Privacy Statement
 

For patients of
CENTRAL FLORIDA PEDIATRICS

Central Florida Pediatrics is committed to achieving the highest standard of patient care and excellence in every aspect of our practice.  This includes protection of health information.  The following describes how medical information about your child(ren) may be used and disclosed and how you can get access to the information. 

Please review it carefully.

If you have any questions about this notice, please contact our Privacy Officer, Pam Bowman in our Lake Mary office.

  • Who will follow this notice
    This notice describes information about privacy practices followed by our employees, staff and other office personnel.  The practices described in this notice will also be followed by healthcare providers you consult with by telephone who provide call coverage.
  • Your Child’s Health Information
     This notice applies to the information and records we have about your child’s health, health status, and the healthcare and service received at this office.    This information is considered Protected Health Information (PHI) and includes demographic information that may identify the patient.  It can be information related to past present or future physical or mental health conditions and related health care services.   We are required by law to give you this notice.  It will tell you about the ways in which we may use and disclose PHI and describes your rights and our obligations regarding the use of that information.
  • Uses and Disclosure of PHI Based Upon Your Written Consent:
    Some uses and disclosures of PHI are based on written consent from the parent or legal guardian.  You will be asked to update our “Financial Statement and Authorizations” form each calendar year.  This form is your consent for our practice to disclose PHI for treatment, payment and health care operations for the purpose of providing services to your child(ren).  PHI may also be disclosed to collect payment for your health care bills and to support the operation of our practice.  Following are examples of the types of uses and disclosures of PHI that our office is permitted to make once you have signed our consent form.

    Treatment:  We will use and disclose PHI to provide, coordinate or manage your health care and any related services.  This includes management with a third party such as a Home Health Agency, pharmacies or another physician to whom we are referring you for diagnosis or treatment.  In addition we may disclose PHI to other physicians, nurses, technicians or office personnel who may provide assistance to our practitioners.  Personnel in our office may share and disclose information to people who do not work in our office in order to coordinate your care, such as phoning prescriptions to pharmacies, ordering or scheduling outside services.

    Payment:  PHI will be used so that the treatment and services you receive from our practice may be billed to and payment may be collected from you, an insurance company or a third party.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the services we recommend or perform, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities.  Examples would be benefit verifications, referral coordination and pre-admission for hospital services.

    Healthcare Operations:  We may use or disclose PHI as needed to support the business activities of the practice and ensure our patients receive quality care.  These would include but are not limited to, quality assessment activities, employee review activities, training and licensing of students.  For example, we may disclose PHI to medical school students who see patients in our office.  In addition, we may use a sign-in sheet at the registration desk and we may call you by name in the waiting room when the practitioner is ready to see you.  We may also use or disclose PHI as necessary to contact you to remind you of appointments.

    We will share PHI with third-party “business associates” that perform various activities such as billing or transcription services on behalf of the practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of PHI, we will have a written contract that contains terms that will protect the information.

    We may use or disclose PHI as necessary to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We may also use and disclose PHI for marketing activities, such as sending you newsletters about our practice and the services we provide. 

    Any other use of PHI will be made only with specific written authorization, unless otherwise permitted or required by law as described below.  You may revoke authorization at any time, in writing, except to the extent that the physician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization.  If you do revoke your consent, we will not be permitted to use or disclose information for purposes of treatment, payment or healthcare operations and we may therefore choose to discontinue providing you with healthcare treatment and services.
  • Other Permitted and Required Uses and Disclosures That May be Made With Your Consent, Authorization or Opportunity to Object
    The following is a list of instances, which may arise causing the need to use or disclose PHI.  You have the opportunity to agree or object to the use or disclosure of all or part of the PHI.  If you are not present or able to agree or object, then the practitioner may, using professional judgment, determine whether the disclosure is in the best interest of the child.  In this case only the PHI that is relevant to the healthcare will be disclosed.

    Others Family Members/Guardians Involved in Healthcare:  You may identify other family members (over the age of 18), guardians or caregivers to whom we may disclose PHI.  If you are unable to agree or object to such a disclosure we may disclose such information as necessary if it is determined to be in the child’s best interest based on our professional judgment.  We may us or disclose PHI to notify or assist in notifying you regarding your child’s location, general condition or death.  Finally we may use or disclose PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in the child’s healthcare.

    Emergencies:  We may use or disclose PHI in an emergency treatment situation.  If this happens, the practitioner shall try to obtain consent as soon as reasonably practicable after the delivery of treatment.  If any practitioner is required by law to treat the patient and has attempted to obtain your consent, but is unable to, he or she may still use or disclose PHI.

    Communication Barriers:  We may use and disclose PHI if the practitioner attempts to obtain consent form you but is unable to do so due to substantial communication barriers and the practitioner determines, using professional judgment, that you intend to give consent under the circumstances.
  • Other Permitted and Required Uses and Disclosures That May be Made WITHOUT Your Consent, Authorization or Opportunity to Object
    The following circumstances may necessitate the use or disclosure of PHI without your consent or authorization:

    Required by Law:  We may use or disclose PHI to the extent that it is required by law.  Such uses or disclosures will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law of any such uses or disclosures.

    Public Health:  We may disclose PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.  The disclosure will be made for the purpose of controlling disease, injury or disability.  We may also disclose PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

    Communicable Diseases:  We may disclose PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

    Health Oversight:  We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.  Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

    Abuse or Neglect:  We may disclose PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.   In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. 

    Food and Drug Administration:  We may disclose PHI to a person or company required by the FDA to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

    Legal Proceedings:  We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discover request or other lawful process.  This includes reporting to our malpractice carrier any suspected proceedings.

    Law Enforcement:  We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes.  The law enforcement purposes include: 1) legal processes as required by law, 2) limited information requests for identification and location purposes, 3) pertaining to victims of a crime, 4) suspicion that death has occurred as a result of criminal conduct, 5) in the event that a crime occurs on the premises of the practice, and 6) medical emergency (not on the practice’s premises) and it is likely that a crime has occurred.

    Coroners, Funeral Directors, and Organ Donation:  We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.  We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.  We may disclose such information in reasonable anticipation of death.  PHI may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

    Research:  We may disclose PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of the PHI.

    Criminal Activity:  Consistent with applicable federal and state laws, we may disclose PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

    Military Activity and National Security:  When the appropriate conditions apply, we may use or disclose PHI to federal officials for conducting national security and intelligence activities.
  • Your Rights
    Following is a statement of your rights with respect to PHI and a brief description of how you may exercise these rights.

    1)  You have the right to inspect and receive a copy of your child’s PHI for as long as our practice maintains it.  This includes medical and billing records and any other records that the practitioner and/or practice uses for making decisions regarding your child’s healthcare.

    Under Federal law, however, you may not inspect or receive a copy of the following records:  psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, and PHI that is subject to law that prohibits access.  In some circumstances, you may have a right to have this decision reviewed.  Please contact our Privacy Officer if you have questions about access to your child’s medical record.

    2)  You have the right to request a restriction of PHI.  This means you may ask us not to use or disclose any part of the PHI for the purposes of treatment, payment or healthcare operations.  You may also request that any part of the PHI not be disclosed to family members not involved in the care, or for notification purposes as described in this policy.  Please note, we will not restrict information from any person who has legal custody/guardianship of a child unless ordered to do so by the court.  Our practice is not required to agree to a restriction that you request and if the practitioner believes it is not in the child’s best interest, the PHI will not be restricted.  If the practitioner does agree to the requested restriction, we will not use or disclose the PHI in violation of that restriction unless it is needed to provide emergency treatment.  With this in mind, please discuss any restriction request with the practitioner prior to making a formal request. 

    Requests for restriction must be made in writing, addressed to the Privacy Officer at the Lake Mary location.  The request must state the specific restriction requested and to whom you want the restriction to apply.  The Privacy Officer will contact you to confirm the restriction specifics and advise you that the restriction has been made effective throughout the practice.

    3) You have the right to request alternative and/or specific forms of communication.  This means you may request all communication be by mail only or phone calls be made to your home number only, etc.  We will accommodate reasonable requests.  We may also condition this accommodation.  Please make this request in writing to our Privacy Officer.

    4) You have the right to request your physician amend the PHI.  This means you may request an amendment of PHI in a designated record for as long as we maintain the information.  In certain cases, we may deny your request for an amendment.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  Please contact our Privacy Officer if you have questions about amending your medical record.

    5)  You have the right to receive an accounting of certain disclosures we have made, if any, of your child’s PHI.  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this notice.  It excludes disclosures we may have made to you directly, to others you have designated as authorized caregivers or notifications.  The right to receive this information is subject to certain exceptions, restrictions and limitations.
  • Complaints
    You may file a complaint directly to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by our practice.  You may contact our Privacy Officer, Pam Bowman, in our Lake Mary office at 407-321-0085 for further information about the complaint process.
  • Changes To This Notice
    We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about your child(ren) as well as any information we receive in the future.  We will post a summary of the current notice in the office with its effective date indicated.  You are entitled to a copy of the notice currently in effect.

    This notice was published and is effective:  January 1, 2003