Notice of Privacy Practices

Your rights

When it comes to your child's health information, you have certain rights. This section explains them and how to use them.

Get a copy of the medical record

• You can ask to see or get a copy of your child's medical record and other health information we have. If we keep the record electronically, you can ask for an electronic copy. Ask us how.
• We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct the record

• You can ask us to correct health information you think is incorrect or incomplete. Ask us how.
• We may say "no" to your request, but we will tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way, for example at a particular phone number, or to send mail to a different address.
• We will say "yes" to all reasonable requests.

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, and we may say "no" if it would affect your child's care.
• If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or our operations. We will say "yes" unless a law requires us to share it.

Get a list of those with whom we have shared information

• You can ask for a list, called an accounting, of the times we have shared your child's health information in the six years before the date you ask, who we shared it with, and why.
• We will include all disclosures except those about treatment, payment and health care operations, and certain other disclosures such as any you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another within 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide a paper copy promptly.

Choose someone to act for you

If someone holds medical power of attorney or is a child's legal guardian, that person can exercise these rights and make choices about the child's health information. We will confirm the person has this authority before we act.

File a complaint if you feel your rights are violated

You can complain to us or to the U.S. Department of Health and Human Services if you feel we have violated your rights. See Complaints below. 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 information in the situations below, talk to us. Tell us what you want us to do and we will follow your instructions.

In these cases you have both the right and the 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.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share information if we believe it is in your child's best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share information unless you give us written permission:

• marketing purposes;
• sale of health information;
• most sharing of psychotherapy notes.

Fundraising. We do not contact families to raise funds. If that ever changes, we will tell you and you will be able to tell us not to contact you again.

How we use and share health information

We typically use or share health information in the following ways.

To treat your child

We can use health information and share it with other professionals who are treating your child. Example: a clinician here refers your child to a specialist and sends the specialist the relevant records, or a school nurse asks about a medication your child takes at school with your permission.

To run our practice

We can use and share health information to run our practice, improve care and contact you when necessary. Example: we use health information to manage appointments and send reminders, or to review the quality of care our clinicians provide.

To bill for services

We can use and share health information to bill and get payment from health plans or other entities. Example: we give information about a visit to your health insurance plan so it will pay for the visit.

Other uses and disclosures

We are allowed or required to share health 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 information for these purposes.

Help with public health and safety issues

We can share health information for certain situations such as:

• reporting immunizations to the Georgia Registry of Immunizations and Transactions (GRITS), as Georgia law requires, and providing proof of immunization to a school when the law requires the school to have it and you have agreed;
• preventing disease, including reporting infectious diseases to public health authorities;
• helping with product recalls;
• reporting adverse reactions to medications;
• reporting suspected abuse, neglect or domestic violence, which we are required to do for children;
• preventing or reducing a serious threat to anyone's health or safety.

Do research

We can use or share health information for health research, subject to the conditions the law sets.

Comply with the law

We will share information when state or federal law requires it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information 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.

Address workers' compensation, law enforcement and other government requests

We can use or share health information:

• 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.

Respond to lawsuits and legal actions

We can share health information in response to a court or administrative order, or in response to a subpoena.

Substance use disorder treatment records

If we receive records from a substance use disorder treatment program that is covered by federal confidentiality rules (42 CFR Part 2), we will not use or disclose those records, or testimony about them, in any civil, criminal, administrative or legislative proceeding against your child unless we have your written consent or a court order issued after you have had notice and an opportunity to be heard. A court order must be accompanied by a subpoena or other legal requirement before we release the record.

Business associates

We work with companies that provide services to us, such as our electronic health record and patient portal vendor, our registration form provider, our billing service and our secure fax service. They may receive health information to do their work for us. Each is required by written agreement to protect the information in the same way we do.

Uses that need your written permission

Any use or disclosure of health information that is not described in this notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures for marketing, and any sale of health information.

If you give us an authorization, you may revoke it in writing at any time. The revocation will stop future uses and disclosures, but it cannot undo anything we did in reliance on the authorization before we received your revocation.

Once health information has been disclosed to someone outside the practice, it may be re-disclosed by the recipient and may no longer be protected by federal privacy law.

Our responsibilities

• We are required by law to maintain the privacy and security of your child's protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of that 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 health 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.

Changes to this notice

We reserve the right to change the terms of this notice, and the changes will apply to all information we have about your child, including information created or received before the change. The new notice will be available on request, posted in our office, and posted on this website at ivyleaguepediatrics.com/notice-of-privacy-practices. The effective date of the current notice appears at the top of this page.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the federal government. Filing a complaint will not affect your child's care and we will not retaliate against you in any way.

To complain to us, contact our Privacy Officer:

To complain to the federal government, contact the U.S. Department of Health and Human Services Office for Civil Rights:

Contact

For more information about this notice or our privacy practices, or to exercise any of the rights described here, contact our Privacy Officer at 678-407-4489 or in writing at the address above.

For how this website itself handles information about visitors, which is separate from your child's medical record, see our Privacy Policy.