effective date: September 23, 2013
This notice describes how your child’s medical information may be used and disclosed and how you can get access to this information. Please review it carefully. It explains how the physicians and staff of Harpeth Pediatrics may use and disclose your protected health information (PHI) for purposes of treatment, payment, and health care operations, and for other purposes that are permitted or required by law.
If you have any questions about this notice, or if you need more information, please contact our Privacy Officer:
What is Protected Health Information (PHI)?
How We May Use and Disclose your PHI:
For Treatment. We may use PHI to give you medical treatment or services and to manage and coordinate your medical care. For example, we may disclose PHI to doctors, nurses, technicians, or other personnel who are involved in taking care of you, including people outside our practice, such as referring or specialist physicians, labs, pharmacies, and hospitals.
For Payment. We may use and disclose PHI so that we can bill for the treatment and services you get from us and can collect payment from you, an insurance company, or another third party. For example, we may need to give your health plan information about your treatment in order for your health plan to pay for that treatment. We also may tell your health plan about a treatment you are going to receive to find out if your plan will cover the treatment.
For Health Care Operations. We may use and disclose PHI for our health care operations, such as conducting quality assessment and improvement activities, contracting with insurance companies, conducting medical review and auditing services, and general administrative and business functions.
Appointment Reminders. We may use and disclose PHI to contact you to remind you that you have an appointment for medical care.
Minors. We may disclose the PHI of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.
As Required by Law. We will disclose PHI about you when required to do so by international, federal, state, or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose PHI when necessary to prevent a serious threat to your health or safety or to the health or safety of others.
Business Associates. We may disclose PHI to our business associates who perform functions on our behalf or provide us with services if the PHI is necessary for those functions or services. All of our business associates are obligated, under contract with us, to protect the privacy of your PHI.
Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, licensure, and similar activities that are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Uses and Disclosures that Require Us to Give You an Opportunity to Opt Out
Individuals Involved in Your Care or Payment for Your Care. We may disclose PHI to a person who is involved in your medical care or helps pay for your care, such as a family member or friend, to the extent it is relevant to that person’s involvement in your care or payment related to your care. We will provide you with an opportunity to object to and opt out of such a disclosure whenever we practicably can do so.
Disaster Relief. We may disclose your PHI to disaster relief organizations that seek your PHI to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we can practicably do so.
Your Written Authorization is Required for Other Uses and Disclosures
When is my Authorization/Consent Not Required?
Your Rights Regarding Your PHI
Right to Inspect and Copy. You have the right to inspect and/or receive a copy of PHI that may be used to make decisions about your care or payment for your care. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request.
Right to an Electronic Copy. You have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We may charge you a reasonable cost-based fee for the labor associated with providing you this service. If you choose to have your PHI transmitted electronically, you will need to provide a written request to this office listing the contact information of the individual or entity who should receive your electronic PHI.
Right to Receive Notice of a Breach. We are required to notify you by first class mail or by email (if you have indicated a preference to receive information by email) of any breach of your unsecured PHI.
Right to Request Amendments. If you feel that PHI we have is incorrect or incomplete, you may ask us to amend the information. A request for amendment must be made in writing. We may deny your request if it is not in writing or if (1) the information was not created by us, (2) is not part of the medical information kept by us, (3) is not information that you would be permitted to inspect and copy, or (4) is accurate and complete. If we deny your request, you may submit a written statement of disagreement of reasonable length. Your statement of disagreement will be included in your medical record, but we may also include a rebuttal statement.
Right to an Accounting of Disclosures. You have the right to ask for an accounting of disclosures, which is a list of the disclosures we made of your PHI. We are not required to list certain disclosures, including (1) disclosures made for treatment, payment and healthcare operations purposes, (2) disclosures made with your authorization, and (3) disclosures made directly to you. You must submit your request in writing, and your request must state a time period but may not be longer than 6 years before your request.
Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your child’s care or the payment of your child’s care. We are not required to agree with your request.
Right to Restrict Certain Disclosures to Your Health Plan. You have the right to restrict certain disclosures of PHI to a health plan if the disclosure is for payment or health care operations and pertains to a health care item or service for which you have paid out of pocket in full. We will honor this request unless we are otherwise required by law to disclose this information. This request must be made at the time of service.
Right to Request Confidential Communications. You have the right to request that we communicate with you only in certain ways to preserve your privacy. For example, you may request that we contact you by mail at a special address or call you only at your work number. You must make any such request in writing and you must specify how or where we are to contact you. We will accommodate reasonable requests. We will not ask you for the reason for your request.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. You can get a copy of this Notice at our website: www.harpethpediatrics.com.
How to Exercise your Rights
Changes to This Notice