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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 review it carefully.
Your Information. Your Rights. Our Responsibilities.
Note to Parents/Guardians of Minor Patients: In many cases, the individual reviewing this notice (i.e., “you”) will be the parent or guardian of one of our patients. In general, as your child’s personal representative, you have the ability to act for him/her and exercise his/her rights as described herein. Please note, however, that all references herein to “your information,” or “your records,” etc., refer to the information and records of your child.
You have the right to:
You have some choices in the way that we use and share information as we:
Our Uses and Disclosures
We may use and share your information as we:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
Ask us to correct your medical record
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we’ve shared information
Get a copy of this privacy notice
Choose someone to act for you
File a complaint if you feel your rights are violated
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 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, you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Run our organization
Bill for your services
How else can we use or share your health information?
Help with public health and safety issues
We can share health information about you for certain situations such as:
Comply with the law
Respond to organ and tissue donation requests
Work with a medical examiner or funeral director
Address workers’ compensation, law enforcement, and other government requests
Respond to lawsuits and legal actions
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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 you. The new notice will be available upon request, in our office, and on our web site.
Use and Disclosures Where Special Protections May Apply
Some kinds of information, such as HIV-related information, alcohol and substance abuse treatment information, mental health information, and genetic information, are considered so sensitive that state or federal laws provide special protections for them which may include obtaining your written authorization before we use and/or disclose such information. If you have questions or concerns about the ways these types of information may be used or disclosed, please speak with your or your child’s health care provider or our Privacy Officer as described below.
Please direct any questions concerning this notice to our Privacy Officer: Privacy Officer Patriot Pediatrics P.C. 74 Loomis Street, Bedford, MA 01730 781-674-2900
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