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Notice ofPrivacy Practices

Notice of Privacy PracticesTABLE OF CONTENTSUnderstanding Your Health Record/Information. ....2Your Child’s Health Information Rights. ............3Our Responsibilities. .............................4For More Information or to Report a Problem .......9Changes to This Notice. ..........................91

Notice of Privacy PracticesUNDERSTANDING YOUR CHILD’S HEALTHRECORD/INFORMATION:Each time your child visits a hospital, physician, or other healthcareprovider, a record of your child’s visit is made. This informationis often referred to as your child’s health record or medical record.Typically, this record contains your child’s symptoms, examinationand test results, diagnoses, treatment, and a plan for future care ortreatment. Your child’s record serves as:• A basis for planning your child’s care and treatment• A means of communication among the many health professionalswho contribute to your child’s care• A legal document describing the care your child received• A means by which your child or a third-party payer can verifythat services billed were actually provided• A tool in educating health professionals• A source of data for medical research• A source of information for public health officials charged withimproving the health of the nation• A source of data for facility planning and marketing• A tool with which we can assess and continually work to improvethe care we render and the outcomes we achieve.Understanding what is in your child’s record and how yourchild’s health information is used helps ensure its accuracy, betterunderstand who, what, when, where, and why others may accessyour child’s health information and make more informed decisionswhen authorizing disclosure to others.2

Notice of Privacy PracticesOUR RESPONSIBILITIES:This organization is required to:• Maintain the privacy of your child’s health information• Provide you with a notice as to our legal duties and privacypractices with respect to information we collect and maintainabout your child• Abide by the terms of this notice• Notify you if we are unable to agree to a requested restriction• Accommodate reasonable requests you may have made tocommunicate health information by alternative means toalternative locations.We will not use or disclose your child’s health information withoutyour child’s authorization, except as described in this notice.PERMITTED DISCLOSURES FOR TREATMENT,PAYMENT, AND HEALTH CARE OPERATIONS THATDO NOT REQUIRE PATIENT AUTHORIZATION:We will use your child’s health information for treatment. Forexample: Information, obtained by a nurse, physician, or othermember of your child’s healthcare team will be recorded in yourchild’s record and used to determine the course of treatment thatshould work best for your child.Members of your child’s healthcare team will then record theactions they took and their observations. In that way, the physicianwill know how your child is responding to treatment. We willprovide your child’s physician or a subsequent healthcare providerwith copies of various reports or share your child’s health informationelectronically to assist him or her in treating your child in the future.4

Notice of Privacy PracticesWe will use your child’s healthcare information for payment. Forexample: A bill may be sent to you or a third-party payer. Presentinginsurance information at the time of service provides us with theauthorization to release personal information to your insurancecarrier. This includes, but is not limited to, social security number,full name, and date of birth, as well as the diagnosis pertaining tothe service provided. Other personal information will be updatedas necessary. In addition, many insurance carriers require medicalrecords and results to determine payment. By requesting us to filea claim with your insurance company, you are consenting to thisrelease of information.Your child’s clinical information may be reviewed to determinewhether your insurance company will reimburse for your child’scontinued care.We will use your child’s health information for regular healthcareoperations. For example: The risk or quality improvement manager,or members of the quality improvement team may use information inyour child’s health record to assess the quality of care and outcomesin your child’s case and others like it. This information will then beused in an effort to continually improve the quality and effectivenessof the healthcare and service we provide.Appointment reminders and calls; sign-in sheets: We may contactyou to remind you of your child’s appointment for treatment ormedical care at one of our facilities. We may ask your child to signin when your child comes for care so we can prepare for your child’svisit and call your child when your child’s caregiver is ready to seeyour child.Healthcare oversight and quality assurance; peer review: Wemay disclose medical information to a health oversight agency foractivities authorized by law. These oversight activities include, forexample, audits, investigation, inspections, and licensure. Theseactivities are necessary for the government to monitor the health caresystem, government programs, and compliance with civil rights laws.5

Notice of Privacy PracticesSharing information to decide about treatment alternatives or otherhealth related benefits and services that might be of interest to youor your child. We may use and disclose medical information to tellyou about or recommend possible treatment options or alternativesthat may be of interest to you or your child. We may also use anddisclose medical information to tell you about health-related benefitsor services that may be of interest to you or your child.Business Associates: There are some services provided in ourorganization through contracts with others. Examples includephysician services in the emergency department, radiology,anesthesiology, certain laboratory tests, and a copy service weuse when making copies of your child’s health record. Whenthese services are contracted, we may disclose your child’s healthinformation to our business associates so that they can perform thejob we’ve asked them to do and bill you or your third-party payerfor services rendered. To protect your child’s health information,however, we require the business associate to appropriately safeguardyour child’s information.Family Notification and Communication: We may use or discloseinformation to notify or assist in notifying a family member, personalrepresentative, or another person responsible for your child’s care,your child’s location, and general condition. If these people areinvolved in your child’s medical care in any way, we may shareinformation about your child. If someone is in charge of payingfor your child’s care, we may share information with that person.During a disaster, we may share information with a disaster relieforganization so that you can be notified of your child’s condition,status, and location.Research: We may disclose information to researchers when aninstitutional review board has reviewed the research proposal,established protocols to ensure the privacy of your child’s healthinformation, and has approved their research.6

Notice of Privacy PracticesFood and Drug Administration (FDA): As required by law, we maydisclose health information relative to adverse events with respect tofood, supplements, and/or product defects.Public health: We may disclose medical information about yourchild for public health activities. These activities generally include thefollowing:• to prevent or control disease, injury, or disability;• to report child abuse or neglect;• to report reactions to medications or problems with products;• to notify people of recalls of products they may be using;• to notify a person who may have been exposed to a disease ormay be at risk for contracting or spreading a disease or condition;• to notify the appropriate government authority if we believe apatient has been the victim of abuse, neglect, or domestic violence.We will only make this disclosure if you agree or when requiredor authorized by law.Law enforcement: We may release medical information if asked todo so by a law enforcement official:• In response to a court order, subpoena, warrant, summons, orsimilar process;• To identify or locate a suspect, fugitive, material witness, ormissing person;• About the victim of a crime if, under certain limitedcircumstances, we are unable to obtain the parent’s agreement;• About a death we believe may be the result of criminal conduct;• About criminal conduct at the School Based Health Center; and• In emergency circumstances to report a crime; the location of thecrime or victims, or the identity, description or location of theperson who committed the crime.7

Notice of Privacy PracticesTo Avert a Serious Threat to Health or Safety: We may use anddisclose medical information about your child when necessary toprevent a serious threat to your child’s health and safety or the healthand safety of the public or another person. Any disclosure, however,would only be to someone able to help prevent the threat.Access by attorneys and the judicial system: If your child isinvolved in a lawsuit or a dispute, we may disclose medicalinformation about your child in response to a court or administrativeorder. We may also disclose medical information about your childin response to a subpoena, discovery request, or other lawful processby someone else involved in the dispute, but only if efforts have beenmade to tell you about the request or to obtain an order protecting theinformation requested.Government security and intelligence; bioterrorism: We may releasemedical information about your child to authorized federal officialsfor intelligence, counterintelligence, and other national securityactivities authorized by law. We may disclose medical informationabout your child to authorized federal officials so they may provideprotection to the President, other authorized persons or foreign headsof state or conduct special investigations.Mental Health, Substance Abuse, Sexual Assault, HIV/AIDS: Thereare special state and federal privacy rules relating to these care areas.If you have concerns about how information is used, maintainedand disclosed relating to these areas, please contact the HealthInformation Management Department at 301-790-8137.8

Notice of Privacy PracticesFOR MORE INFORMATION OR TO REPORT APROBLEM:If you have questions and would like additional information, youmay contact the Privacy Officer through the GUIDELine at 301-790-7950 or toll-free at 888-847-9247. If you believe your child’s privacyrights have been violated, you can file a complaint in writing withour Privacy Officer at 11116 Medical Campus Road, Hagerstown, MD21742 or with the U.S. Secretary of Health and Human Services, Officeof Civil Rights. There will be no retaliation for filing a complaint.CHANGES TO THIS NOTICEWe reserve the right to change our practices and amend our Noticeof Privacy Practices effective for all protected health informationwe maintain for now and the future. An amended Notice shall beavailable to you in paper or electronic form upon request.Effective Date: January 20139

You have the right to a paper copy of this notice upon request, even ifyou agreed to receive this notice electronically. You may obtain a copyof this notice at our website, www.MeritusHealth.com.11116 Medical Campus RoadHagerstown, MD 21742