Kids Doc

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

Uses and Disclosures

Treatment:

Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical records to all health professionals who may provide treatment or who may be consulted by staff members.

Payment:

Your health information may be used to seek payment from your health plan, from other sources of coverage such as automobile insurer, or from credit card companies that you may use to pay services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health Care Operations:

Your health information may be used as necessary to support the day-to-day activities and management of the office of Kids Doc. For example, information on services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality of treatment and services provided.

Law Enforcement:

Your health information may be disclosed to law enforcement agencies to support government audits or inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting.

Public Health Reporting:

Your health information may be disclosed to public health agencies as required by law, for example, we are required to report certain communicable diseases to the state's public health department.

OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION :

Disclosures of your health information or its use for any purpose other than those listed above requires your authorization. If you change your mind after authorizing a use or disclosure of information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified Kids Doc of your decision to revoke your prior authorization

Individual Rights

You have certain rights under the federal privacy standards. These include:

the right to request restriction on the use and disclosure of your health information

the right to receive confidential communications concerning your child's medical condition and treatment

the right to inspect and copy your health information

the right to amend or submit corrections to your health information

the right to receive an accounting how and to whom your health information has been disclosed

the right to receive a printed copy of this notice

Kids Doc Duties:

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies that are outlined in this notice.

Right to Revise Practice Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in your policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulations, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting: Pat, Office Manager. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

Comments/Concerns/Complaints

If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to :

                          Kids Doc

                          30210 Rancho Viejo Rd, Suite A

                          San Juan Capistrano, CA 92675

If you believe that your privacy rights have bee violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.

                              Kids Doc

                              30210 Rancho Viejo Rd, Suite A

                              San Juan Capistrano, CA 92675

                                       Receipt of Notice of Privacy Practices