Notice of Privacy Policy

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. Please review it carefully.

If you have any questions about this Notice please contact a representative of our office.

This notice of Privacy Practices describes how we may use and disclose your child's protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your child's protected health information. 'Protected health information' is information about your child, including demographic information, that may identify him/her and relates to your child's past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or by asking for one at the time of your child's next appointment.

1. Uses and Disclosures of Protected Health Information based upon your written consent
You will be asked by our office to sign a consent form. Once you have consented to use and disclosure of your child's protected health information for treatment, payment and health care operations by signing the consent form, your physician will use or disclose your child's protected health information as described in this section 1. Your child's protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your child's care and treatment for the purpose of providing health care services to your child. Your child's protected health information may also be used and disclosed to pay your health care bills and support the operation of the physician's practice.

Following are examples of the types of uses and disclosures of your child's protective health care information that our office is permitted to make once you have signed our consent form. These examples are not meant to be all-inclusive but describe the types of uses and disclosures that may be made by our office once you have provided consent.

Treatment: We will use and disclose your child's protected health information to provide, coordinate, or manage his/her health care and any related services. For example, we would disclose your child's protected healthcare information, as necessary, to another physician to whom your child has been referred to ensure the physician has the necessary information to diagnose or treat your child. In addition, we may disclose your child's protected health care information from time-to-time to another physician or healthcare provider (e.g., a specialist or laboratory) who at the request of your child's physician becomes involved in his/her care by providing assistance with your child's health care diagnosis or treatment to his/her physician.

Payment: Your child's protected health information will be used, as needed, to obtain payment for your child's health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for your child such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to your child for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your child's relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
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