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Pediatric Partners LLC
Notice of Privacy Practices
(Effective June 1, 2006)
This notice describes how medical information about you may
be used and disclosed and how you can get access to this information. Please
review it carefully.
The law requires us to keep you medical records confidential
and to provide you with the Notice of Privacy Practices describing
how we may use and disclose your health information, including
your medical history, symptoms, examination and test results,
diagnoses and treatment plans, to carry out treatment, payment
and health care operations and for other purposes that are allowed
or required by law. It also describes your rights to review
and control the use and disclosure of your health information.
We are required to abide by the privacy practices described
in this Notice. We may change our privacy practices at
any time. The revised privacy practices will be set forth
in a revised Notice and will be effective for all health information
that we maintain at that time. Upon your request, we will
provide you with a copy of the most recent Notice. A current
copy of our Notice of Privacy Practices will be posted in our
office in a visible location at all times. You may also
access a copy of our Notice on our web site at http://pediatricpartnersllc.org.
- Uses and disclosures. The
law allows us to use and disclose your health information for
treatment, payment and health care operations. The following
are examples of such uses and disclosures:
- Treatment. We will use and
disclose your health information to individuals within our
office in order to provide, coordinate, and manage your medical
care and any related services. This includes the use
or disclosure of your health information to aid in the coordination
or management of your medical care with a third party. For
example, your heath information may be provided to a physician
with who you have been referred to ensure that the physician
has the necessary information to diagnosis or treat you.
- Payment. Your health information
will be used or disclosed, as needed, to allow us to obtain
payment for health care services provided to you. This
may include disclosure to your health insurance plan or carrier
as they undertake certain activities before approving or paying
for medical services. Such activities include make a
determination of eligibility or coverage for insurance benefits
reviewing service provided to you for medical necessity, and
undertaking utilization review activities.
- Healthcare Operations. We may
use or disclose, as needed, your health information to operate
our business. These activities include, but are not limited
to, quality assessment and improvement activities, reviewing
the quality of care provided by your health care providers,
training of personnel and medical students, licensing and conducting
or arranging for other business activities.
- Incidental Uses and Disclosures. There
may also be incidental uses or disclosures of your health information
as a result of otherwise allowed uses and disclosures. Such
uses and disclosures may occur because they cannot reasonably
be prevented. For example, when your name is called in
the waiting room, we cannot reasonably prevent others from
overhearing your name.
- Other. 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 use or
disclose your health information, as necessary, to contact
you to schedule or remind you of an appointment, including
leaving massages on your answering machine/voice mail.
We may fax your health information to carry out treatment,
payment or health care operations.
We will share your health information with other organizations
that perform various activities on our behalf such as billing
or transcription services. Whenever an arrangement between
our office and another organization involves the use or disclosure
of your health information, we will have a written contract
that contains terms that will protect the privacy of your health
information.We may use or disclose your health information,
as necessary, to provide you with information about treatment
alternatives or other health-related benefits and services
that may be of interest to you. For example, your name and address may
be sued to send you a newsletter about our practice and the services
we offer. We may also send you information about products
or services we believe may be beneficial to you.
We may disclose your health information to another health care
provider of yours for their health care operations relating to
their quality assessment and improvement activities, reviewing
the competence or qualifications of their health care professionals,
or detecting or preventing health care fraud and abuse.
- Uses and Disclosures Allowed or Required by Law. We
may use or disclose your health information in the following
situations as allowed or required by law:
- Required by Law. We may use
or disclose your health information if we are legally required
to do so. We will limit the use or disclosure to that
required by such law.
- Public Health. We may disclose
your health information to a public health authority for purposes
of controlling disease, injury or disability. We may
also disclose your health information, if directed by the public
health authority, to a foreign government agency that is collaborating
with the public health authority.
- Communicable Diseases. We may
disclose your health information, if authorized by law, to
a person who may have been exposed to a communicable disease
or may otherwise be at risk of contracting or spreading the
disease or condition.
- Health Oversight. We may disclose
health information to a health oversight agency for activities
authorized by law, such as audits, investigations, and inspections. Oversight
agencies seeking this information include, but are not limited
to, government agencies that oversee the health care system,
government benefit programs, other government regulatory programs
and entities subject to civil rights laws.
- Abuse or Neglect. We may disclose
your health information to a public health authority that is
authorized by law to receive reports of child abuse or neglect. In
addition, we may disclose your health information to the governmental
entity or agency authorized to receive such information if
we believe that you have been a victim of abuse, neglect or
domestic violence. In this case, the disclosure will
be made consistent with the requirements of applicable federal
and state laws.
- Food and Drug Administration. We
may disclose your health information to a person or company
as required by the Food and Drug Administration’s (“FDA”)
for purposes relating to the quality, safety or effectiveness
of FDA regulated products or activities.
- Legal Proceedings. We may disclose
your health information in the course of any judicial or administrative
proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized),
and in certain conditions, in response to a subpoena, discovery
request or other lawful process.
- Law Enforcement. We may disclose
health information, so long as applicable legal requirements
are met, to law enforcement officials, for law enforcement
purposes.
- Coroners, Funeral Directors and Organ Donation. We
may disclose health information to a coroner or medical examiner
for identification purposes, to determine cause of death or
for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose health information
to a funeral director, as authorized by law, in order to permit
the funeral director to carry out his/her duties. Health
information may be used and disclosed or cadaveric organ, eye
or tissue donation purposes.
- Research. We may disclose your
heath information to researchers when their research has been
approved by a privacy board or an institution review board.
- Criminal Activity. Consistent
with applicable federal and state laws, we may disclose your
heath information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent threat
to the health or safety of a person or to the public.
- Military Activity and National Security. When
the appropriate conditions apply, we may use or disclose heath
information of individuals who are Armed Forces personnel (1)
for activities deemed necessary for appropriate military command
authorities; (2) for the purpose of a determination by the
Department of Veterans Affairs of your eligibility for benefits,
or (3) to foreign military authority if you a member of that
foreign military services. We may also disclose your
health information to authorized federal officials for conducting
national security and intelligence activities, including providing
protective services to the President of the United States or
others.
- Employers. We may disclose to your
employer health information obtained in providing medical services
to you at the request of your employer for purposes of conducting
an evaluation relating to medical surveillance of the workplace
or determining whether you have a work-related illness
or injury when such medical service are needed by the employer
to comply with certain legal requirements.
- Correctional Institutions. If
you are an inmate or in legal custody, we may disclose to the
correctional institution or law enforcement official having
legal custody of you, certain health information if necessary
for health and safety purposes.
- Worker’s Compensation. You
health information may be disclosed by us as authorized to
comply with workers’ compensation laws and other similar
legally established programs.
- Compliance. Under the law,
we must make disclosures of health information to the Secretary
of the Department of Health and Human Services to enable it
to investigate or determine our compliance with the requirements
of the privacy laws.
- Written Authorization. Any
uses and disclosures of your health information for purposes
other than treatment, payment and health care operations, or
as otherwise allowed or required by law as described above
will be made only with your written authorization. Any
authorization you provide to us is effective for the period
specified in the authorization (which cannot exceed one year)
unless you revoke the authorization in writing. Any written
authorization may be revoked by you, at any time. Your
revocation shall not apply to those uses and disclosures we
made on your behalf pursuant to your authorization prior to
the time we received your written revocation. We will
accept authorizations by facsimile and will treat such as originals.
- Facility Directories. Unless
you notify us, we will use and disclose in our facility directory
your name, the locations at which you are receiving care, your
condition (in general terms), and your religious affiliations. All
of this information, except religious affiliation, will be
disclosed to people that ask for your by name. Members
of the clergy will be told your religious affiliation. If
you do not want use to use or disclose such information or
want some restrictions on what is placed in our facility directory
or who the information is disclosed to, your request must be in
writing, addressed to our Privacy Officer and state the
specific restrictions requested. If you are not present
or able to express your objection or request a restriction
to such use or disclosure, then your physician may, using the
physician’s professional judgment, determine whether
the use or disclosure is in your best interest.
- Others Involved in Your Healthcare. We
may disclose to a member of your family, a relative, a close
friend or any other person you identify, your health information
that directly relates to that persons involvement in your health
care or who has responsibility for payment of your health care. We
may also use or disclose your health information to notify
or assist in notifying a relative or any person responsible
for your care, or your location, general condition or death. In
addition, we may use or disclose your health information to
a public or private entity, authorized by law or by its charter
to assist in disaster relief efforts, for the purposes of coordinating
the above uses and disclosures to your family or other individuals
involved in your health care.
- Your Rights. Following is a
statement of your legal rights with respect to your health
information ad a brief description of how you may exercise
these rights.
- Access. You have the limited
right, subject to certain grounds for denial, to look at
all of your health information that we keep except for the
following records: psychotherapy notes; information
compiled in reasonable anticipation of, or use in a civil,
criminal, or administrative action or proceeding; and certain
laboratory information restricted by federal law. You
also have the limited right, subject to certain grounds for
denial, to obtain copies of that health information you have
a right to look at. Our office may charge you a reasonable
fee for copying, mailing labor and supplies associated with
your request. Any request for access to or copies
of your health information must be in writing and
provided to our Privacy Officer. If your request for
access to or copies of your health information is denied,
you may, depending on the circumstances, have a right to
have a decision to deny access reviewed. We will provide
you, in writing, with our reasons for denial of access and,
if, by law, your are allowed to have such denial reviewed,
we will provide you with instructions for having a denial
of access reviewed.
- Restrictions. You may ask
us to restrict the use or disclosure of any part of your
health information to carry out treatment, payment or healthcare
operations. You may also request that any part of your
health information not be disclosed to family, relatives,
or friends who may be involved in your care or to notify
them of your location, general condition or death, in
addition, you may request that we restrict the use and disclosure
of you health information for disaster relief efforts. Your
request must be in writing, addressed to our Privacy
Officer and state the specific restriction requested and
to whom you want the restriction to apply. If you are
not present or able to express an objection or request a
restriction to such use or disclosure, then your physician
may, using the physician’s professional judgment, determine
whether the use or disclosure is in your best interest.
We are not required to agree to a restriction that you may request.
If your physician believes it is in your best interest to permit
use and disclosure of your health information, your health information
will not be restricted. If your physician does agree to
the requested restriction, we may not use or disclose your health
information in violation of that restriction unless there is
an emergency. We may terminate our agreement to restrict
uses and disclosures of your health information by providing
you with written notice of ; provided, however, that our termination
shall only be effective with respect to health information created
or received after we have given you notice of termination of
the restriction.
- Confidential Communication. You
have the right to request that we send your health information
to you by alternative location. We will accommodate
reasonable requests. We may condition this accommodation
by having you sign an authorization, asking you for information
as to how payment will be handled or specification of an
alternative address or other method of contact. We
will not request an explanation from you as to the basis
for the request. Your request must be in writing,
addressed to our Privacy Officer and state the accommodations
you are requesting.
- Amendments. You may request
an amendment of your health information that we maintain. Such
request must be in writing and provided to our Privacy
Officer. In certain cases, we may deny you request
for an amendment. If we deny your request for amendment,
you have the right to file a statement of disagreement that
will become part of your health information. If you
file a statement of disagreement, we reserve the right to
respond to you statement. You will receive a copy of
any response we make and any such response will become part
of your health information.
- Accounting of Disclosures. You
have the right to receive an accounting of certain disclosure
we have made, if any, of your health information. This
right applies to disclosures made on and after April 14,
2003 for purposes other than (i) treatment, payment or healthcare
operations as described in this Notice; (ii) disclosures
made to you; (iii) disclosures to a facility directory; (iv)
disclosures to family members or friends involved in your
care or for notifications purposes; or (v) disclosures pursuant
to an authorization. The right to receive this information
is subject to certain exceptions, restrictions and limitations. Your
request for an accounting must be in writing, addressed
- Electronic Notice. If you
receive a copy of the Notice on our web site or by e-mail,
you have the right to obtain a paper copy from us upon request.
- Complaints. You may complain
to us or the Secretary of Health and Human Services if you
believe we have violated your privacy rights. To complain
to us, you may send our Privacy Officer a letter describing
your concerns to the address found below. We respect
your privacy and support any efforts to protect the privacy
of you health information. We will not retaliate against
you for filing a complaint.
- Privacy Officer Contact Information. If
you have any questions about this Notice, you may contact our
privacy Officer by telephone or mail at the address set forth
below. If, however, you want to exercise any of your
rights pursuant to this Notice of Privacy Practice or have
a complaint, such actions must be in writing and mailed to
our Privacy Officer at the address set forth below.
Pediatric Partners LLC
Attn: Privacy Officer
750 East 29th Street
Fremont NE 68025
Phone: 402-753-2900 |
