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Privacy Policy

Effective Date of this Notice:  2/10/16
 
NOTICE OF PRIVACY PRACTICES
 
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR CHILD’S INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI)
 
PLEASE REVIEW THIS NOTICE CAREFULLY
 
A.  OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of the patient’s individually identifiable health information (IIHI).  In conducting our business, we will create records regarding the patient and the treatment and services we provide to the patient.   We are required by law to maintain the confidentially of health information that identifies the patient.  We also are required by law to provide the patient (or legal representative) with this notice of our legal duties and the privacy practices that we maintain in our practice concerning the patient’s IIHI.  By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
 
We realize that these laws are complicated, but we must provide you with the following important information:
·        How we may use and disclose the patient’s IIHI
·        The patient’s privacy rights in regards to their IIHI
·        Our obligations concerning the use and disclosure of a patient’s IIHI
 
The terms of this notice apply to all records containing the patient’s IIHI that are created or retained by our practice.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all of the patient’s records that our practice has created or maintained in the past, and for any of the patient’s records that we may create or maintain in the future.  Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
 
B.  IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH 45014  (513) 874-9460.

C.  WE MAY USE AND DISCLOSE THE PATIENT’S INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS:

  1. Treatment Our practice may use the patient’s IIHI to treat the patient.  For example, we may ask the patient to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis.  We might use the patient’s IIHI in order to write prescriptions for the patient, or we might disclose the patient’s IIHI to a pharmacy when we order a prescription for the patient.
  2. Payment – Our practice may use and disclose the patient’s IIHI in order to bill and collect payment for the services and items the patient may receive from us.  For example, we may contact your health insurer to certify that the patient is eligible for benefits (and for what range of benefits), and we provide your insurer with details regarding the patient’s treatment to determine if your insurer will cover, or pay for the treatment.  We also may use and disclose the patient’s IIHI to obtain payment from third parties that may be responsible for such costs, such as family members.
  3. Health Care Operations – Our practice may use and disclose the patient’s IIHI to operate our business.  As examples of the ways in which we may use and disclose the patient’s information for our operations, our practice may use the patient’s IIHI to evaluate the quality of care the patient received from us, or to conduct cost-management and business planning activities for our practice.  In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your health care provider.  We may also call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your Protected Health Information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.
  4. Release of Information - (persons involved with the patient).  Our practice may release the patient’s IIHI to a friend or family member that is involved in the patient’s care, or who assists in taking care of the patient.  For example, a parent or guardian may ask that a babysitter take their child to our office for treatment of a cold.   In this example, the babysitter may have access to this child’s medical information. 
  5. Disclosures Required by Law – Our practice will use and disclose the patient’s IIHI when we are required to do so by federal, state or local law. 

D.  USE AND DISCLOSURE OF THE PATIENT’S IIHI IN CERTAIN SPECIAL CIRCUMSTANCES – The following categories describe unique scenarios in which we may use or disclose the patient’s identifiable health information:

    1.  Public Health Risks – Our practice may disclose the patient’s IIHI to public
             health authorities that are authorized by law to collect information for the
             purpose of:
·        maintaining vital records, such as births and deaths
·        reporting child abuse or neglect
·        preventing or controlling disease, injury or disability
·        notifying a person regarding potential exposure to a communicable disease
·        notifying a person regarding a potential risk for spreading or contracting a disease or condition
·        reporting reactions to drugs or problems with products or devices
·        notifying individuals if a product or device they may be using has been recalled
·        notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of a patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
·        notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
2.    Health Oversight Activities – Our practice may disclose the patient’s IIHI to a health oversight agency for activities authorized by law.  Oversight activities can      
       include, for example, investigations, inspections, audits, surveys, licensure and
       disciplinary actions; civil, administrative, and criminal procedures or actions; or
       other activities necessary for the government to monitor government programs,
       compliance with civil rights laws and the health care system in general.
3.    Lawsuits and Similar Proceedings – Our practice may use and disclose the patient’s IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose the patient’s IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested. 
4.    Law Enforcement – We may release IIHI if asked to do so by law enforcement official.
5.    Deceased Patients – Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.  If necessary, we may release information in order for funeral directors to perform their jobs.
6.    Organ and Tissue Donation – Our practice may release the patient’s IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if the patient is an organ donor. 
7.    Immunizations - We will provide proof of immunizations to a school that requires a patient’s immunization record prior to enrollment or admittance of a student in which you have informally agreed to the disclosure for yourself or on behalf of your legal dependent.  We will submit immunization records electronically to Impact – Ohio Immunization Registry.
8.    Research –Your Protected Health Information may be disclosed
       to researchers for the purpose of conducting research when the research has
       been approved by an Institutional Review or Privacy Board and in compliance with
       laws governing research.   
9.    Serious Threats to Health or Safety – Our practice may use and disclose
       the patient’s IIHI when necessary to reduce or prevent a serious threat to the
       patient’s health and safety or the health and safety of another individual or the
       public.  Under these circumstances, we will only make disclosures to a person or
       organization able to help prevent the threat.
10. Military – Our practice may disclose your IIHI if you are a member of U.S. or   
       foreign military forces (including veterans) and if required by the appropriate
       authorities. 
11. National Security – Our practice may disclose the patient’s IIHI to federal
       officials for intelligence and national security activities authorized by law.
12. Inmates – Our practice may disclose the patient’s IIHI to correctional
       institutions or law enforcement officials if the patient is an inmate or under the
       custody of a law enforcement official.
 13. Worker’s Compensation – Our practice may release the patient’s IIHI for
       workers’ compensation and similar programs.
14. Practice Ownership Change – If our medical practice is sold, acquired, or merged
       with another entity, your protected health information will become the property
       of the new owner.  However, you will still have the right to request copies of your
       records and have copies transferred to another physician.
15. Breach Notification Purposes – If for any reason there is an unsecured breach
       of your Protected Health Information, we will utilize the contact information you
       have provided us with to notify you of the breach, as required by law.  In addition,
       your Protected Health Information may be disclosed as a part of the breach
       notification and reporting process.    

E.  THE PATIENT’S RIGHTS REGARDING THEIR IIHI
You have the following rights regarding the IIHI that we maintain about you:

1.    Confidential Communications – You have the right to request that our practice communicate with you about the patient’s health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to Privacy Officer, Pediatric Associates of Fairfield, Inc., 5502 Dixie Highway, Fairfield, OH  45014 specifying the requested method of contact, or the location where you wish to be contacted.  Our practice will accommodate reasonable requests.  You do not need to give a reason for your request.
2.    Requesting Restrictions – You have the right to request a restriction in our use or disclosure of the patient’s IIHI for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure of the patient’s IIHI to only certain individuals involved in the patient’s care or the payment for the patient’s care, such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use of disclosure of the patient’s IIHI, you must make your request in writing to Privacy Officer, Pediatric Associates of Fairfield, Inc., 5502 Dixie Highway, Fairfield, OH 45014.  Your request must describe in a clear and concise fashion:
·        the information you wish restricted;
·        whether you are requesting to limit our practice’s use, disclosure or both;
·        to whom you want the limits to apply
3.    Inspection and Copies – You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about the patient, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to Privacy Officer, Pediatric Associates of Fairfield, Inc., 5502 Dixie Highway, Fairfield, OH  45014 in order to inspect and/or obtain a copy of the patient’s IIHI.  Our practice may charge a fee for the cost of copying, mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.  Another licensed health care professional chosen by us will conduct reviews.
4.    Amendment – You may ask us to amend the patient’s health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.  To request an amendment, your request must be made in writing and submitted to Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH  45014.   You must provide us with a reason that supports your request for amendment.  Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also we may deny your request if you ask us to amend information that is in our opinion:  (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5.    Accounting of Disclosures – All of our patients have the right to request an “accounting of disclosures.”  An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of the patient’s IIHI for non-treatment or operations purposes.  The patient’s individually identifiable health information used in routine patient care in our practice is not required to be documented.  For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH  45014. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period.  Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6.    Right to a Paper Copy of This Notice – You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a copy of this notice, contact Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH  45014.
7.    Right to File a Complaint – If you believe the patient’s privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH  45014. All complaints must be submitted in writing.  You will not be penalized for filing a complaint.
8.    Right to Provide an Authorization for Other Uses and Disclosures – Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.   Any authorization you provide to us regarding the use and disclosure of the patient’s IIHI may be revoked at any time in writing.  After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization.  Please note, we are required to retain records of your care.
 
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Privacy Officer, Pediatric Associates of Fairfield, Inc. 5502 Dixie Highway, Fairfield, OH  45014 or at (513) 874-9460.