NOTICE OF PRIVACY PRACTICES

 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

PLEASE READ IT CAREFULLY

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential.  This Act gives you, the legal guardian, the right to understand and control how your child’s personal health information (“PHI”) is used.  HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your child’s health information and how we may disclose his/her personal information.

We may use and disclose your child’s medical records only for each of the following purposes: treatment, payment and health care operation.

  • Treatment means providing, coordinating, or managing health care and related services by one or more healthcare providers.  An example of this would include referring your child to an allergy specialist.
  • Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review.  An example of this would include sending your insurance company a bill for your child’s visit and/or verifying coverage prior to a surgery.
  • Health Care Operations include business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service.  An example of this would be new patient survey cards.
  • The practice may also disclose your child’s PHI for law enforcement and other legitimate reasons although we shall do our best to assure its continued confidentiality to the extent possible.

We may also create and distribute de-identified health information by removing all reference to individually identifiable information.

We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services. The following use and disclosures of PHI will only be made pursuant to us receiving a written authorization from you:

  • Uses and disclosure of your child’s PHI for marketing purposes, including treatment and health care operations;
  • Other uses and disclosures not described in this notice.

You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You may have the following rights with respect to your child’s PHI.

  • The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you.  We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask.  If we do agree to the restriction, we must abide by it unless you agree in writing to remove it.
  • The right to reasonable requests to receive confidential communications of Protected Health Information by alterative means or at alternative locations.
  • The right to inspect and copy your child’s PHI.
  • The right to amend your child’s PHI.
  • The right to receive an accounting of disclosures of your child’s PHI.
  • The right to obtain a paper copy of this notice from us upon request.
  • The right to be advised if your child’s unprotected PHI is intentionally or unintentionally disclosed.

If you have paid for services “out of pocket”, in full, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.

We are required by law to maintain the privacy of your child’s Protected Health Information and to provide you the notice of our legal duties and our privacy practice with respect to PHI.

This notice is effective as of September 23, 2013 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect.  We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain.  We will post, and you may request a written copy of the revised Notice of Privacy Practice from our office.

You have recourse if you feel that your child’s protections have been violated by our office.  You have the right to file a formal, written complaint with our office and with the Department of Health and Human Services, Office of Civil Rights.  We will not retaliate against you for filing a

For more Information or to Report a Problem:

If you have questions, would like to file a complaint or would like additional information, you may contact us at:

Southfield Office

29120 Franklin Road, Southfield, MI 48034-1105

Phone:(248) 355-3100 Fax: (248) 354-8378