This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review carefully.
WHO MUST FOLLOW THIS NOTICE
This notice of Privacy Practices will be followed by all Physicians and staff of Cross Creek Pediatrics. Any health care professional authorized to enter information into your medical record will understand be committed to protecting your medical information.
OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION
At Cross Creek Pediatrics, we are committed to treating and using protected health information (PHI) about your responsibly. This notice describes the personal information we collect and how and when we use or disclose that information. It also describes your rights as they relate to your PHI.
UNDERSTANDING YOUR HEALTH INFORMATION
Each time you visit Cross Creek Pediatrics a record of your visit is made. Typically this record contains your child's symptoms, examination, test results, diagnosis, treatment and a plan for future care of treatment. This information is referred to as your health or medical record. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, in addition to who, what when, where and why others may access your health information, which helps you make informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of Cross Creek Pediatrics, the information belongs to you. You have the right to: a. Obtain a paper copy of this notice of information practices upon request. b. Inspect or receive a copy of your health record as provided by 45 CFR 164.528. (A fee will be assessed a $10 fee for the supplies and time to copy such.) c. Amend your health record as provided in 45 CFR 164.528. d. Obtain an accounting of disclosures of your health information as provide in 45 CFR 164.528. e. Request communications of your health information by alternative means or at alternative locations. f. Request restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. g. Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
Cross Creek Pediatrics is required to maintain the privacy of your PHI and abide by the terms of this notice. We will not use or disclose your PHI without your authorization, except as described in this notice. We may release without your consent medical information to law enforcement for a court order, warrant, summons, grand jury demands or similar process. We may provide your information to providers or correctional institutions who are personally involved in providing care pursuant to your consent and treatment. We can provide your information to health insurance carrier for any charges you incurred while you were a patient at this clinic and in case of any emergency transferring you to a receiving facility for care. If you believe you privacy rights have been violated, you can file a complaint with our Medical Director or the Office for Civil Rights.
Cross Creek Pediatrics
2035 Valleygate Drive
Fayetteville, NC 28304
US Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, DC 20201