Privacy Statement

Notice of Privacy Practices
For patients of Central Florida Pediatrics
Effective January 1, 2014

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information.

You have the right to:

  • Get an electronic or paper copy of your child’s medical record
    • You can ask to see or get an electronic or paper copy of your child’s medical record and other health information we have.
    • We will provide a copy or a summary of your child’s health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • Ask us to correct your child’s medical record
    • You can ask us to correct health information that you think is incorrect or incomplete.
    • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
  • Request confidential communication
    • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • Ask us to limit what we use or share
    • You can ask us not to use or share certain health information for treatment, payment, or our operations.
    • We are not required to agree to your request, and we may say “no” if it would affect your child’s care.
    • If you pay for a service or health care item out- of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
  • Get a copy of this privacy notice
    • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
  • Choose someone to act for you
    • If you have given someone medical power of attorney, that person can exercise your rights and make choices about health information.
    • We will make sure they have this authority and can act for you before we take any action.
  • Get a list of those with whom we’ve shared information
    • You can ask for a list of the times we’ve shared your child’s health information for six years prior to the date you ask, who we shared it with, and why.
    • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
  • File a complaint if you feel your child’s rights are violated
    • You can complain if you feel we have violated your child’s rights by contacting us using the information on the back page.
    • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting
    • We will not retaliate against you for filing a complaint.

Your Choices

  • For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your child’s information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
  • In these cases we never share your child’s information unless you give us written permission:
    • Marketing purposes
    • Sale of your information
    • Most sharing of psychotherapy notes
  • In these cases, you have both the right and choice to tell us to:
    • Share information with your family, close friends, or others involved in your child’s care
    • Share information in a disaster relief situation
    • Include your child’s information in a hospital directory
    • If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your child’s information if we believe it is in your child’s best interest. We may also share your child’s information when needed to lessen a serious and imminent threat to health or safety.
  • In the case of fundraising:
    • We may contact you for fundraising efforts, but you can tell us not to contact you again.

How do we typically use or share your child’s health information?

We typically use or share your child’s health information in the following ways:

  • Treat your child
    • We can use your child’s health information and share it with other professionals who are treating you child.
    • Example: A doctor treating your child for an injury asks another doctor about your child’s overall health condition.
  • Run our organization
    • We can use and share your child’s health information to run our practice, improve care, and contact you when necessary.
    • Example: We use health information about your child to manage his or her treatment and services.
  • Bill for your child’s services
    • We can use and share your child’s health information to bill and get payment from health plans or other entities.
    • Example: We give information about your child to your health insurance plan so it will pay for our services.
  • Do research
    • We can use or share your child’s information for health research.
  • Comply with the law
    • We will share information about your child if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
  • How else can we use or share your child’s health information?
    • We are allowed or required to share your child’s information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share his or her information for these purposes. For more information see:
  • Help with public health and safety issues
    • We can share health information about your child for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety
  • Respond to organ and tissue donation requests
    • We can share health information about your child with organ procurement organizations.
  • Work with a medical examiner or funeral director
    • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
  • Respond to lawsuits and legal actions
    • We can share health information about your child in response to a court or administrative order, or in response to a subpoena.
  • Address workers’ compensation, law enforcement, and other government requests
    • We can use or share health information about your child:
    • For workers’ compensation claims
    • For law enforcement purposes or with a law enforcement official
    • With health oversight agencies for activities authorized by law
    • For special government functions such as military, national security, and presidential protective services

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  • For more information see:

Changes to the Terms of This Notice

  • We can change the terms of this notice, and the changes will apply to all information we have about your child. The new notice will be available upon request, in our office, and on our web site.