NOTICE OF HEALTH INFORMATION PRACTICES Effective Date: 07/15/2024THIS NOTICE EXPLAINS HOW YOUR CHILD’S MEDICAL INFORMATION MAY BE UTILIZED AND SHARED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE READ IT CAREFULLY.Willow Pediatric Wellness
Our Commitment to Your Privacy
We recognize the importance of keeping your child's health information private. We are dedicated to protecting their medical information. Willow Pediatric Wellness creates a record of the care and services provided to your child, which is essential for delivering quality care and meeting legal requirements. This Notice applies to all records generated by Willow Pediatric Wellness, whether created by clinic personnel or your personal doctor. It explains how we may use and disclose your child's medical information, your rights regarding this information, and our legal obligations.
We are required by law to:
Ensure the privacy of medical information that identifies your child.
Provide you with this Notice detailing our legal duties and privacy practices concerning your medical information.
Notify you in the event of a breach involving your identifiable medical information.
Adhere to the terms of the Notice currently in effect.
For certain health information, you can inform Willow Pediatric Wellness of your preferences regarding how it is shared, including information with family or others involved in your child’s care or in a disaster relief situation. If you have specific preferences for how your child's information is handled in the situations described, please let us know. Any questions can be directed to the Willow Pediatric Wellness HIPAA Privacy Officer for assistance.
Uses and Disclosures of Health Information
1. Treatment:
We may use and disclose health information about your child to provide, coordinate, or manage their medical treatment or services. This includes the disclosure of information to other healthcare providers who are involved in your child’s care.
2. Payment:
We may use and disclose health information about your child to obtain payment for the services provided. This may include contacting your health insurer to obtain authorization for services or to confirm coverage.
3. Healthcare Operations:
We may use and disclose health information about your child for healthcare operations. These uses and disclosures are necessary to run our practice and ensure that all patients receive quality care.
4. Appointment Reminders:
We may use and disclose health information to contact you to remind you of an appointment for your child.
5. As Required by Law:
We will disclose health information about your child when required to do so by federal, state, or local law.
6. Public Health Activities:
We may disclose health information about your child for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; to report child abuse or neglect; and to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
7. Health Oversight Activities:
We may disclose health information to a health oversight agency for activities authorized by law. These activities include audits, investigations, inspections, and licensure.
8. Lawsuits and Disputes:
If your child is involved in a lawsuit or a dispute, we may disclose health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process.
9. Law Enforcement:
We may release health information if asked to do so by a law enforcement official in certain situations, such as in response to a court order or subpoena.
10. Research:
Under certain circumstances, we may use and disclose health information for research purposes. All research projects, however, are subject to a special approval process.
11. To Avert a Serious Threat to Health or Safety:
We may use and disclose health information about your child when necessary to prevent a serious threat to their health and safety or the health and safety of the public or another person.
12. Special Situations:
Other uses and disclosures will be made only with your written permission, unless otherwise permitted or required by law.
Your Rights Regarding Health Information
Right to Inspect and Copy:
You have the right to inspect and copy health information we have that may be used to make decisions about your child's care. Upon request, we will provide a copy of your child’s health information and a cost-based fee will apply.
Right to Amend:
If you believe that health information we have about your child is incorrect or incomplete, you may ask us to amend the information. We may say no to the request, but we will notify you in writing why within 60 days.
Right to an Accounting of Disclosures:
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about your child including who we shared the information with and why. If more than one accounting disclosure is requested in a 12 month period, a cost-based fee will be charged.
Right to Request Restrictions:
You have the right to request a restriction or limitation on the health information we use or disclose about your child for treatment, payment, or healthcare operations. We may say no if it will affect your child’s care.
Right to Request Confidential Communications:
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will say yes to all reasonable requests.
Right to a Paper Copy of This Notice:
You have the right to a paper copy of this notice at any time.
Changes to This Notice
We reserve the right to change this notice and the changes will apply to all information Willow Pediatric Wellness has about your child. We will post a copy of the current notice in our office and on our website. The notice will contain the effective date on the first page.
Our Responsibilities
Willow Pediatric Wellness is legally obligated to protect the privacy and security of your child’s health information. Specific privacy protections are in place for HIV-related information, alcohol and substance abuse treatment information, mental health information, and genetic information. Willow Pediatric Wellness will only disclose this information as allowed by state and federal laws, unless it is necessary for continuity of care. If your child’s treatment includes this information, you can contact our Privacy Officer for details on these protections.
If there is a breach of your child’s health information that requires legal notification, Willow Pediatric Wellness will inform you promptly.
We are committed to following the duties and privacy practices outlined in this notice and will provide you with a copy of it. Willow Pediatric Wellness will not use or share your information other than as described here, including for marketing purposes, unless you provide written authorization. You have the right to revoke your authorization in writing at any time, except to the extent that Willow Pediatric Wellness has already taken action based on it and is legally permitted to do so.
If you are unable to communicate your preferences, such as in the case of unconsciousness, Willow Pediatric Wellness may share your child's information if we believe it is in their best interest, based on our professional judgment. We may also share your information when necessary to mitigate a serious and imminent threat to health or safety.
Complaints
If you believe your privacy rights have been violated, you can file a complaint. You can contact the Willow Pediatric Wellness HIPAA Privacy Officer, Dr. Laura Crocker Mitchell, at drlaura@willowpediatrics.com. You can visit our website at www.willowpediatrics.com/hipaa-privacy to review our privacy policy.
You also have the option to 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be penalized for filing a complaint.
Contact Information
If you have any questions about this notice or need to file a complaint, please contact:
Willow Pediatric Wellness
2850 Cahaba Road, Suite 140
Mountain Brook, AL, 35223
205-964-9575
drlaura@willowpediatrics.com