Examples of Using Your/ Your Child’s Health Information for Treatment Purposes:
- A nurse obtains treatment information about your child and records it in their medical record.
- During the course of your child’s treatment, the provider determines they will need to consult with a specialist. The provider will share the information with the specialist and obtain their input.
- We may contact you by phone, SMS text message, or email if we need to speak to you about a medical condition or to remind you of medical appointments.
Example of Using Your Health Information for Payment Purposes:
- We submit requests for payment to your/your child’s health insurance company. We will respond to health insurance company requests for information about the medical care we provided to your child.
Example of Using Your Health Information for Health Care Operations:
- We may use or disclose your child’s PHI in order to conduct certain operational activities, such as quality assessments or training. We may share your/ your child’s PHI with our Business Associates, third parties who perform operational functions on our behalf, as necessary to obtain their services.
Your Health Information Rights
The health and billing records we maintain are the physical property of the Practice. The information in them, however, belongs to you. You have the right to:
- Obtain a paper copy of our current Notice of Privacy Practice for Protected Health Information (“the notice”)
- Receive Notification of a breach of your unsecured PHI
- Request restrictions on certain uses and disclosures of your health information. We are not required to grant most requests, but we will comply with any request with which we agree.
- Request that you be allowed to inspect and copy the information about your child that we maintain the Practice’s designated record set. You may exercise this right by delivering your request, in writing, to the Practice
- Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to the Practice. We may deny your request if you ask us to amend information that (a) was not created by us (unless the person or entity that created the information is no longer available to make the amendment), (b) is not part of the health information kept by the Practice, (c) is not part of the information that you would be permitted to inspect and copy, or (d) 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 placed in your record
- Request that communication of your health information be made by alternative means or at alternative locations by delivering a written request to the Practice
- Obtain a list of instances in which we have shared your health information with outside parties, as required by the HIPAA Rules
- Revoke any of your prior authorizations to use or disclose information by delivering a written revocation to the Practice (except to the extent action has already been taken based on a prior authorization).
Our Responsibilities
The Practice is required to:
- Maintain the privacy of your health information as required by law
- Notify you following a breach of your unsecured PHI
- Provide you with a notice describing our duties and privacy practices with respect to the information we collect and maintain about your child and abide by the terms of the Notice
- Notify you if we cannot accommodate a requested restriction or request
- Accommodate your reasonable requests regarding methods for communicating with you about your child’s health information
We reserve the right to amend, change, or eliminate provisions of our privacy practices and to enact new provisions regarding the PHI we maintain about you. If our information practices change, we will amend our Notice. You are entitled to receive a copy of the revised Notice upon request by phone or by logging into the Patient Portal.
Other Uses and Disclosures of your PHI
Communication with Family
- Using our best judgment, 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 child’s care or payment for care, if you do not object or in an emergency.
Public Health
- We may disclose your child’s PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reaction to medications or problems with products; to notify people of recalls; or to notify a person who may have been exposed to a disease or who is at risk for contracting a disease or condition.
As Required by Law
- We may disclose your child’s PHI as required by law, or to appropriate public authorities as allowed by law to report abuse or neglect.
Law Enforcement
- We may disclose your child’s PHI to law enforcement officials (a) in response to a court order, court subpoena, warrant or similar judicial process; (b) to identify or locate a suspect, fugitive, material witness, or missing person; (c) if your child is a victim of a crime and we are unable to obtain your agreement; (d) about criminal conduct on our premises; and (e) in other limited emergency circumstances where we need to report a crime.
Health Oversight
- Federal law allows us to release your child’s PHI to appropriate health oversight agencies or for health oversight activities such as state and federal auditors.
Judicial/Administrative Proceedings
- We may disclose 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 a proper court order.
For Specialized Governmental Functions or Serious Threat
- We may disclose your child’s PHI for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, to public assistance program personnel, or to avert a serious threat to health or safety.
Other uses and disclosures of your PHI not described in this Notice will only be made with your authorization, unless otherwise permitted or required by law. Uses and disclosure of your child’s PHI for marketing purposes, and disclosures of your child’s PHI that constitute a sale of PHI will require your authorization. You may revoke any authorization at any time by submitting a written revocation request to the Practice (as previously provided in this Notice under “Your Health Information Rights.”)
To Request Information, Exercise a Patient Right, or File a Complaint
If you have questions, would like additional information, want to exercise a Patient Right described above, or believe your (or someone else’s) privacy rights have been violated, you may contact the Practice’s Privacy Officer at 212-226-7666, or in writing to us at:
Compliance Department
Tribeca Pediatrics, PLLC
11 Park Place, STE 1200
New York, NY 10007
Please note that all complaints must be submitted in writing to the Privacy Officer at the above address. You may also file a complaint with the Secretary of Health and Human Services (HHS), Office for Civil Rights (OCR).
- We cannot, and will not, require you to waive the right to file a complaint with the Secretary of HHS as a condition of receiving treatment from the Practice.
- We cannot, and will not, retaliate against you for filing a complaint with the Secretary of HHS.