HIPAA Privacy Notice
 
 

 

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

Protection of Your Personally Identifiable Health Care Information

  • Your Right to Privacy Protection

In order to provide you with health care services, ProKids LLP acquires personally identifiable health information (hereafter “Protected Health Information”) about you, and it is required by a federal law known as the Health Insurance Portability and Accountability Act (hereafter “HIPAA”), and by state law, to maintain the privacy of your Protected Health Information.  The federal requirements, called the “Privacy Rule,” are spelled out in detailed regulations that may be found in volume 45 of the Code of Federal Regulations (“CFR”), Parts 160 and 164. In addition, under HIPAA and the Privacy Rule, ProKids LLP is required to provide you with this notice of its legal duties and privacy practices with respect to that Protected Health Information.  This notice explains how ProKids LLP provides that protection.  ProKids LLP reserves the right to change its privacy practices, but when it does, it will provide you with a written copy of any material change within 60 days after such a change becomes effective.

  • Your Right to Complain About Violations of Your Right to Privacy Protection

If you believe that your privacy rights have been violated, you may complain to Maxine Heumann, Privacy Officer, either in writing addressed to 636 Wantagh Avenue, Levittown, NY 11756, or by telephone at 516-520-7750.  Complaints may also be made in writing to the Secretary of the US Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue SW, Washington DC 20201.

There will be no retaliation if you file any such complaint.

  • Effective Date of This Notice

The effective date of this notice is April 14, 2003

Uses and Disclosures of Your Medical Information

ProKids LLP may acquire Protected Health Information about you for purposes of your treatment, payment of benefits or provisions of health care services, or for overall health care operations.

This Protected Health Information will not be disclosed to anyone without your express written authorization, except as follows:

  • Disclosure for Treatment, Payment and Health Care Operations

Per HIPAA regulations, your Protected Health Information may be disclosed, without your written consent or authorization, to covered entities, which include:

 

    • ProKids LLP staff and administration.
    • The insurer or administrator of the plan under which your services are provided.
    • Your other health care providers.
    • Other insurers or administrators of any plan that provides additional services to you.
    • Any health care clearinghouse.
    • Any Business Associate of ProKids LLP or any other Covered Entity.

A “Business Associate” is an entity that provides related services to ProKids LLP or any Covered Entity and that has entered into a contract under which it agrees to abide by the rules and regulations established pursuant to federal law and regulations to protect the privacy of your Protected Health Information.

Examples of the disclosures that will be made to any of the Covered Entities described in this paragraph include, but are not limited to:

  • Treatment:

• ProKids LLP discloses symptoms identified in the course of your care to your specialist so that your specialist can provide adequate health care services.

• ProKids LLP calls in prescriptions to your pharmacy.

? ProKids LLP contacts hospital for scheduling of surgery.

  • Payment:

• ProKids LLP contacts your Health Plan in order to determine that you are eligible.

• ProKids LLP discloses your Protected Health Information to any other Covered Entity or Business Associate in order to process, or expedite the processing of, your claims for benefits or request for health care services.

  • Health Care Operations:

• Review or audit of ProKids LLP services, with respect to quality, timeliness, accuracy, and/or compliance with laws and regulations.

? Use of sign in sheets and announcement of name in a waiting room.

 

  • Additional Disclosures and Contacts Without Authorization
    • A Covered Entity that is a health care provider may contact you to raise funds for its operations.
    • A group health plan or its health insurer, HMO, or third party administrator may disclose Protected Health Information to ProKids LLP, but that information must be used only for the purposes of health care operations.
  • Disclosures Required by Law

Your Protected Health Information will be disclosed, without your written consent or authorization, when required by law.  This may include disclosure for any of the following purposes (with examples of each):

 

    • Public Health Activities (when the law requires disclosure that you were exposed to a communicable disease).
    • Abuse, Neglect or Domestic Violence (when the law requires disclosure if the circumstances indicate that might have occurred).
    • Law Enforcement Purposes (if you are treated for gunshot or other types of wounds or if the information may help in apprehension of someone other than you who is suspected of a crime).
    • Requests From a Coroner or Medical Examiner (to identify a deceased person or determine the cause of death).
    • Requests From a Funeral Director (to help carry out his or her duties).
    • Subpoenas or Requests For Discovery issued by any court or government agency.  To the extent it is reasonably possible, ProKids LLP will attempt to provide you with notice of its receipt of any such subpoena, but it must be clearly understood that ProKids LLP will not be responsible if it is unable to or fails to provide you with such notice.
    • Compliance With Worker’s Compensation Laws (to administer the program).
    • Oversight of Activities Authorized by Law (including government investigations of possible crime or fraud).

ProKids LLP is also required by law to provide all Protected Health Information to the Secretary of Health and Human Resources for enforcement purposes.

  • All Other Uses and Disclosures

All other uses and disclosures of your Protected Health Information, including but not limited to medical research, will only be made with your written authorization which you may revoke, in writing, at any time. 

All disclosures made prior to your revocation request will be covered by the original authorization.

Your Individual Rights

  • Restriction on the Use of Protected Health Information

You have the right to request that ProKids LLP or any other Covered Entity restrict the uses and disclosures of your Protected Health Information to carry out treatment, payment and health care operations described above, or to a member of your family, other relative or close personal friend who is directly involved with or responsible for your care or payment for that care.

However, ProKids LLP or other Covered Entity is not required to agree to any such restrictions, and ProKids LLP will not do so.  As a result, if you make such a request, ProKids LLP will refuse to honor it.  So if you do not provide any Protected Health Information that ProKids LLP determines is necessary to process your request for health care services, your request will be denied.

  • Confidential Communications

You have the right to request in writing that we communicate with you about your Protected Health Information in a certain way or at a certain location if you tell us that communication in another manner may endanger you.  ProKids LLP will make those reasonable accommodations that it deems appropriate.

  • Inspection of Your Protected Health Information

You have the right to inspect and copy your Protected Health Information maintained in ProKids LLP’s files, except for:

 

    • Psychotherapy notes.
    • Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
    • Information maintained by a Covered Entity pursuant to the Clinical Laboratory Improvements Amendments of 1988, to the extent applicable under that law.

If your access to such Protected Health Information is denied, you may have a right to have that denial reviewed, but only under the following circumstances:

  • A licensed health care provider has determined that the access requested is likely to endanger your life or physical safety.
  • That information refers to another person and a licensed health care provider has determined that the access requested is likely to endanger that person’s life or physical safety.
  • The request is made by your authorized personal representative and a health care provider has determined that the access requested is reasonably likely to cause substantial harm to you or another person.

The following administrative procedures will apply:

  • All requests for inspection and copying of one’s medical records must be in writing.  Requests must be addressed to the Office Manager.
  • ProKids LLP will act upon your request within 30 days of its receipt, or within an additional 30 days if it cannot do so within that 30-day period.
  • You may be charged the reasonable costs for copying the Protected Health Information, postage or other charges incurred in mailing or sending that information to you, and preparation of any requested explanation or summary of that information.
  • You will be advised of your right to appeal a denial of that information if you have such a right, or that you have no such right if it is not available.
  • If ProKids LLP does not maintain that information and knows where that information is maintained, you will be advised where to direct your request for access to it.
  • Amendment of Your Protected Health Information

You have the right to request an amendment of your Protected Health Information, however, that information may not be amended if it:

 

    • Was not created by ProKids LLP and the creator of that information is available to act on your request to amend that information.
    • Is not part of ProKids, LLP’s records.
    • Would not be available for your inspection, as indicated above.
    • Is accurate and complete.

The following administrative procedures will apply:

  • All requests for amendment of medical records must be in a notarized written form, addressed to the Office Manager.
  • All requests must include a reason to support the requested amendment.
  • ProKids LLP will act on your request within 60 days after it is received, or within an additional 30 days if it cannot do so within the 60-day period.
  • ProKids LLP will inform you when that amendment is made, and will provide a copy of it to anyone else who previously received the unedited Protected Health Information and/or may have relied, or could have relied, on it to your detriment, and thus needs to have that amendment.
  • If the request is denied, you will be informed of the reason for the denial, and you will be advised of your rights to file a statement of disagreement and/or to seek further relief from that denial.
  • Receipt of an Accounting of Disclosure

You have the right to receive a six-year accounting of disclosures of your Protected Health Information, except for disclosures:

  • That occurred before April 14, 2003.
  • To carry out treatment, payment and/or health care operations, as described above.
  • Of Protected Health Information about other individuals.
  • To you.
  • Permitted or otherwise required by applicable law or regulation.
  • Pursuant to written authorization by you or by your authorized representative.
  • For national security or intelligence purposes, as required by applicable law or regulation.
  • To correctional institutions or law enforcement officials, as required by applicable law or regulation.

The following administrative procedures will apply:

 

  • All requests for an accounting of disclosures must be in writing, addressed to the Office Manger.
  • ProKids LLP will act on your request within 60 days after it is received, or within an additional 30 days if it cannot do so within that 60-day period.
  • You may be charged the reasonable costs for copying the Protected Health Information, postage or other charges incurred in mailing or sending that information to you.  If you do not consent to paying any such charges, your request will be considered to have been withdrawn.
  • The accounting will include:
    • The date of each disclosure.
    • The name and, if known, the address of each recipient.
    • A brief description of the information provided.
    • A brief statement of the purpose of the disclosure, or a copy of the written request for that disclosure.
  • Additional Information

If you have any questions about this notice, the Privacy Rule, or your rights as applied to your individual circumstances, contact Maxine Heumann, Privacy Officer, either in writing addressed to ProKids LLP, 636 Wantagh Avenue, Levittown, NY  11756, or by telephone at 516-520-7750.