Patriot Pediatrics P.C.

Policy on Notice of Privacy Practices

Patient Rights

Patriot Pediatrics acknowledges that it must maintain and provide to patients a notice of privacy practices that informs patients about their rights concerning protection of their protected health information (PHI). Under the Privacy Rule patients have the following rights:

· Right to receive a copy of Patriot Pediatrics notice of privacy practices

· The right to request restrictions on certain uses and disclosures of PHI

· The right to request restrictions on how Patriot Pediatrics communicates PHI to the patient

· The right to inspect and copy PHI

· The right to request an amendment of PHI

· The right to authorize the use and disclosure of PHI for certain purposes unrelated to treatment, payment, or health care operations (“TPO”) and for psychotherapy notes

· The right to request an accounting of the disclosures of PHI made by Patriot Pediatrics for purposes other than TPO and made pursuant to a valid authorization

· The right to complain about alleged violations to Patriot Pediatrics and to the Department of Health and Human Services.

Practice Obligations

Commencing no later than April 14, 2003 the Practice shall distribute the notice of privacy practices to all patients on the day services are first rendered.

· If Patriot Pediatrics offers patients the opportunity to receive a copy of the notice of privacy practices via e-mail, it may do so only if the patient accepts.

· The practice must use its best efforts to obtain a written acknowledgement from each patient that he/she has received a copy of the notice of privacy practices. If unable to obtain such an acknowledgement, the practice must document its efforts to obtain the acknowledgement and the reason why the acknowledgment was not obtained. Each acknowledgement or best efforts statement shall be placed and retained in the patient’s medical record.

· Patriot Pediatrics will post a notice of privacy practices in an area of the office where it is clearly visible to patients. If the notice of privacy practices is revised, the revised version will be posted in a clearly visible area, and the revised version must be distributed to each patient upon his/her request. The Practice is not required to mail or send the revised notice to all patients.

· Patriot Pediatrics shall post its notice of privacy practices on its website.

· Patriot Pediatrics shall retain a complete copy of each version of the notice of privacy practices for at least six years.