Effective Date: March 27, 2008
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
YOUR PRIVATE HEALTH INFORMATION (PHI)
Each time you have contact with a healthcare provider for
delivery of healthcare, a record of your contact/visit is prepared.
This record, maintained in written, oral or electronic format,
contains presenting signs/symptoms, results of examination and
tests, diagnoses, treatment and future care. Your medical record is
the physical property of HEALTHY KIDS PEDIATRICS, but you have
certain rights to restrict some of the uses or disclosures of the
information in your medical record. HEALTHY KIDS PEDIATRICS,
however, has the right to use and disclose the information
contained in your medical record in the process of providing
treatment, receiving payment and performing other regular health
operations such as:
Protecting your privacy and maintaining the security of your
health information is one of the most important responsibilities of
HEALTHY KIDS PEDIATRICS. HEALTHY KIDS PEDIATRICS is required by law
to maintain privacy and confidentiality of your health information,
provide you with thisNotice of Privacy Practices, notify you of
your rights to restrict use of this information, notify you if
HEALTHY KIDS PEDIATRICS is unable to agree to a requested
restriction, and allow you to review the Notice of Privacy
Practices prior to granting consent and notifying you of
changes/revisions to this Notice.
EXAMPLES OF DISCLOSURE OF YOUR PHI
Healthcare delivery and treatment:
Billing and payment:
Other healthcare operations:
Reminders and Treatment:
Other Uses and Disclosures:
YOUR RIGHTS CONCERNING PHI
Except as otherwise provided by law, you have the right to:
HEALTHY KIDS PEDIATRICS is required by law to abide by the terms
of thisNotice of Privacy Practices, allow you to review
thisNoticeprior to granting consent, and notify you of
changes/revisions to thisNotice.
If you believe your privacy rights have been violated, you may
submit a written complaint to HEALTHY KIDS PEDIATRICS or the
Secretary of Health and Human Services describing in detail the
manner in which you feel your privacy rights have been violated.
HEALTHY KIDS PEDIATRICS will not retaliate against you in any way
for filing a complaint with the HEALTHY KIDS PEDIATRICS, or with
For further information regarding PHI, please
Eileen Kranzberg, MAOM, CPM
HEALTHY KIDS PEDIATRICS