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.

Wellness Innovations Physician Partners associated with Children’s Health System of Texas (collectively referred to as “Children’s Health”) takes the privacy of your/your child’s (“your”) health information seriously. We are required by law to keep your health information private, provide you with this Notice of Privacy Practices (“Notice”), and make a good faith effort to obtain a signed document acknowledging your receipt of this Notice. This Notice provides information about how your medical information may be used and disclosed and describes your rights and our obligations. We are required to abide by the terms of the Notice currently in effect. The Notice will be posted in clear and prominent locations and on our website (www.childrens.com). Any changes made to the Notice will be posted in the Patient Registration area, posted on our website and the revised Notice will be provided to you upon request.

If you have any questions about this Notice, please contact Children’s Health Privacy Officer at 214.456.4444.

Thank you, Privacy Officer

Children’s Health

This Notice explains how Children’s Health, its employees, medical/dental staff, students and trainees, volunteers, all departments and  clinics, and other healthcare providers whose names will be made available upon request, may use and provide your Protected Health Information (PHI) to others for treatment, payment, and healthcare operations as described below, and for other purposes allowed or required by law.

PHI is information that you provide Children’s Health or that we create or receive about your healthcare. PHI contains a patient’s age, race, gender, and other personal health information that may identify the patient. The information relates to the patient’s past, present, or future physical or mental health and to related treatment, services, and payment for care.

Understanding Your Health Information

Each time you or your child visit Children’s Health, a record of your visit is made in order to manage the care you receive. Children’s Health understands that PHI is personal, and the confidentiality of PHI is protected under both state and federal law.

Children’s Health has an electronic health record and will not use or release your PHI without your written authorization, except as described in this Notice. Use or disclosure pursuant to this Notice may include electronic transfer of your PHI.

Breach Notification

In certain instances, you have the right to be notified in the event that Children’s Health, or one of our business associates, discovers an unauthorized use or disclosure of your unsecured health information. Notice of any such use or disclosure will be made as required by state and federal law.

Children’s Health Use and Release of PHI Without Your Authorization

The following section explains the various purposes Children’s Health is permitted to use and release PHI.

Treatment Purposes

In providing healthcare services at Children’s Health, your PHI may be shared with your treating healthcare providers to the extent necessary to provide treatment and care to you. These healthcare providers may include doctors, nurses, pharmacists, labs, and other healthcare providers who are involved in your care both at Children’s Health and at outside healthcare providers.

Payment Purposes

Children’s Health may need to share your PHI in connection with payment for services you receive. For example, Children’s Health may contact and share information with an insurance company, a government program, or other third parties to determine eligibility status, obtain prior approval, determine if your health plan will pay for treatment, and to file claims.

Healthcare Operations Purposes

Children’s Health may use and release your PHI for general healthcare operations purposes, including the following:

Other Disclosure Purposes

Required by Law: Children’s Health must report certain parts of your PHI to legal officials or authorities, including law enforcement, the court system, or government agencies. Examples include: reporting suspected abuse or neglect, domestic violence, or certain physical injuries, and responding to a court order, subpoena, warrant, or lawsuit request.

Releases of Your PHI that Require Your Authorization

Your authorization is needed for other uses and disclosures of your PHI, except for the types of examples included under the exceptions described above. This includes, unless otherwise required by law, release of psychotherapy notes, broader marketing purposes, sale of your PHI, HIV/AIDS information, substance abuse treatment records, and deceased patients’ records. If you provide Children’s Health the authorization to use or release your PHI, you may revoke that authorization at any time; however, Children’s Health cannot take back information that has already been shared. The authorization can be revoked by following the instructions described on the Authorization for the Inspection, Use, Disclosure and Release of Health Information form which can be obtained on our website at www.childrens.com or by contacting the Privacy Office.

Your Privacy Rights

Your rights regarding your PHI are as follows:

Right to receive this Notice of Privacy Practices

You have the right to receive a copy of this Notice at any time. You may obtain a paper copy of the current notice in all clinical areas or an electronic copy by visiting Children’s Health website at www.childrens.com.

Right to review and ask for a copy of your PHI

You have the right to review and request copies of your medical records that may be used to make decisions about your care. Usually this includes medical and billing records, but there may be exceptions for psychotherapy notes or information about third parties. You may request a paper or electronic copy of your medical record by visiting our Health Information Management department, by completing the Authorization for the Inspection, Use, Disclosure and Release of Health Information form located at www.childrens.com, or by contacting the Privacy Office. Also, you can sign up for a MyChart account, which allows you to electronically access portions of your health information at www.childrens.com. Children’s Health may charge you a fee to copy and/or mail your medical record to you as permitted by law. If we are able, we will provide an electronic copy to you within 15 days of your written request and receipt of appropriate fees.

Right to request confidential communications

You have the right to specify that Children’s Health 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 by telephone at work, or that we only contact you by mail at home or by email.   We will follow your request whenever it is reasonably possible. You can request an    alternate    place    for communication by completing the form Request for Alternative Communication of Health Information at the time of   registration, or   on Children’s Health website at www.childrens.com, or by contacting the Privacy Office at 214.456.4444 to request an alternate place for communication.

Right to request restrictions

You have the right to request restrictions or limitations on how your PHI is used or released. We have the right to deny your request, except we must agree when the disclosure of PHI would be to a health plan if the disclosure of PHI is for payment or healthcare operations and is not otherwise required by law, and if the PHI is for a healthcare item or service which was paid in full by you, or was paid in full by a person, other than health plan, on your behalf. You can complete the form Request for Restricting the Use or Disclosure of Health Information which can be found at www.childrens.com or by contacting the Privacy Office at 214.456.4444.

Right to Amend

You have the right to ask that your medical record at Children’s Health be changed if it is not correct or complete. Children’s Health does have the right to deny your request if: we did not create the information; we do not keep the information; you are not allowed to see and copy the information; or the information is already correct and complete. You may request a change by completing the form Request for an Amendment of Health Information which can be found at www.childrens.com or by contacting the Privacy Office at 214.456.4444.

Right to a Record of Releases

You have the right to request a record of releases (accounting of disclosures) when Children’s Health has disclosed your PHI. You can request a record of releases of your PHI by submitting the form Request for an Accounting of Disclosures of Health Information to the Health Information Management Department. This form can be found at www.childrens.com or by contacting the Privacy Office at 214.456.4444. If you request this record of releases more than once per year, Children’s Health may charge a fee for providing the list. The list will contain only information that is required by law. This list will not include releases for treatment, payment, and healthcare operations, or releases that you have authorized.

Questions or Complaints

If you have questions regarding your privacy rights, please call Children’s Health Privacy Office. If you believe your privacy rights have been violated, you may file a complaint by contacting Children’s Health Privacy Officer through Children’s Health HIPAA Hotline at 214.456.4444, by e-mail at privacy@childrens.com, or with the Secretary of Health and Human Services. You will not be penalized for filing a complaint.

Privacy Officer Contact Information:

Privacy Officer

Children’s Health

1935 Medical District Drive

Dallas, TX 75235

214.456.4444