NOTICE OF PRIVACY PRACTICES
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.
This Notice applies to uses and disclosures we may make of all your protected health information, whether created by us in our practice or received by us from another healthcare provider.
At Total Care Pediatrics we understand that your medical/health information is personal and private. In order to provide you with quality healthcare services and to ensure compliance with all legal requirements, we create a record of the care and services you receive in our office. We understand and respect the privacy and confidentiality of medical health information.
In this Notice, protected health information or PHI refers to any individually identifiable information that we obtain from you or another person that relates to your past, present or future physical or mental health conditions, the health care you have received or the payment for your care.
Protected health information includes, but is not limited to:
- Demographic information (such as your age, gender, race, ethnicity, or marital status)
- Geographic information (such as where you live or work)
- Medical information about your health conditions (such as your test results)
- Information about the services you have or will receive (such as an X-ray or surgical procedure)
- Information about your health insurance plan (such as your insurer’s coverage policies)
- Information that may identify you (such as your Social Security number or a phone number)
- Biometric identifiers (such as fingerprints)
- Full-face photographs
Use and Sharing of Information
Total Care Pediatrics generally requires a written authorization form the patient or parent/legal guardian before information may be released by our practice. In some cases, as described in our Notice of Privacy Practices, we may use and share information for certain purposes without the written authorization of a patient/parent/legal guardian.
For example, we may:
- Use and share information with doctors, nurses and other healthcare providers to treat the patient
- Share information with health insurance companies to get paid for the services we provide
- Use information to review the quality of our services
- Share information with local health departments to report certain contagious diseases, and to conduct public health surveillance, investigations, and interventions
- Share information with local authorities about suspected child abuse or neglect
- Share limited information with police in certain situations, such as if the patient was the victim of a crime
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease
Your Privacy Rights
Except as described in this Notice, and consistent with its legal obligations, Total Care Pediatrics will not use or disclose your protected health information without your written authorization.
All of our patients have the following rights regarding their PHI. We may ask you to submit a written request to enforce any of these rights:
- Inspect and obtain a copy of your medical records in a written or electronic form, subject to certain restrictions
- Request that we amend your records if you believe the PHI we have about you is incorrect or incomplete
- Obtain a list of people and entities with whom we have shared your PHI, subject to certain exceptions under the law
- Direct us to NOT share your information in the online health information exchange system utilized by Total Care Pediatrics by submitting to us a signed Opt Out Form, or rescind your prior decision to opt out of participation in online system if you so choose
- Request that we limit to whom we disclose your PHI in the future
- Request that we communicate PHI with you in a particular way, such as only by phone
- Receive prompt notice in the event your PHI is improperly used or disclosed
- Obtain a paper copy of this Notice
- File a complaint regarding the improper use or disclosure of your PHI
- You have the right to request restrictions on certain uses and disclosures of your health
Fees for Requesting Patient Records
The party requesting the patient's records shall be responsible to Total Care Pediatrics for the costs of copying and mailing the patient's record. A charge of up to $20.00 may be collected for search, retrieval, and other direct administrative costs related to compliance with the request under this chapter. A fee for certifying the medical records may also be charged not to exceed $7.50 for each record certified. The actual cost of postage incurred in mailing the requested records may also be charged. In addition, copying costs for a record which is in paper form shall not exceed $.75 per page for the first 20 pages of the patient's records which are copied; $.65 per page for pages 21 through 100; and $.50 for each page copied in excess of 100 pages. All other fees allowed by applicable sections of the Georgia Code may apply.
To the extent the request for medical records includes portions of records which are not in paper form, including but not limited to radiology films, models, or fetal monitoring strips, we shall be entitled to recover the full reasonable cost of such reproduction.
Disposal of PHI and ePHI
In accordance with HIPAA guidelines, Total Care Pediatrics applies appropriate administrative, technical, and physical safeguards to protect the privacy of protected health information in any form. We have implemented reasonable and compliant safeguards to limit incidental, and avoid prohibited, uses and disclosures of PHI, including in connection with the disposal of such information. PHI is never abandoned, disposed of in dumpsters, other trash receptacles, or any other bags or containers that are accessible by the public or other unauthorized persons.
Total Care Pediatrics practices the following disposal methods:
For PHI in paper records, we practice shredding, burning, pulping, or pulverizing the records so that PHI is rendered essentially unreadable, indecipherable, and otherwise cannot be reconstructed. Total Care Pediatrics uses a security level p-5 Level shredder. The level p-5 shredder is deemed ideal for the destruction of sensitive documents. All tangible PHI must be shredded.
We maintain labeled prescription bottles and other PHI in opaque bags in a secure area and using a disposal vendor as a business associate to pick up and shred or otherwise destroy the PHI inhouse.
For PHI on electronic media, we practice clearing (using software or hardware products to overwrite media with non-sensitive data), purging (degaussing or exposing the media to a strong magnetic field in order to disrupt the recorded magnetic domains), or destroying the media (disintegration, pulverization, melting, incinerating, or shredding).
Staff Training for Disposal of PHI and ePHI
Total Care Pediatrics staff members are required to receive training on the disposal policies and procedures outlined above. Training is mandatory as necessary and appropriate for each member of the Total Care Pediatrics team. Any staff member involved in the disposal of PHI, or who supervises other who dispose of PHI, must receive training on disposal. This includes any volunteers.
Use of TCP Website by Minors
The Total Care Pediatrics website is not directed to children under the age of 13; and Total Care Pediatrics does not collect personal information via its website from children known by Total Care Pediatrics to be under the age of 13. We are committed to protecting the privacy of children. Nothing on the Total Care Pediatrics website or any of its related apps is or should be construed as having been designed to attract children under the age of 13.
For more information please contact:
Dr. Melvin Perry
Total Care Pediatrics
3672 Marathon Circle
Austell, Georgia 30106
Any medical information provided on the Total Care Pediatrics website is for educational purposes only. It is not intended, nor should it be used as a substitute for professional medical advice from a licensed physician. Always consult your physician with any questions you may have regarding a medical condition.