Prima Pediatrics

Notice of Privacy Practice

(HIPAA)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

For purposes of treatment, payment and health care operations, we are permitted to use and disclose your health care records without specific written authorization.

▪ Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. Examples of treatment would include office visits, writing prescriptions, checking lab results, arranging referrals, and so forth.

▪ Payment means such activities as obtaining reimbursement for services, confirming coverage, billing and collection activities, and utilization review. An example of this would be billing your medical plan for services rendered.

▪ Health Care Operations include the business aspect of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. Examples of Health Care Operations would include internal quality assessment review or periodic evaluation of our documentation protocols.

In addition, your confidential information may be used to remind you of an appointment (verbally or in writing) or provide your with information about treatment options or other health-related services including release of information to friends and family members that are directly involved with your care or who assist in taking care of you. We will use and disclose your protected health information when we are required to do so by federal, state or local law. We may disclose your protected health information to public health authorities that are authorized by law to collect information, to a health oversight agency for activities authorized by law including, but not limited to: response to a court or administrative order, if you are involved with a legal proceeding requiring response to a discovery request by subpoena or other lawful process by another party involved in the dispute, but only if we made an effort to inform you or your legal counsel of the request to obtain your protected health information. We may release your protected health information to a medical examiner or coroner for identification purposes and for the determination of cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs. We may also disclose your protected health information to organizations that handle organ or tissue transplantation if you are an organ donor. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or to the health and safety of others. Under these circumstances, we will only make protected health information to federal officials for intelligence and national security activities authorized by law.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our Privacy Officer.

◘ The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

◘ The right to request or receive confidential communications of protected health information from us by alternative means or at alternative locations.

◘ The right to inspect and copy your protected health information.

◘ The right to request an amendment to your protected health information.

◘ The right to receive an accounting of disclosures of protected health information outside of treatment, payment, and health care operations.

◘ The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the revised notice from our Privacy Officer.

You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.

For more information about HIPAA or to file a complaint, please contact:

Faith Marquez
Privacy Officer
Prima Pediatrics
18520 Via Princessa, C-2
Canyon Country,CA 91387
Phone: (661)-424-9000 extn 240
Fax: (661) 424-0808
 

The U.S. Dept of Health and Human Services