HIPAA Privacy Policy & Acknowledgement
HIPAA Privacy Policy
This Notice of Privacy Practices (“Notice”) describes how medical information about your child may be used and disclosed, and how you can access this information. Please review it carefully.
Our Legal Duty
We are required by law to:
● Maintain the privacy of protected health information (PHI).
● Provide you with this Notice of our legal duties and privacy practices.
● Abide by the terms of this Notice.
● Notify you if a breach occurs that may have compromised the privacy or security of your child’s PHI.
How We May Use and Disclose Health Information
We may use and disclose your child’s PHI without your written authorization for the following purposes:
Treatment
We may use and disclose PHI to provide, coordinate, or manage your child’s healthcare and related services. For example, we may share information with another physician, specialist, or hospital that is involved in your child’s care.
Payment
Although our practice operates under a direct primary care model, we may still use and disclose PHI to coordinate with outside laboratories, pharmacies, or services where separate payment is required.
Healthcare Operations
We may use PHI for quality assessment, training, practice management, accreditation, and licensing.
Public Health and Safety
We may disclose PHI to public health authorities for preventing or controlling disease, reporting child abuse or neglect, reporting adverse events, or preventing serious threats to health or safety.
Legal Requirements
We will disclose PHI when required to do so by federal, state, or local law.
Law Enforcement and Judicial Proceedings
We may disclose PHI in response to court orders, subpoenas, or other lawful processes.
Other Uses Without Authorization
We may also disclose PHI to coroners, medical examiners, funeral directors, organ donation organizations, military authorities, and government agencies as permitted by law.
Uses and Disclosures That Require Your Written Authorization
Other uses and disclosures of PHI not covered by this Notice or by applicable law will be made only with your written authorization. Examples include:
● Marketing communications.
● Sale of PHI.
● Most uses of psychotherapy notes.
You may revoke your authorization in writing at any time, except to the extent we have already acted in reliance on it.
Your Rights Regarding Your Child’s Health Information
You have the following rights:
Right to Access and Copies – You may request to view or receive a copy of your child’s PHI in paper or electronic format. We may charge a reasonable fee as allowed by law.
Right to Amend – You may request an amendment to PHI if you believe it is incorrect or incomplete. We may deny your request in certain circumstances.
Right to Accounting of Disclosures – You may request a list of disclosures we have made of PHI for purposes other than treatment, payment, or operations.
Right to Request Restrictions – You may request that we limit how PHI is used or disclosed. While we are not required to agree, we will consider your request.
Right to Confidential Communications – You may request that we communicate with you in a specific way (e.g., only by mail or phone).
Right to a Paper Copy of This Notice – You may request a paper copy of this Notice at any time.
Right to File a Complaint – If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you.
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr
Changes to This Notice
We reserve the right to change this Notice and apply the revised Notice to PHI we already have as well as to information we receive in the future. The current Notice will be posted in our office and available upon request.