LAKESIDE PEDIATRICS HEALTH INFORMATION
NOTICE OF PRIVACY PRACTICES
Effective September 23, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Notice of Privacy Practices Policy
Lakeside Pediatrics is required by Federal and Florida law to maintain the privacy of all individually identifiable health information maintained by Lakeside Pediatrics. ("Protected Health Information" or "PHI"). On your child's first visit to our office, you will be offered the opportunity to review our Privacy Policy. At that time, as part of registering your child with our office, you will be asked to sign a Consent and Authorization form. The form states that you have had the opportunity to review our policies related to privacy and that you understand them and agree with them.
In this Notice, when we refer to "you" or to "parents" we contemplate not only the actual parents of the child but also a guardian appointed by the parents or by a Court, a personal representative of the estate of a parent or of the child and any other person who is legally responsible for medical care of the child or payment for the medical care of the child.
Confidentiality Policy
All employees, staff, business associates [consultants who work with our Practice] and agents of our Practice may have access to your child's complete medical record and related Protected Health Information. All physicians, employees, staff, contractors and agents of the Practice and Business Associates by contract with the Practice, are required to have training to maintain the confidentiality of Protected Health Information of the patients of our Practice. All of them are required to maintain the confidentiality of all medical, personal and financial information of the child and to the extent necessary, the child's parents.
On an annual basis, all employees, physicians, staff, contractors and agents of our Practice receive confidentiality training. Annually, all of them are required to sign Confidentiality Agreements. Any of them who breach this confidentiality will be disciplined and each is under the risk of immediate termination.
Incidental Disclosures
The rules governing Protected Health Information recognize there occasionally are incidental disclosures which (1) cannot be reasonably prevented; (2) are limited in nature; and (3) occur as a by-product of an otherwise permissible use or disclosure of Protected Health Information.
Examples are:
1.When a patient or a person accompanying the patient happens to see what may be Protected Health Information on another patient on sign-in sheets at the front desk; or see parts of patients' charts in the bins outside treatment rooms or other places within a doctor's office.
2.When office staff calls out a patient's name in the waiting room.
3.When a patient or a person with a patient is in a treatment room or in the doctor's office and overhears a conversation that may be occurring in an adjoining treatment room or outside the treatment room where nurses, doctors and other personnel are having necessary conversations related to care and treatment of a patient.
Reasonable safeguards are in place to minimize such disclosures. Where applicable, the minimum necessary standard has been implemented.
Authorization Forms for Release of Protected Health Information
Protected Health Information may be released from our practice only with a properly executed authorization signed by the patient's parents or his or her guardian or personal representative in place of parents or upon a Court order or a subpoena for records with verification of actual notice of the subpoena or the order to the parents. To the extent that our practice has records of psychotherapy notes or mental health records, we will never disclose those without a specific authorization signed by the parents or other authorized person specific to mental health records. Any other uses of PHI not specifically described in this Notice will be made only with a proper authorization. You may, in writing, revoke any authorization signed by you at any time.
There are instances where the practice is required to disclose Protected Health Information. These are situations where we make application for payment or other physicians or health care institutions require records be sent, public health disclosure activities, report of possible victims of abuse, neglect or domestic violence or health oversight activities or law enforcement purposes. Under certain circumstances, disclosure is allowed for research purposes or organ donor purposes.
Minimum Necessary Disclosure Policy
All uses, disclosure of, or requests for Protected Health Information will be limited to the minimum amount of information necessary to accomplish the states purpose of a request. Professional judgment will determine the amount of information to be released. The minimum necessary standard is not intended to impede the provision of quality health care.
Disclosures of Protected Health Information may include electronic PHI between providers for treatment, payment and health care operations, or as allowed by an Authorization. An Authorization is exempt from minimum necessary disclosure requirement.
Accounting for Disclosures
The parents or other person responsible for the child may request, in writing, an accounting of all disclosures of PHI. You are allowed one accounting per year at no charge. If you request frequent disclosures, the practice may charge for this service provided we have informed you of the approximate charge in advance and you have agreed to it.
The practice is not required to account for disclosures made to individuals to which the information pertains, for treatment, payment or health care operations, when authorization is given by the patient or the patient's parents, to persons involved in the care of the patient, for National Security or Intelligence, and under certain circumstances to various law enforcement agencies. We are not required to account for disclosure to public health authorities, the Food & Drug Administration or to the Medical Examiner or Coroner under some circumstances.
All of our Business Associates are required to report to us in writing any possible reportable breach committed by or identified by a Business Associate. If there is a reportable breach reported by a Business Associate, we are required to notify the parents, HHS and possibly the media. The breach or suspected breach must be reported to us in a timely manner providing us with all information necessary or requested by us not later than 60 days of discovery of the breach or possible breach.
Patient Access to Medical Records
Parents have the right to inspect and receive copies of their child's medical records. Copies may be in electronic format or a paper copy. The practice may charge for the copying of records including supplies, labor and postage. Parents will be notified of the cost in advance. If the parents' divorce, we require that we receive a copy of any Court order dissolving the marriage and awarding parental responsibility for the medical care of any children and governing access to medical records. We will maintain a copy of records furnished to us in the patient's file. Absent a Court order, or written consent from both parents, stepparents, grandparents or companions of one of the parents may not inspect or receive copies of a child's medical records.
Consent to Treatment
Except in emergencies, stepparents, grandparents and companions of a parent or a patient may not consent to any health care. The practice will provide to the parents an appropriate authorization form by which you will assign to a person or persons, not parents of the child, the right to consent to care in an emergency or because one or both parents are absent and not available to consent.
Amendments to Medical Records
The parents of any child may request that the child's medical records be changed, corrected or amended. This request must be in writing and signed and must specifically note the parts of the record or particular information the parents wish to have changed, amended or corrected. Lakeside Pediatrics may accept or deny the request and will inform the parents in writing of the decision within sixty (60) days of the request. If the request is denied, the reason for denial will be included in the written decision. Parents may file a written statement signed by the parents contesting the denial which will be kept in the medical record.
Restrictions on Use or Disclosure of Protected Health Information
The parents of any child have the right to request restrictions or limitations on certain uses and disclosure of PHI, the right to receive confidential communications on PHI. All such requests must be in writing and signed and specify if the request covers use, disclosure or both. Lakeside Pediatrics may choose not to comply with a restriction request except if the parents document that particular care or services for the child were paid out-of-pocket, in full and the request is that Lakeside Pediatrics not disclose PHI to a health plan related solely to the services for which the parents paid. In that limited instance, the restriction on disclosure will be honored. The requested restriction must specifically identify the information to be restricted and the scope of the restriction. You can make this request by letter to the practice signed by both parents or the parent responsible for medical decision making for the child or you may provide it on a form the practice will furnish to you. E-mail instructions or telephone instructions will not be honored. We require signatures on restrictions. If Lakeside Pediatrics is required by law to make a disclosure of records which the parents have restricted, Lakeside Pediatrics must comply with the law.
Parents may request that communication from the practice be sent to an alternate location or by alternate means. Lakeside Pediatrics will accommodate reasonable requests for such confidential communications.
Privacy Complaint Policy
Parents have a right to file a formal complaint if they feel Lakeside Pediatrics has not adequately protected the Protected Health Information as outlined in the Lakeside Pediatrics' HIPAA Compliance Plan. This complaint must be submitted in writing to the Compliance and Privacy Officer. The Compliance and Privacy Officer of Lakeside Pediatrics may be contacted at any time during normal business hours through the Practice Administrator at the North Office, 2929 Lakeland Hills Boulevard, Lakeland, Florida 33805 or the South Office at 5950 South Florida Avenue, Lakeland, Florida 33813. The Compliance and Privacy Officer may be contacted during normal business hours by telephone at 863-688-3550, Extension 121 or by Fax at 863-687-8969 or by E-Mail at . A formal complaint also may be submitted directly to the Secretary of the United States Department of Health and Human Services. The complaint must be submitted within 180 days of any event which may have been a breach of the Privacy Policy. The Compliance and Privacy Officer or the Incident Response Team will investigate any complaint and provide a written response to the complaint to the parents within thirty (30) days of receipt of the complaint.
Authorization for Sale of Protected Health Information
Lakeside Pediatrics must obtain an authorization for any disclosure of Protected Health Information which is a sale of such information. The authorization will state if the disclosure will result in remuneration to Lakeside Pediatrics. Such authorization shall not be required in the event that Lakeside Pediatrics is sold to another Covered Entity. In the event of such sale, there will be notice to all parents of all patients.
Authorization Required for Marketing
Lakeside Pediatrics must obtain an authorization from parents for any use or disclosure of Protected Health Information for marketing. Such consent shall not be needed in the event: (1) a face-to-face communication made by Lakeside Pediatrics to an individual; or (2) a promotional gift of nominal value is provided to Lakeside Pediatrics.
Modification Policy
Lakeside Pediatrics may change or amend the HIPAA Compliance Plan and to amend this Notice of Privacy Practice from time-to-time as needed or to comply with appropriate laws and regulations.
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