Privacy Practices for Protected Health Information

Notice of Privacy Practices for Protected Health Information for Patients

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 privacy of your health information is important to us. Federal and state laws require us to maintain the privacy of your protected health information (PHI.) South East Bay Pediatric Medical Group (SEBPMG) is permitted by federal privacy laws to make uses and disclosures of your/your child’s 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/your child. Such information may include documenting your/your child’s symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.

Examples of uses of your/your child’s PHI for treatment purposes:

• A medical receptionist obtains records pertaining to your child’s birth from a hospital and includes that in your child’s health record in our office.
• A medical assistant records a list of your child’s symptoms and medications in the child’s health record.
• During the course of treatment, the physician determines that he/she will need to consult a specialist to provide your child with the best possible care. He/she will share your child’s PHI with the specialist.

Example of use of your/your child’s PHI for payment purposes:

• Requests for payment are submitted to your health insurance company. The health insurance company requests information from us regarding medical care provided. We will provide such information.

Example of use of your/your child’s PHI for health care operations:

• We obtain services from our insurers and other business associates such as quality assessment, quality improvement, outcome evaluation, training programs, credentialing, legal services and insurance. We will share information about you/your child with such insurers and business associates as necessary to obtain these services.

Your Health Information Rights:

The medical and billing records that we maintain are the physical property of SEBPMG; however, the information contained in them belongs to you. You have a right to:

• Request a restriction on certain uses and disclosures of your/your child’s PHI by delivering a written request to our office—we will consider your request, but are NOT required to grant it.
• Request a restriction on disclosure of PHI to a health insurance plan for purposes of carrying out payment or health care operations, but NOT for carrying out treatment, IF the PHI pertains solely to a service for which the provider has been paid in full.
• Obtain a paper copy of this notice upon request.
• Request to be allowed to inspect and copy your/your child’s medical and billing records by delivering a written request to our office.
• Appeal a denial of access to your PHI, except in certain circumstances.
• Request that your/your child’s health care record be amended to correct incomplete or incorrect information by delivering a written request to our office. Your request may be denied if you ask us to amend information that was not created by us, that is not part of the PHI kept by the office, or that is accurate and complete. If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.
• Request that communication of your PHI be made by alternative means by delivering a written request to our office.
• Obtain an accounting of disclosures of your/your child’s PHI as required to be maintained by law by delivering a written request to our office. This accounting will not include uses and disclosures of information for treatment, payment, or operations.
• Revoke authorizations that you have previously made to use or disclose information by delivering written revocation to our office, except to the extent that action has already been taken.

If you wish to exercise any of the above rights, please contact Carmen Nava, Office Manager. She will inform you of the steps that need to be taken to exercise your rights.

Our Responsibilities:

SEBPMG is required to:

• Maintain the privacy of your/your child’s health information as required by law.
• Provide you with a notice of our privacy practices as to the information we collect and maintain about you/your child.
• Abide by the terms of this Notice.
• Notify you if we cannot accommodate a request.
• Accommodate reasonable requests regarding communication of your health information.

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 upon request.

To Request Information or to File a Complaint:

If you have questions, or would like additional information, or want to report a problem regarding the handling of your information, you may contact:

• Carmen Nava, Office Manager
• Dennis Unson, MD

If you believe your privacy rights have been violated, you may file a written complaint to our office, directed to the above individuals or by contacting the Secretary of Health and Human Services.

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment. We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

Other Disclosures and Uses:

Patients 18 Years and Above

When a patient turns 18 years of age, privacy laws come into effect. Even though an adult patient is still being insured under his/her parents’ insurance, we are not permitted to discuss any aspect of the patient’s care without expressed written consent from the patient detailing what portions of his/her case we may discuss. This includes release of any information involving issues that were addressed even before the 18th birthday.

Communication with Family

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/your child’s care, or in payment for such care if you do not object, or in an emergency.

Notification

We may use or disclose your/your child’s PHI to notify a family member, personal representative, or other person responsible for your/his or her care about location, general condition, or death.

California Minor Consent and Confidentiality Laws

In most cases, parents or legal guardians must consent to health care on behalf of their children. However, there are cases where minors may consent for their own healthcare and/or be protected under California confidentiality laws. See a summary of California Minor Consent and Confidentiality Laws.

Food and Drug Administration

We may disclose to the FDA your/your child’s PHI relating to adverse events with respect to food, supplements, products, or post-marketing surveillance information, to enable product recalls, repairs or replacements.

Public Health

As authorized by law, we may disclose your/your child’s PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.

Abuse and Neglect

We may disclose your/your child’s PHI to public authorities as required by law to report abuse or neglect.

Employers

We may release PHI to your employer if we provide health care services at the request of your employer, and the services are provided 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.

Correctional Institutions

If you are an inmate of a correctional institution, we may disclose to the institution or its agents the PHI necessary for your health and the health and safety of other individuals.

Law Enforcement

We may disclose your PHI for law enforcement purposes as required by law.

Health Oversight

We may release your/your child’s PHI to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings

We may disclose your/your child’s PHI in the course of any judicial or administrative proceeding as allowed or required by law, with your authorization, or as directed by court order.

Serious Threat

We may disclose your/your child’s PHI to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

For Specialized Governmental Functions

We may disclose your/your child’s PHI for specialized government functions as authorized by law.

Coroners, Medical Examiners, and Funeral Directors

We may release your/your child’s PHI to a coroner or medical examiner, or to funeral directors, as necessary.

Other Uses

Other uses and disclosures will be made only as required by law or with your written authorization.

Website

This notice will remain posted on our website.