NOTICE OF PRIVACY PRACTICES

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. 

“Protected health information” is information about you or your child, including demographic information, that may identify you and that relates to your child’s past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices describes how we may use and disclose yours or your child’s protected health information for purposes of treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your child’s protected health information.

We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to your child’s protected health information. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. You may request a revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail, by accessing it on our website or asking for one at the time of your next appointment.

HOW WE USE PROTECTED HEALTH INFORMATION

Uses and Disclosures of Protected Health Information with your Consent 

You will be asked to sign a consent form. Your written consent allows your child’s protected health information to be used and disclosed by your physician, our office staff and others outside of our office who are involved in your child’s care and treatment for the purpose of providing health care services. Protected health information may also be used and disclosed to pay your health care bills and to support the operation of this practice.

Examples for uses of health information for treatment purposes are:

• A nurse obtains treatment information about your child and records it in a health record.
• During the course of your child’s treatment, the physician determines he/she will need to consult with a specialist. We may provide your child’s protected health information to ensure that the physician has the necessary information to diagnosis or treat your child.

Examples for use of protected health information for payment purposes:

• Providing information to your insurance carrier who will make determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Examples for use to protected health information for Healthcare operations:

• We may use or disclose your child’s protected health information in order to support the business activities of  Preston Ridge Pediatric Associates, P.C. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, and conducting or arranging for other business activities. We will share information about your child with such business associates as necessary to obtain these services.
• We may use a sign in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may contact you to remind you of your appointment.
• We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you for your child’s care.

You have the right to object to any of the above uses of your protected health information; however, we do not have to treat you if you do not give your consent. Please notify the Privacy Officer to request a restriction. If we do not agree to your restriction, we will notify you.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization.

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent or Authorization, but with the Opportunity to Object. 

We may use and disclose your child’s protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your child’s protected health information, then your child’s physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your child’s health care will be disclosed. 

• Others involved in your child’s healthcare
• Emergencies

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your child’s protected health information in the following situations without your consent or authorization. These situations include those required by law and for public health to report communicable diseases, for health oversight, to report abuse or neglect as required by law. Other situations may include those required by legal proceedings and law enforcement relating to criminal activity, Workers’ Compensation, inmates, or military activity and national security.

YOUR HEALTH INFORMATION RIGHTS

The health and billing records we maintain are the physical property of the doctor’s office. You have the following rights with respect to your child’s Protected Health Information.

1. Request a restriction on certain uses and disclosures of your child’s health information by delivering the request in writing to our office. We are not required to grant the request, but we will comply with any request granted;
2. Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office;
3. Right to inspect and receive a copy of your child’s health record and billing record – you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request; appeal a denial of access to your child’s protected health information except in certain circumstances;
4. Right to request that your child’s health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request. (However, we are not required to make such an amendment.) You may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
5. Right to receive an accounting of disclosures of your child’s health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.
6. Right to confidential communication by requesting that communication of your health information be made by an alternative means or at an alternative location by delivering the request in writing to our office using the form we give you upon request; and,
7. If you want to exercise any of the above rights, please contact Katheryne Beverly in person or in writing during normal hours. She will provide you with assistance on the steps to take to exercise your rights.

You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

 

COMPLAINTS

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint. 

You may contact our Privacy Officer, Katheryne Beverly at 770.751.6111 for further information about the complaint process.

This notice was published and becomes effective on July 29, 2022.

If you have any questions about this Notice please contact:

Katheryne Beverly, Privacy Officer
Preston Ridge Pediatric Associates, P.C..
3400A Old Milton Parkway, Suite 330
Alpharetta, GA 30005
770.751.6111