NOTICE OF PRIVACY POLICY

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.

This office is required by a federal regulation, known as the HIPAA Privacy Rule, to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices.  This office will not use or disclose your health information except as described in this Notice. 

The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations.  Protected health information (PHI) is the information we create and obtain in providing our services to you.  The health information about you is documented in a computer medical record.  Such information may include documenting your symptoms, medical history, examination and test results, diagnoses, treatment, and applying for future care or treatment.  It also includes billing for those services.

Following are examples of the types of uses and disclosures of your PHI that the physician's office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment

We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you. We will also disclose PHI to other physicians who may be treating you when we have the necessary permission from you to disclose your PHI.

In addition, we may disclose your PHI from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment

Your PHI will be used, as needed, to obtain payment for your 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 you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Healthcare Operations

We obtain services from our insurers or other business associates (an individual or entity under contract with us to perform or assist us in a function or activity that necessitates the use or disclosure of health information) such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical transcription, medical review, legal services, and insurance.  We will share health information about you with our insurers or other business associates as necessary to obtain these services.  We require our insurers and other business associates to protect the confidentiality of your health information. 

Your Health Information Rights

The health and billing records we maintain are the physical property of the doctor's office.  The information in it, however, belongs to you.  You have a right to:

  • Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office-we are not required to grant the request but we will comply with any request granted;
  • Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office;
  • Request that you be allowed to inspect and copy your medical record and billing record-you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request;
  • Appeal a denial of access to your protected health information except in certain circumstances;
  • Request that your medical record be amended to correct incomplete or incorrect information by delivering a written request, including a reason to support it, to our office using the form we provide to you upon request. (We are not required to make such amendments);
  • File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
  • Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include uses and disclosures of information for treatment, payment, or health care operations; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; or to family members or friends or uses relevant to that person's involvement in your care or in payment for such care; or uses or disclosures to notify family or others responsible for your care of your location, condition, or your death; we may charge a cost-based fee for more than one accounting in a 12-month period.
  • Request that confidential communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we provide to you upon request; and,
  • Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.

 

If you want to exercise any of the above rights, please contact: Edward Matrose, Office Administrator, Valley of the Sun Pediatrics, P.C., 10200 West Happy Valley Parkway, Suite 125, Peoria, AZ 85383 in writing.  He will provide you with assistance on the steps to take to exercise your rights.

You have the right to review this Notice before signing the acknowledgment authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

Our Responsibilities

The office is required to:

  • Maintain the privacy of your health information as required by law;
  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request; and
  • Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our Notice.  You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our office and picking up a copy.

To Request Information or File a Complaint

If you have questions, would like additional information, want to report a problem regarding the handling of your information, of if you believe your privacy rights have been violated and wish to file a written complaint with our office, please contact: Edward Matrose, Office Administrator, Valley of the Sun Pediatrics, P.C., 10200 West Happy Valley Parkway, Suite 125, Peoria, AZ 85383.  You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services. 

  • We cannot, and will not, require you to waive your rights under the Privacy Rule including the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.
  • We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

 

Other Disclosures and Uses We Can Make Without Your Written Authorization

Notification of Family/Friends: Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Communication with Family/Friends: Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.

Disaster Relief: We may use and disclose your health information to assist in disaster relief efforts.

Employers: We may release health information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury.  In such circumstances, we will give you written notice of such release of information to your employer.  Any other disclosures to your employer will be made only if you execute an authorization for the release of that information to your employer.

Deceased Persons: We may disclose your health information to funeral directors, medical examiners, or coroners consistent with applicable law to allow them to carry out their duties.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release health information about patients to funeral directors as necessary for them to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant