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HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date 07/15/05
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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. If you have any questions about this notice, please contact:
Privacy Officer, C.A.R.E Pediatrics LLC, 4855 River Green Parkway Suite
610 Duluth, GA 30096. This notice describes the privacy practices at
C.A.R.E Pediatrics LLC:
We are required by law to:
· Maintain the privacy of protected health information
· Give you this notice of our legal duties and privacy practices
regarding your health information
· Follow the terms of the notice currently in effect.
How we may use and disclose your health information
Described as follows are the ways we may use and disclose your health
information. Except for the following purposes we will use and disclose
your health information only with your written permission. You may revoke
such permission at any time by writing to: Privacy Officer, C.A.R.E
Pediatrics LLC, 4855 River Green Parkway Suite 610 Duluth, GA 30096.
Treatment. We may use and disclose your health information for your
treatment and to provide you with treatment-related health care services.
For example, we may disclose your health information to doctors, nurses,
technicians, or other personnel, including people outside our office, who
are involved in your medical care and need the information to provide you
with medical care.
Payment. We may use and disclose your health information so that
others or we may bill and receive payment from you, an insurance company,
or a third party for the treatment and services you received. For example,
we may give information to your health plan so that they will pay for your
treatment.
Health Care Operations. We may use and disclose your health
information to evaluate and improve our medical care and to operate and
manage our office. For example, we may use and disclose information to a
peer review organization or a health plan that is evaluating our care. We
may also share information with others that have a relationship with you
for their health care operation activities.
Appointment Reminders, Treatment Alternatives, and Health-Related
Benefits and Services. We may use and disclose your health information
to contact you and remind you of your appointment, to tell you about
treatment alternatives or health-related benefits and services you could
use.
Individuals Involved in Your Care or Payment for Your Care. When
appropriate, we may share your health information with a person involved
in, or paying for, your care (such as your family or a close friend). We
may notify your family about your location or condition or disclose such
information to an entity assisting in disaster relief.
Research. We may use and disclose your health information for
research. For example, a research project may involve comparing the health
of patients who received one treatment to those who received another for
the same condition. Before we do so, the project needs to go through a
special approval process. Even without special approval, we may permit
researchers to look at records to help identify patients who may be
included in their research, as long as they do not remove or copy any of
your health information.
As Required by Law. We will disclose your health information 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 your health information when necessary to prevent a serious
threat to the health and safety of you, another person, or the public.
Disclosures will be made only to someone who can prevent the threat.
Business Associates. We may disclose your health information to our
business associates that perform functions on our behalf or provide us
with services if necessary. For example, we may use another company to
perform billing services on our behalf. All of our business associates are
obligated to protect the privacy of your information and are not allowed
to use or disclose the information for any other purpose than appears in
their contract with us.
Military and Veterans. If you are a member of the armed forces, we
may release your health information as required by military command
authorities. If you are a member of a foreign military we may release your
health information to the foreign military command authority.
Worker's Compensation. We may release your health information for
worker's compensation or similar programs that provide benefits for
work-related injuries or illness.
Public Health Risks. We may disclose your health information for
public health activities to prevent or control disease, injury or
disability. We may use your health information in reporting births or
deaths, suspected child abuse or neglect, medication reactions or product
malfunctions or injuries, and product recall notifications. We may use
your health information to notify someone who may have been exposed to a
disease or may be at risk for contracting or spreading a disease or
condition. If we are concerned that a patient may have been a victim of
abuse, neglect, or domestic violence we may ask your permission to make a
disclosure to an appropriate government authority. We will make that
disclosure only when you agree or when required or authorized to do so by
law.
Health Oversight Activities. We may disclose your health
information to a health oversight agency for activities authorized by law.
These may include audits, investigations, inspections, and licensure.
These activities are necessary to for the government to monitor the health
care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or dispute,
we may disclose your health information in response to a court or
administrative order. We may disclose your health information in response
to a subpoena, discovery request, or other lawful process by someone else
involved in the dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information
requested.
Law Enforcement. We may release your health information request by
law enforcement official if 1) there is a court order, subpoena, warrant,
summons or similar process; 2) if the request is limited to information
needed to identify or locate a suspect, fugitive, material witness, or
missing person; 3) the information is about the victim of a crime even if,
under certain very limited circumstances, we are unable to obtain your
agreement; 4) the information is about a death that may be the result of
criminal conduct; 5) the information is relevant to criminal conduct on
our premises; and 6) it is needed in an emergency to report a crime, the
location of a crime or victims, or the identity, description, or location
of the person who may have committed the crime.
Coroners, Medical Examiners, and Funeral Directors. We may release
your health information to a coroner, medical examiner, or funeral
director to identify a deceased person or cause of death, or other similar
circumstance.
National Security and Intelligence Activities. We may disclose your
health information to authorized federal officials for intelligence and
other national security activities authorized by law.
Inmates or Individuals in Custody. If you are an inmate of a
correctional institution or in custody we may disclose your information 1)
for the institution to provide you with health care, 2) to protect your
health and safety or that of others, and 3) for the safety and security of
the institution.
Your Rights Regarding Your Health Information
Right to Inspect and Copy. You have the right to inspect and
copy your medical and billing records by written request to Privacy
Officer, C.A.R.E Pediatrics LLC, 4855 River Green Parkway Suite 610
Duluth, GA 30096.
Right to Amend. You have the right to request an amendment to your
records by written request to Privacy Officer, C.A.R.E Pediatrics LLC,
4855 River Green Parkway Suite 610 Duluth, GA 30096.
Right to an Accounting Of Disclosures. You have a right to an
accounting of certain disclosures by written request to Privacy Officer,
C.A.R.E Pediatrics LLC, 4855 River Green Parkway Suite 610 Duluth, GA
30096.
Right to Request Restrictions. You have the right to request
restriction or limitation on your health information used for treatment,
payment or health care operations. You may request us to limit disclosure
to someone involved in your care or in payment for your care (such as a
spouse) by written request to Privacy Officer, C.A.R.E Pediatrics LLC,
4855 River Green Parkway Suite 610 Duluth, GA 30096. We are not required
to agree with your request, but we will try to comply.
Right to Request Confidential Communication. You have the right to
request that we communicate with you about medical matters in a certain
way or at a certain location. You can ask, for example, that we contact
you only by mail or at work. Your written request must specify how or
where you wish to be contacted and be addressed to Privacy Officer,
C.A.R.E Pediatrics LLC, 4855 River Green Parkway Suite 610 Duluth, GA
30096 We will accommodate reasonable requests.
Changes To This Notice
We may change this notice and make it effective for medical
information we already have about you as well as new information. The
current notice will be posted and available at all times. You have a right
to request a paper copy of the current notice at any visit or by written
request to Privacy Officer, C.A.R.E Pediatrics LLC, 4855 River Green
Parkway Suite 610 Duluth, GA 30096.
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To download a copy of this Privacy Policy click on
the "Request Form" tab on the right.
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