Notice of Privacy Practices

We are required by law to:

• Maintain the privacy and security of your child's protected health information.
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your child's information.
• Follow the duties and privacy practices described in this notice and give you a copy of it.
• Not use or share your child's information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

Treatment

We may use and disclose your child's health information to provide, coordinate, or manage your child's health care and related services. For example, we may share information with other physicians or health care providers who are involved in your child's care, such as specialists, hospitals, or laboratories.

Payment

We may use and disclose your child's health information to obtain payment for services we provide. For example, we may submit claims to your health insurance company and include information about your child's diagnosis and treatment.

Health Care Operations

We may use and disclose your child's health information for our health care operations. These activities are necessary to run our practice and ensure that all of our patients receive quality care. For example, we may use health information to review our treatment and services, to evaluate the performance of our staff, or for training purposes.

Appointment Reminders

We may use and disclose your child's health information to contact you as a reminder that your child has an appointment for treatment or medical care.

Treatment Alternatives

We may use and disclose your child's health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services

We may use and disclose your child's health information to tell you about health-related benefits or services that may be of interest to you.

We may also use or disclose your child's health information without your written authorization in the following circumstances:

• As Required by Law: We will disclose health information about your child when required to do so by federal, state, or local law.
• Public Health Activities: We may disclose health information for public health activities such as reporting communicable diseases, vital statistics, or adverse reactions to medications or products.
• Abuse, Neglect, or Domestic Violence: We may disclose health information to appropriate authorities if we reasonably believe a child has been a victim of abuse, neglect, or domestic violence.
• Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
• Judicial and Administrative Proceedings: We may disclose health information in response to a court or administrative order, subpoena, discovery request, or other lawful process.
• Law Enforcement: We may release health information for law enforcement purposes as required by law or in response to a valid legal request.
• Serious Threats to Health or Safety: We may use and disclose health information when necessary to prevent a serious threat to your child's health or safety or the health or safety of the public or another person.
• Military and Veterans: If your child is or becomes a member of the U.S. Armed Forces, we may release health information as required by military command authorities.
• Workers' Compensation: We may release health information for workers' compensation or similar programs.
• Coroners, Medical Examiners, and Funeral Directors: We may release health information to a coroner, medical examiner, or funeral director as necessary.
• Organ and Tissue Donation: If your child is an organ donor, we may release health information to organizations that handle organ procurement or transplantation.
• Research: Under certain circumstances, we may use and disclose health information for medical research, subject to applicable legal requirements.

Other uses and disclosures of your child's health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose health information about your child, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about your child for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization.

The following uses and disclosures will be made only with your written authorization:

• Most uses and disclosures of psychotherapy notes.
• Uses and disclosures of health information for marketing purposes.
• Disclosures that constitute a sale of health information.

Right to Inspect and Copy

You have the right to inspect and copy health information that may be used to make decisions about your child's care. To inspect and copy your child's health information, you must submit your request in writing to our Privacy Officer. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

Right to Amend

If you feel that health information we have about your child is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.

Right to an Accounting of Disclosures

You have the right to request an accounting of disclosures. This is a list of the disclosures we made of health information about your child other than for treatment, payment, and health care operations purposes. To request this list, you must submit your request in writing to our Privacy Officer.

Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose about your child for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about your child to someone who is involved in your child's care or the payment for your child's care. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide your child with emergency treatment.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

We reserve 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. We will post a copy of the current notice in our office. The notice will contain on the first page, in the top right-hand corner, the effective date.

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact our Privacy Officer at the address or phone number listed below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.