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.


If you have any questions about this Notice please contact

SUNSHINE PEDIATRICS

 

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

 

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. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our web site; sunshine-pediatrics.com, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.


1. Uses and Disclosures of Protected Health Information

Patient protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in patient care and treatment for the purpose of providing health care services to patients. Patient protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician's practice.

 

Following are examples of the types of uses and disclosures of patient protected health care information that the physician's office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.


  • Treatment: We will use and disclose patient protected health information to provide, coordinate, or manage patient health care and any related services. This includes the coordination or management of patient health care with a third party that has already obtained your permission to have access to patient protected health information. For example, we would disclose patient protected health information, as necessary, to a home health agency that provides care to patients. We will also disclose protected health information to other physicians who may be treating our patients when we have the necessary permission from our patients to disclose patient protected health information. For example, patient protected health information may be provided to a physician to whom patients have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose patient protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in patient care by providing assistance with patient health care diagnosis or treatment to your physician.
  • Payment: Patient protected health information will be used, as needed, to obtain payment for patient health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you 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. For example, obtaining approval for a hospital stay may require that patient relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
  • Healthcare Operations: We may use or disclose, as-needed, patient protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.

  • For example, we may disclose patient protected health information to medical school students that see patients at our office. In addition, 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 patients by name in the waiting room when your physician is ready to see you. We may use or disclose patient protected health information, as necessary, to contact you to remind you of your appointment.

  • We will share patient protected health information with third party "business associates" that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of patient protected health information, we will have a written contract that contains terms that will protect the privacy of patient protected health information.

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

Other uses and disclosures of patient 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 With Your Consent as Legal Guardian, Authorization or Opportunity to Object

We may use and disclose patient protected health information in the following instances. You, as the legal guardian have the opportunity to agree or object to the use or disclosure of all or part of patient protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your 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 patient health care will be disclosed.

  • Others Involved in Patient Healthcare: Unless you, as the legal guardian object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, patient protected health information that directly relates to that person's involvement in patient health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in the patient's best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose patient protected health information 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 your health care.

  • Emergencies: We may use or disclose patient protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose patient protected health information to treat patients.

  • Communication Barriers: We may use and disclose patient protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
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  • Other Permitted and Required Uses and Disclosures That May Be Made Without Patient Consent, Authorization or Opportunity to Object
  • We may use or disclose patient protected health information in the following situations without your consent or authorization. These situations include:

  • Required By Law: We may use or disclose patient protected health information to the extent that the use or disclosure is required by law. The use or disclosure 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 patient protected health information 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 your protected health information, 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 patient protected health information, 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 patient protected health information 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 patient protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. 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 patient protected health information to a person or company required by the Food and Drug Administration 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 protected health information 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, discovery request or other lawful process.

  • Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise 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 protected health information 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 protected health information 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. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

  • Research: We may disclose patient protected health information 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 your protected health information.

  • Criminal Activity: Consistent with applicable federal and state laws, we may disclose patient protected health information, 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 protected health information 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 protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

  • Required Uses and Disclosures: Under the law, we must make disclosures to legal guardians and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.


2. Legal Guardians Rights

Following is a statement of patient rights with respect to their protected health information and a brief description of how you may exercise these rights.


  • Legal guardians have the right to inspect and copy patient protected health information. This means you may inspect and obtain a copy of protected health information about the patient that you have legal guardianship of that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that the physician and the practice use for making decisions about the patient.

  • Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be review able. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to the patient medical record.

  • Legal guardians have the right to request a restriction of patient protected health information. This means you may ask us not to use or disclose any part of the patients protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of the patients protected health information not be disclosed to family members or friends who may be involved in the patients care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
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  • Your physician is not required to agree to a restriction that you may request. If physician believes it is in patient's best interest to permit use and disclosure of patient protected health information, patient protected health information will not be restricted. If patient physician does agree to the requested restriction, we may not use or disclose patient protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with patient physician. You may request a restriction by contacting our Privacy Contact,  at (706) 769-9410 or at 1160 Capital Avenue, Suite 105; Watlkinsville, GA  30677.
  • Legal guardians have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.

  • Legal guardians may have the right to have your physician amend patient protected health information. This means you may request an amendment of protected health information about the patient in a designated record set for as long as we maintain this 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 Contact to determine if you have questions about amending your medical record.

  • Legal guardians have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.

  • You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.


3. 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 contact of your complaint. We will not retaliate against you for filing a complaint.

  • You may contact our Privacy Contact for further information about the complaint process.

  • 1160 Capital Avenue, Suite 105
  • Watkinsville, GA  30677
  • Phone:  (706) 769-9410

 

This notice was published and becomes effective on March 1, 2003 and no later than April 14, 2003.

Sunshine Pediatrics

Office Hours

Monday through Friday:

9:00 a.m. to 5:00 p.m.


Closed:

Daily from:

12:00 p.m. to 2:00 p.m.

Saturday and Sunday


Address

1160 Capital Avenue, 

Suite 105

Market Center

Watkinsville, GA  30677


Phone

706-769-9410


Fax

706-769-9475