NOTICE OF PRIVACY POLICY

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information.  Please review it carefully.

Introduction:
Sierra Pediatrics understands that medical information about your child is personal.  This notice will tell you about the information we may collect and how we may use or disclose that information.  It also describes your rights and certain obligations we have regarding the use and disclosure of your child’s protected medical information.

Understanding Your Child’s Medical Information:
Each time your child visits Sierra Pediatrics a record of the visit is documented.  This documentation is referred to as your child’s medical information which typically contains the following: symptoms, examination, lab / x-ray reports, diagnoses, treatments, plan, and future follow-up.  This information allows Sierra Pediatrics to do the following:

Plan your child’s care and treatment, communicate among the many health professionals who contribute to your child’s care, legally document the care your child received, verify to you or a third-party payer that services billed were actually provided, educate health professionals, draw upon as a resource for medical research, utilize for public health activities to improve the health of this state and the nation, use for Sierra Pediatrics’ planning and marketing, and utilize to assess and continually improve the care we render and the outcomes we achieve.

It is important to understand your child’s medical information and why others may access this information.  This will help you ensure its accuracy and will allow you to make informed decisions about authorizing disclosure to others.

Your Rights Regarding Your Child’s Medical Information:
Your child’s medical chart is the physical property of Sierra Pediatrics, however the information belongs to you.  The following are your rights regarding your child’s medical information.

Right to Inspect and Copy:
You have the right to inspect and copy your child’s medical and billing information, except in certain circumstances.  Your requests must be submitted in writing. You may obtain a form to request access to your child’s records by contacting Sierra Pediatrics. We may charge a fee for the costs of copying your child’s information and other supplies associated with your request.

Right to Amend:
You have the right to request an amendment to your child’s records by written request to Sierra Pediatrics.  The request must also explain the reason why the information should be amended. We may deny your request under certain circumstances.

Right to an Accounting of Disclosures:
You have the right to request a list of instances in which we disclosed your child’s medical information.  To request this list you must submit your request in writing to Sierra Pediatrics, stating a time period that may not be longer than three (3) years.  If you request this accounting more than once in a 12-month period, we may charge you a reasonable fee for responding to these additional requests.

Right to Request Restrictions:
You have the right to request a restriction or limitation on your child’s medical information used for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about your child to someone who is involved in their care or involved in the payment of your child’s care, such as a family member or friend.  Restriction requests must be made in writing and contain the following information:  (1) what information you want to limit, and (2) to whom you want the limits to apply.  We reserve the right to deny your request and will notify you in the event this should occur.

Right to Request Confidential Communication:
You have the right to request that we communicate with you about your child’s medical matters in a certain way or at a certain location.  You can ask for example, that we contact you only at home.  Your request must be made in writing and specify how or where you wish to be contacted.  We will accommodate reasonable requests.

Sierra Pediatrics’ Responsibilities:
Sierra Pediatrics is required by law to:  (1) maintain the privacy of your child’s medical information, (2) provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about your child, and (3) abide by the terms of this notice.

We Reserve the Right to Change or Revise this Notice:
We may change this notice and make it effective for medical information we already have about your child as well as new information.  We will always post a copy of the current notice in the waiting room.  The notices first page will show the effective date.

Complaints:
If you believe your rights have been violated, you can file a complaint with Sierra Pediatrics’ Privacy Officer (listed at the end of this notice), or the US Department of Health and Human Services. All complaints must be submitted in writing. There will be no retaliation for filing a complaint with either the Privacy Officer or the Department of Health and Human Services.

Use and Disclosure of Your Child’s Medical Information:
Described as follows are the ways we may use and disclose your child's health information. Except for the following purposes we will use and disclose their health information only with your written permission. You may revoke such permission at any time by writing to Sierra Pediatrics.

Treatment:
We may use and disclose your child's health information for their treatment and to provide them with treatment-related health care services.  For example, we may disclose your child's health information to doctors, nurses, technicians, or other personnel (including people outside our office) who are involved in your child's medical care and need the information to provide them with medical care.

Payment:
We may use and disclose your child's health information so that we or a billing company may bill and receive payment from you, an insurance company, or a third party for the treatment and services they received. For example, we may give information to your health plan so that they will pay for your child's treatment.

Health Care Operations:
We may use and disclose your child's health information for health care operations. Healthcare operations include quality assessment and improvement activities, reviewing the competency or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities, and to operate and manage our office.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services:
We may use and disclose your child's health information to contact you and remind you of their appointment, to tell you about treatment alternatives or health-related benefits and services your child could use.  For example, Sierra Pediatrics may communicate about doctor participation / elimination with a particular health plan.  Another example, Sierra Pediatrics may communicate changes and expansions of new services.

Business Associates:
We may disclose your child's health information to our business associates that perform functions on our behalf or provide us with services if necessary.  For example, we may use another company to perform billing services on our behalf.  All of our business associates are obligated to protect the privacy of your child's information and are not allowed to use or disclose the information for any other purpose than appears in their contract with us.

Individuals Involved in Your Child’s Care or Payment for Their Care:
When appropriate, we may share your child’s medical information with a person involved in or paying for their care, such as family or a friend.  We may notify them about your child’s location, condition, or disclose such information to an entity assisting in your child’s care.

Research:
We may use and disclose your child's health information for research.  For example, a research project may involve comparing the health of patients who received one treatment to those who received another for the same condition.  We may disclose information to researchers when their research has been approved by an institutional review board that reviews the research proposal and has established protocols to ensure the privacy of your child’s medical information.

Fund Raising:
We will not use your child’s medical information for fund raising without your authorization.

Required by Law:
We may use or disclose your child’s medical information when we are required to do so by federal, state or local law.  This includes disclosures required by health oversight agencies.

To Avert a Serious Threat to Health or Safety:
We may use and disclose your child’s medical information when necessary to prevent a serious threat to the health and safety of you, your child, another person, or the public. Disclosures will be made only to someone who can prevent the threat.

Military:
If your child is a member of the armed forces, we may release their medical information as required by military command authorities.

Organ and Tissue Donations:
If you choose for your child to be an organ donor, we may release medical information to organizations that handle organ procurement, tissue transplantation, or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

Workers’ Compensation:
We may release medical information about your child for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health Risks:
We may disclose your child’s medical information for public health activities to prevent or control disease, injury or disability. We may use their medical information in reporting births, deaths, suspected child abuse or neglect, medication reactions, product malfunctions, product recall notification, etc.  We may also notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

Lawsuits and Disputes:
We may disclose medical information about your child in response to a subpoena, discovery request, or other lawful order from a court.

Law Enforcement:
We may release your child’s medical information to law enforcement officials in response to court orders, in emergency circumstances, or when required to do so by law.

Coroners or Medical Examiners:
We may release your child’s medical information to a coroner or medical examiner to identify a deceased person, cause of death, or other similar circumstance.

National Security and Intelligence Activities:
We may disclose your child’s medical information to authorized federal officials for intelligence and other national security activities authorized by law.

Inmates or Under the Custody of Law Enforcement:
If your child is an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about your child to the correctional institution or law enforcement official. This release would be necessary for:  (1) the institution to provide your child with health care, (2) to protect your child’s health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.

Contacting Sierra Pediatrics:
If this Notice of Privacy Practices meets your expectations, there is nothing you need to do except sign our Acknowledgment Form indicating that you have received a copy.  If you have questions, requests, complaints, or need additional information you may contact Sierra Pediatrics’ Privacy Officer at the following address:

Sierra Pediatrics
Attn: Jodi (Office Manager & Privacy Officer)
10581 Double R Blvd
Reno, NV  89521
(775) 324-0766