HIPAA Notice of Privacy Practices
Beacon Pediatrics LLC
18947 John J. Williams Hwy.
Suite 212
Rehoboth Beach, DE 19971
302-645-8212
Effective as of 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 READ CAREFULLY.
This Notice of Privacy is NOT an authorization. It describes how we, our Business Associates and their subcontractors, may use and disclose your Protected Health Information (PHI) to carry out 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 Protected Health Information. "Protected Health Information" (PHI) is information, including demographic, that may identify your child and that relates to the past, present or future physical or mental health conditions and related health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION (PHI)
PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in the care and treatment for the purpose of providing health care services, to pay bills, to support the operation of the physician's practice and any other use as required by law.
Treatment: We will use and disclose your PHI to provide, coordinate or manage the health care or any related services. This includes the coordination and management of health care with a third party i.e. so a referral physician will have the necessary information to diagnose and treat.
Payment: PHI will be used to obtain payment for services rendered.
Reminders/Announcements: We may use PHI to contact you by phone, text or mail or email for appointment reminders or with newsletters or announcements about special events.
As Required by Law: We must disclose PHI about you without authorization if federal, state or local laws require us to do so or if there is a serious threat to health and safety.
Judicial Proceedings: We may disclose PHI in response to a court order or subpoena or other lawful process.
YOUR RIGHTS REGARDING PRIVATE HEALTH INFORMATION (PHI) WE MAINTAIN ABOUT YOU
Inspect and Copy: You have the right to inspect and obtain a copy of your child's PHI. You must state the reason for your request. The request must be in writing. There will a charge for this as allowed by the State of Delaware.
Right to Amend: If you believe that any PHI we have is incorrect or incomplete, you have the right to request an amendment. The request must be in writing. We may deny your request if you ask us to amend information that was not created by us, is not part of information that you would be permitted to inspect and copy or is accurate and complete. If the request is denied, you will be notified in writing.
Confidential Communications: You have the right to request that we communicate by alternative means or at an alternative location.
Restricted Use: You can restrict, in writing, that we restrict PHI disclosure to insurance payer if you pay cash at the time of service.
Right to Accounting of Disclosures: You have the right to receive an accounting of the disclosures made by us as required by law except for disclosures pursuant to an authorization, for purposes of treatment, payment and healthcare operations.
Breach of PHI: You will be notified if your unsecured PHI has been breached.
Paper Copy of the Notice: You have the right to receive a paper copy of this Notice. The Notice is available at our reception desk and from our website www.beaconpediatrics.net.
COMPLAINTS
You may complain to us or the Secretary of Health and Human Services within 180 days if you believe your privacy rights have been violated. There will be no retaliation for filing a complaint.
Acknowledgement
Patient's Name:__________________________________________
Parent or Legal Guardian's Signature:_______________________
Date:_______________________________________
