HIPAA NOTICE

CENTURY-AIRPORT PEDIATRICS NOTICE OF PRIVACY PRACTICES

CENTURY-AIRPORT PEDIATRICS – NOTICE OF PRIVACY PRACTICES

As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOUR CHILD (AS A PATIENT OF CENTURY-AIRPORT PEDIATRICS) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR CHILD’S INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your child’s individually identifiable health information (IIHI). In conducting our business, we will create records regarding your child’s treatment and the services we provided. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your child’s IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your child’s IIHI
Your privacy right in regard to your child’s IIHI
Our obligations concerning the use and disclosure of your child’s IIHI

The terms of this notice apply to all records containing your child’s IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your children’s records that our practice has created or maintained in the past, and for any records that we may created or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT Privacy Officer (893-7337)

C. WE MAY USE AND DISCLOSE YOUR CHILD’S INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS:

1. Treatment. Our practice may use your child’s IIHI to treat your child. For example, we may ask your child to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your child’s IIHI in order to write a prescription for him/her, or we might disclose your child’s IIHI to a pharmacy when we order a prescription for him/her. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your child’s IIHI in order to treat your child or to assist others in your child’s treatment. Additionally, we may disclose your child’s IIHI to others who may assist in your child’s care, such as your spouse, siblings or grandparents.

2. Payment. Our practice may use and disclose IIHI in order to bill and collect payment for the services and items received from us. For example, we may contact your child’s heath insurer to certify that he/she is eligible for benefits (and for what range of benefits), and we may provide your child’s insurer with details regarding treatment to determine if the insurer will cover, or pay for, treatment. We also may use and disclose your child’s IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your child’s IIHI to bill you directly for services and items.

3. Health Care Operations. Our practice may use and disclose your child’s IIHI to operate our business. As examples of the ways in which we may use and disclose the information for our operations, our practice may use IIHI to evaluate the quality of care received from us, or to conduct cost-management and business planning activities for our practice.

4. Appointment Reminders. Our practice may use and disclose your child’s IIHI to contact you and remind you of his/her appointment. It is our policy to leave messages on answering machines.

5. Treatment Options. Our practice may use and disclose your child’s IIHI to inform you of potential treatment options or alternatives.

6. Health-Related Benefits and Services. Our practice may use and disclose your child’s IIHI to inform you of health-related benefits that may be of interest to you.

7. Release of Information to Family/Friends. Our practice may release your child’s IIHI to a friend or family member that is involved in his/her care, or who assists in taking care of him/her. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.

8. Disclosure Required By Law. Our practice will use and disclose your child’s IIHI when we are required to do so by federal, state or local law.

9. Incidental Disclosure. While we will take reasonable steps to safeguard the privacy of your child’s IIHI, certain disclosure of the IIHI may occur during, or as an unavoidable result of our otherwise permissible uses and disclosures of your child’s IIHI. For example, during the course of a treatment session, other patients in the treatment area may see, or overhear discussion of, your child’s IIHI.

D. USE AND DISCLOSURE OF YOUR CHILD’S IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your child’s identifiable health information.

1. Public Health Risks. Our practice may disclose your child’s IIHI to public health authorities that are authorized by law to collect information for the purpose of:

maintaining vital records, such as births and deaths
reporting child abuse or neglect
preventing or controlling disease, injury or disability
notifying a person regarding potential exposure to a communicable disease
notifying a person regarding a potential risk for spreading or contracting a disease or condition
reporting reactions to drugs or problems with products or devices
notifying individuals if a product or device they may be using has been recalled
notifying an employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our practice may disclose your child’s IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil right laws and the health care system in general.

3. Lawsuit and Similar Proceedings. Our practice may use and disclose your child’s IIHI in response to a court or administrative order, if your child is involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:

Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
Concerning a death we believe has resulted from criminal conduct
Regarding criminal conduct at our offices
In response to a warrant, summons, court order, subpoena or similar legal process
To identify/locate a suspect, material witness, fugitive or missing person
In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

6. Organ and Tissue Donation. Our practice may release your child’s IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donations and transplantation if your child is an organ donor.

7. Research. Our practice may use and disclose your child’s IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your child’s IIHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your child’s IIHI is being used only for research and (iii) the researcher will not remove any of your IIHI from our practice; or (c) the IIHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the IIHI of the decedents.

8. Serious Threats to Health or Safety. Our practice may use and disclose your child’s IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

9. Military. Our practice may disclose your child’s IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security. Our practice may disclose your child’s IIHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your child’s IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

11. Inmates. Our practice may disclose your child’s IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety of the health and safety of other individuals.

12. Workers’ Compensation. Our practice may release your child’s IIHI for workers’ compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR CHILD’S IIHI

You have the following rights regarding the IIHI that we maintain about your child:

1. Confidential Communications. You have the right to request that our practice communicate with you about your child’s health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225 specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in our use of disclosure of your child’s IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your child’s IIHI to only certain individuals involved in your child’s care or the payment of your child’s care, such as family members and friends. We are not required to agree to your request, however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat your child. In order to request a restriction in our use of disclosure of your child’s IIHI, you must make your request in writing to Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225). Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about your child, including patient medical records and billing records, but not including psychotherapy notes. Your must submit your request in writing to Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225) in order to inspect and/or obtain a copy of your child’s IIHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4. Amendment. You may ask us to amend your child’s health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by us or for our practice. To request an amendment, your request must be made in writing and submitted to Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225. You must provide us with a reason that supports your requests for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of Disclosures. All of our patients’ guardians have the right to request an “accounting of disclosures.” An “accounting of disclosure” is a list of certain non-routine disclosures our practice has made of your child’s IIHI for non-treatment or operations purposes. Use of your child’s IIHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your child’s information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period if free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Privacy Officer (893-7337).

7. Right to File a Complaint. If you believe your child’s privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225. All complaints must be submitted in writing. You will not be penalized for filing a complaint.You have the following rights regarding the IIHI that we maintain about your child:

8. Right to Provide and Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your child’s IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your child’s IIHI for the reasons described in the authorization. Please note, we are required to retain records for your child’s care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Privacy Officer, 2625 Harlem Road, Suite 210, Cheektowaga, NY 14225.

For more information, or to schedule an appointment, call us at 716-893-7337.