Virginia Pediatric & Adolescent Center
Notice of Privacy Practices

Effective Date: April 14, 2003

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. We understand that medical information about your child's health is personal. Virginia Pediatric & Adolescent Center is required by law to maintain the privacy of your health information, to follow the terms of this Notice, and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are required to follow the terms of the Notice that is currently in effect.

How Virginia Pediatric & Adolescent Center May Use or Disclose Your Child's Health Information

Virginia Pediatric & Adolescent Center protects the privacy of your child's health information. For some activities, we must have your written authorization to use or disclose your child's health information. However, the law permits Virginia Pediatric & Adolescent Center to use or disclose your child's health information for the following purposes without your authorization:

For Treatment. Information obtained by the Practice will be used to provide, coordinate, or manage your child’s health care and related services. We may disclose health information about your child to health care professionals and other persons who are involved in providing health care to your child. For example, we would disclose your child’s health information as necessary to a home health agency that provides care to your child or to another physician to whom your child has been referred to ensure that the physician has the necessary information to diagnose and treat your child.

For Payment. We may use and disclose your child's health information so that medical treatment services may be billed to, and payment may be collected from, you, an insurance company or a third party.

For Health Care Operations. We may use and disclose health information about your child for practice operations. We may use a sign-in sheet at the registration desk where you will be asked to sign your name and the name of your child and indicate your physician. We may call you by name in the waiting room when your physician is ready to see your child. Unless you provide us with alternative instructions, we may call your home with appointment reminders and send other materials related to your child's health care to your home. These uses and disclosures are necessary to run the Practice and make sure that you receive information important to your child's health care.

As Required by Law. We will disclose health information about your child when required to do so by federal, state or local law.

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 his/her health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Public Health Risks. We may disclose health information about your child for public health activities. These activities generally include the following: (1) to prevent or control disease, injury or disability; (2) to report reactions to medications or problems with treatments; (3) to notify people of recalls of products they may be using; (4) 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; and (5) to notify the appropriate government authority if we believe a person has been the victim of abuse, neglect or domestic violence (we will only make this disclosure if you agree or when required or authorized by law).

For Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities, which are necessary for the government to monitor the health care system, include audits, investigations, inspections and licensure.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose health information about your child in response to a court order or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.

For Specific Government Functions. Virginia Pediatric & Adolescent Center may disclose health information for the following specific government functions: (1) health information of military personnel, as required by military command authorities; (2) health information of inmates, to a correctional institution or law enforcement official; (3) in response to a request from law enforcement, if certain conditions are satisfied; and (4) for national security reasons.

When Virginia Pediatric & Adolescent Center May Not Use or Disclose Your Child's Health Information

Except as described in this Notice Virginia Pediatric & Adolescent Center will not use or disclose your child’s health information without your written authorization. If you do authorize Virginia Pediatric & Adolescent Center to use or disclose your child's health information for another purpose, you may revoke your authorization in writing at any time.

You Have the Following Rights With Respect to Your Child's Health Information. You have the right to request restrictions on certain uses and disclosures of your child's health information. Virginia Pediatric & Adolescent Center is not required to agree to a restriction that you request. If we do agree to any restrictions, we will put the agreement in writing and follow it, except to provide emergency treatment to your child. We cannot agree to limit the uses or disclosures of information that are required by law. You have the right to inspect and copy your child's health information as long as the Practice maintains the health information except as restricted by law. For example some health information relating to the treatment of adolescents protects the privacy of the adolescent. Your child's health information usually will include treatment and billing records. To inspect or copy your child's health information, you must submit a written request to the practice. We may charge you a fee for the costs of copying, mailing or other supplies that are necessary to grant your request. You have the right to request that Virginia Pediatric & Adolescent Center to amend your child's health information that is incorrect or incomplete. To request an amendment, you must submit a written request to the Practice along with the reason for the request. Virginia Pediatric & Adolescent Center is not required to amend health information that is accurate and complete. Virginia Pediatric & Adolescent Center will provide you with information about the procedure for addressing any disagreement with a denial. You have a right to receive an accounting of disclosures of your child’s health information we have made after April 14, 2003 for purposes other than disclosures (1) for Virginia Pediatric & Adolescent Center treatment, payment or health care operations, (2) to you or based upon your authorization and (3) for certain government functions. To request an accounting, you must submit a written request to the Practice. You must specify the time period, which may not be longer than six years. You may request communications of your child’s health information by alternative means or at alternative locations. For example, you may request that we contact you about health matters only in writing or at a different residence or post office box. To request confidential communication of your child’s health information, you must submit a written request to the Practice. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests. If you would like to exercise one or more of these rights, contact the Practice or submit a written request to Virginia Pediatric & Adolescent Center , HIPAA Privacy, 8316 Traford Lane, Springfield, VA 22152.

Changes to this Notice of Privacy Practices Virginia Pediatric & Adolescent Center reserves the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about your child as well as any information we receive in the future. Any revised Notice will be posted in the Practice’s offices. Upon request, we will provide a revised Notice to you.

For More Information or to Report a Problem If you have questions or would like additional information about Practice privacy practices, you may contact HIPAA Privacy, Virginia Pediatric & Adolescent Center, 8316 Traford Lane, Springfield, VA 22152, Telephone 703.569-8400, or by FAX 703.569-1182. If you believe your child’s privacy rights have been violated, you can file a complaint with the Compliance Officer at the above address, or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.