Notice of Privacy Practices
Notice Of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INOFRMATION.
PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures:
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members. We might disclose your health information to a pharmacy when ordering a prescription for you.
Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of services provided, and the medical condition being treated. We may contact your health insurer to certify that you are eligible for benefits (and what range of benefits). We may release your health information for workers' compensation and similar programs.
Health care operations. Your health information may be used as necessary to support the day-to-day activities and management of Cactus Children's Clinic, P.C. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Law enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting (such as reporting child abuse or neglect). We may have to respond to a court or administrative order, if you are involved in a law suit or similar proceedings (subpoena, discovery request or other lawful process).
Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.
Release of Information to Family. Our practice may release your health information to family members involved in your care, or who assist in taking care of your child(ren). For example, a parent or guardian may ask that a babysitter bring your child(ren) into the pediatric office for treament of a cold. In this example, the babysitter may have access to the child's medical information.
Military. Our practice may disclose your health information if you are a member of the United States military forces and if required by the appropriate authorities.
Other uses and disclosure requires your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision. We reserve the right to require annual updates to information and authorizations.
Additional Uses of Information.
Appointment reminders. Your health information will be used by our staff to call/leave appointment reminder.
Information about treatments. Your health information may be used to send you information on the treatment and management of your medical condition that may find to be of interest. We may also send you information describing other health-related goods and services that we believe may interest you.
Deceased Patients. We may release your health information to a medical examiner or coroner to identify a deceased person or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
Organ and Tissue Donations. We may release your health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate the donation and transplantation if you are an organ donor.
Individual Rights. You have certain rights under the federal privacy standards. These include:
The right to receive confidental communications concerning your medical condition and treatment. For example, your request to be called at home, rahter than work (unless emergency situation).
The right to inspect and obtain a copy of your protected health information, not including psychotherapy notes. You must submit your request in writing to Medical Records Coordinator at Cactus Children's Clinic,P.C. We have forms available at reception area. We will charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and or obtain a copy in certain circumstances (such as court restraining order); however, you may request a review of our denial. Custodial and non-custodial birth parents have the same rights, unless we receive a copy of a signed/notorized court order directing us not to release record.
The right to ask us to amend or submit corrections to your protected health information if you believe it is incorrect or incomplete. To request an amendment, your request must be made in writing and submitted to Privacy Officer/Practice Manager at Cactus Children's Clinic, P.C. You must provide a reason that supports your request for amendment. We will deny your request if you fail to submit request (supporting reason) in writing.
We may deny your request if you ask for us to amend information that is in our opinion accurate and complete; not part of the health information kept by or for the practice; not part of health information which you would be permitted to inspect and obatin copy of, such as, psychotherapy notes; not created by our practice.
The right to request a restriction in our use or disclosure of your health information for treatment, payment or health care operations. We are not required to agree to your request. In order to request a restriction you must make your request in writing to Privacy Officer/ Practice Manager at Cactus Children's Clinic, P.C.
The right to receive an accounting of how and to whom your protected health information has been disclosed. Use of your health information as part of the routine care in our practice is not required to be documented. For example, the billing department using your information to file your insurance claim. To obtain an accounting of disclosures, you must submit your request in writing to the Business Office, Cactus Children's Clinic, P.C. All requests for an "accounting of disclosures" must state a time period, which may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but we will charge for additional lists within the same 12-month period. We will notify you of the cost involved with additional requests and you may withdraw your request before you incur any costs.
The right to receive a printed copy of this notice. To obtain copy of this notice, ask the patient service representative at reception window.
Duty of Cactus Children's Clinic, P.C. We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices. As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice in your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Complaints. If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
Privacy Officer/Practice Manager,
Cactus Children's Clinic, P.C.,
5310 W. Thunderbird Rd #300,
Glendale, AZ 85306
If you beleive your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint. You can contact the Privacy Officer/Practice Manager if you have any questions.
Effective Date.
This notice is effective April 14, 2003.
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