses and disclosures for other purposes

 

We may use and disclose your child's protected health information for other purposes. This section generally describes those purposes by category. Each category includes one or more examples.

 

  1. We may disclose your child's protected health information to someone involved in your child's care or payment for your child's care, such as a family member.

  2. We may use and disclose your child's protected health information to notify, or to assist in the notification of a family member, a personal representative or another person responsible for your child's care.

  3. We may use and disclose protected health information when required by federal, state or local law. For example, we may disclose protected health information to comply with mandatory reporting requirements involving births and deaths, child abuse, disease prevention and control, vaccine-related injuries, serious injuries, gunshot and other injuries by a deadly weapon or criminal act, driving impairments, and blood alcohol testing.

  4. We may use and disclose protected health information for public health activities including:

Public health reporting, for example, communicable disease reports.

Child abuse and neglect reports.

FDA-related reports and disclosure, for example, adverse event reports

Public health warnings to third parties at risk of a communicable disease or condition.

OSHA requirements for workplace surveillance and injury reports.

  1. We may use and disclose protected health information for purposes of reporting abuse, neglect or domestic violence

in addition to child abuse to the Department of Public Welfare.

  1. We may use and disclose protected health information for purposes of health oversight activities authorized by law.

For example, we may comply with a Drug Enforcement Agency inspection of patient records.

  1. We may use and disclose protected health information disclosures in judicial and administrative proceedings in

response to a court order or subpoena, discovery request or other lawful process. For example, we may comply with a court order to testify in a case at which your child's medical condition is at issue.

 

III. PATIENT PRIVACY RIGHTS

  1. Further restriction or use or disclosure

You have the right to request that we further restrict use and disclosure of your child's protected health information to carry out treatment, payment or health care operations, to someone who is involved in their care or the payment for your child's care, or for notification purposes. We are not required to agree to a request for a further restriction. To request a further restriction, you must submit a written request to our privacy officer. The request must tell us: (a) what information that you want requested; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.

  1. Confidential communication

You have a right to request that we communicate with you about your child's health information by alternative means or to alternative locations. For example, you might request that we only contact you by mail or at work. We are not required to agree to requests for confidential communications that are unreasonable. You must submit a written request to our privacy officer. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.

  1. Accounting of disclosures

You have a right to obtain (upon written request to our privacy officer) an accounting of certain disclosures of your child's protected health information by us, or a business associate for us. The right is limited to disclosure within six years of the request and other limitations. Also in limited circumstances we may charge you for providing the accounting.

  1. Inspection and copying

You have a right to inspect and obtain a copy of your child's protected health information that we maintain in a designated records set. This right is subject to limitation and we may impose a charge for the labor and supplies involved in providing copies.

To exercise your right of access, you must submit a written request to our privacy officer. The request must:

(a) describe the health information to which access is requested, (b) state how you want to access the information, such as inspection, pick up of copy, mailing of copy, (c) specify any requested form or format and (d) include the mailing address, if applicable.

 

IV. CHANGES TO THIS NOTICE

We reserve the right to change this notice at any time. We further reserve the right to make any change effective for all protected health information that we maintain at the time of the change-including information that we created or received prior to the effective date of the change.

We will post a copy of our current notice in the waiting room for the practice. At any time, patients may review the current notice by contacting our privacy officer. You may also access the current notice at our web site at www.warrenpediatrics.org.

V. COMPLAINTS

If you believe that we have violated your privacy rights, you may submit a complaint to the practice or the Secretary of Health and Human Services. To file a complaint with the practice, submit the complaint in writing to our privacy officer. We will not retaliate against you for filing a complaint.