I have, and Fisher Pediatrics always will, take your privacy very very seriously.  We vow to never share your information unless it is absolutely necessary and part of our job taking care of your child's health.  What follows below is the full Privacy Notice, we ask that you read it and sign it when you receive it on the intake forms that we send before your appointment.  Reading it and signing it at home makes the check in process faster so we can get to your child's appointment sooner.  If you ever want a printed copy of the notice please let us know!  Thanks - Fisher Pediatrics

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Privacy Notice

This Privacy Notice is being provided to you as a requirement of federal law, the Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your “protected health information” means any written and oral health information about you, including demographic data that can be used to identify you. This is health information that is created or received by your healthcare provider, and that relates to your past, present, or future physical or mental health or condition.

The ASC may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless the facility has obtained your authorization, or the use or disclosure is otherwise permitted by the HIPAA privacy regulation or state law. Disclosures of your protected health information for the purposes described in the Privacy Notice may be made in writing, orally, or by facsimile.

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Treatment: We will use and disclose your medical information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes. For example, we may disclose your protected health information to a pharmacy to fill a prescription or to a laboratory to order blood work. We may also disclose protected information to physicians who may be treating you or consult with the facility with respect to your care. In some cases, we may also disclose your protected health information to an outside treatment provider for purposes of the treatment activities of the other provider.

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Payment: Your medical information will be used, as necessary, to obtain payment for services that we provide. This may include certain communications to your health insurance company to get approval for the procedure that we have scheduled. For example, we may need to disclose information to your insurance company to get prior approval for the surgery. We may also disclose protected health information to your health insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. In order to get payment for the services we provide to you, we may also need to disclose your protected health information to your insurance company for utilization review. We may also disclose patient information to another provider in your care for the other provider’s payment activities. This may include disclosure of demographic information to anesthesia providers for payment of their services.

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Operations: We may use or disclose your protected health information, as necessary, for our own healthcare operations to facilitate the function of the ASC and to provide quality care to all patients. Healthcare operations activities include, but are not limited to, training programs including those in which students, trainees, or practitioners in health care learn under supervision, accreditation, certification, licensing, or credentialing activities, review, and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs, business management, and general administrative activities. In certain situations, we may also disclose patient information to another provider or health plan for their healthcare operations.

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Other uses of Disclosures: As part of treatment, payment, and healthcare operations, we also use or disclose your protected health information for the following purposes:

• To remind you of your surgery date

• To inform you of potential treatment alternatives or options

• To inform you of health-related benefits or services that may be of interest to you.

We may release medical information about you to a friend, family member, or personal representative who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends about your condition and that you are in the surgery center. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

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Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for the privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through the research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the facility. We will always ask for your specific permission (authorization) if the researcher will have access to your name, address, or other information that reveals who you are, or what will be involved in your care at the surgery center.

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We will disclose medical information about you when required to do so by federal, state, or local law.

We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would be limited to someone able to help prevent the threat.

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Uses and disclosures beyond treatment, payment, and health care operations permitted without authorization of opportunity to object. Federal Privacy rules allow us to use or disclose your protected health information without your permission for several reasons including the following:

• When legally required.

• When there are risks to public health.

• To report suspended abuse, neglect, or domestic violence.

• To conduct health oversight activities.

• In connection with judicial and administrative proceedings.

• For law enforcement purposes.

• To Coroner, Medical Examiner, Funeral Director, and for organ donations.

• For research purposes.

• In the event of a serious threat to health or safety.

• For Specified Government functions.

• For Worker’s Compensation.

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Uses and disclosures are permitted without authorization but with the opportunity to object. We may disclose your protected health information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your surgery or payment related to your surgery. We can also disclose your information in connecting with trying to locate or notify family members or others involved in your care concerning your location, condition, or death.

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You may object to these disclosures. If you do object to these disclosures or we can infer from the circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interests for us to make disclosure of information that is directly relevant to the person’s involvement with your care, we may disclose your protected health information as described:

• Uses and disclosures with your authorization. Other than as stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have taken action in reliance upon the authorization.

• Your rights. You have the following rights regarding your health information:

  • The right to inspect and copy your protected health information. To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this Privacy Notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing, or other costs incurred by us in complying with your request. Please contact our Privacy Officer if you have questions about access to your medical record.

  • The right to request a restriction on the uses and disclosures of your protected health information. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer.

  • The right to request to receive confidential communications from us by alternative means or at an alternative location. Requests must be made in writing to our Privacy Officer.

  • The right to request amendments to your protected health information. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.

  • The right to receive an accounting. You have the right to request an accounting of certain disclosures of your protected health information made by the facility. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to January 1, 2023. Accounting requests may not be made for periods of time more than six years. We will provide the first accounting you request during a 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

  • The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice, even if you have already received a copy of the notice or have agreed to accept this notice electronically.

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Our Duties The facility is required by law to maintain the privacy of your health information and provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all future protected health information that we maintain. If the facility changes its Notice, we will provide a copy of the revised Notice by sending a copy of the revised Notice via regular mail or through in-person contact.

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Complaints You have the right to express complaints to the facility and to the Security of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the facility by contacting the facility Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

 

Privacy and Compliance Officer: Dr. William J. Fisher, MD