Northpoint Pediatrics
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Protected health information (PHI) about you is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (e.g., name, address, phone number), that may identify you and relates to your past, present, or future physical or mental health conditions, as well as the healthcare services you receive.
Our practice is legally required to maintain the confidentiality of your protected health information (PHI) and to follow specific rules when using or disclosing this information. This Notice describes your rights to access and control your protected health information (PHI). It also explains how we follow applicable rules when using or disclosing your protected health information (PHI) to provide your treatment, obtain payment for services you receive, manage our healthcare operations, and for other purposes that are permitted or required by law.
Your Rights Under the Privacy Rule
The following is a statement of your rights under the Privacy Rule regarding your Protected Health Information (PHI). Please don't hesitate to contact our staff with any questions.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices.
We are required by law to follow the terms of this Notice. We reserve the right to change the terms of the Notice and to make the new Notice provisions effective for all PHI that we maintain. We will provide you with a copy of our current Notice if you call our office and request that it be emailed to you or sent by mail, or if you request one at the time of your next appointment. The Notice will also be posted in a conspicuous location in our practice, and if such is maintained, on our practice's website.
You have the right to authorize other uses and disclosures of your health information.
This means we will only use or disclose your PHI as described in this Notice, unless you authorize other use or disclosure in writing. For example, we would need your written authorization to use or disclose your protected health information (PHI) for marketing purposes, for most uses or disclosures of psychotherapy notes or substance use disorder counseling notes, or if we intend to sell your PHI. You may revoke an authorization at any time, in writing, except to the extent that your healthcare provider, or our practice, has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential communication.
This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, fax, telephone), and/or to a destination designated by you (i.e., cell phone number, alternative address, etc.). You must inform us in writing, using a form provided by our practice, how you wish to be contacted if it is not the address or phone number that we have on file. We will follow all reasonable requests.
You have the right to inspect and obtain a copy of your PHI*
This means you may submit a written request to inspect or obtain a copy of your complete health record, or to direct us to disclose your protected health information (PHI) to a third party. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable, cost-based fee for paper or electronic copies as established by federal guidelines. We are required to provide you with access to your records within 30 days of your written request unless an extension is necessary. In such cases, we will notify you of the reason for the delay and the expected completion date for the request.
You have the right to request a restriction of your PHI*
This means you may ask us, in writing, not to use or disclose any part of your protected health information for treatment, payment, or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In some instances, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this exact type of requested restriction.
You have the right to request an amendment to your PHI*
This means you may submit a written request to amend your PHI for as long as we maintain this information. In some instances, we may deny your request.
You have the right to request a disclosure of accountability*
You may submit a written request for a listing of disclosures we have made of your PHI to entities or persons outside of our practice, except for those made upon your request, or for purposes of treatment, payment, or healthcare operations. We will not charge a fee for the first accounting provided in 12 months.
You have the right to receive a privacy breach notice.
You have the right to receive written notification if the practice discovers a breach of your unsecured PHI and determines, through a risk assessment, that notification is required.
How We May Use or Disclose Protected Health Information
The following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment - We may use and disclose your protected health information (PHI) to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose protected health information (PHI) to other healthcare providers who may be involved in your care and treatment.
Payment - Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan undertakes before it approves or pays for the healthcare services we recommend for you, such as determining eligibility or coverage for insurance benefits.
Healthcare Operations - We may use or disclose your protected health information (PHI) as necessary to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.
Special Notices - We may use or disclose your protected health information (PHI) as necessary to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests, to provide information that describes or recommends treatment alternatives regarding your care, or to provide information about health-related benefits and services offered by our office.
We may contact you regarding fundraising activities, but you will have the right to opt out of receiving further fundraising communications. Each fundraising notice will include instructions on how to opt out.
Health Information Organization - The practice may opt to utilize a health information organization or a similar entity to facilitate the electronic exchange of information for treatment, payment, or healthcare operations.
To Others Involved in Your Healthcare - Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person that you identify, your PHI that directly relates to the person's involvement in your healthcare. Suppose you are unable to agree or object to such a disclosure. In that case, we may disclose such information as necessary if we determine, based on our professional judgment, that it is in your best interest. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, of your general condition or death. Suppose you are not present or able to agree or object to the use or disclosure of PHI (e.g., in a disaster relief situation. In that case, your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the necessary protected health information (PHI) will be disclosed.
Other Permitted and Required Uses and Disclosures - We are also permitted to use or disclose your PHI without your written authorization, or providing you an opportunity to object, for the following purposes: if required by state or federal law; for public health activities and safety issues (e.g. a product recall); for health oversight activities; in cases of abuse, neglect, or domestic violence; to avert a serious threat to health or safety; for research purposes; in response to a court or administrative order, and subpoenas that meet specific requirements; to a coroner, medical examiner or funeral director; to respond to organ and tissue donation requests; to addworker'sker's compensation, law enforcement and specific other government requests, and for specialized government functions (e.g., military, national security, etc); with respect to a group health plan, to disclose information to the health plan sponsor for plan administration; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
Prohibited Uses/Disclosures - Substance use disorder treatment records received from Part 2 programs, or testimony relaying the contents of suchdocumentss, will not be used or disclosed in any criminal investigation, to initiate or substantiate criminal charges, or in civil, criminal, administrative or legislative proceedings against you without your authorization or a court order with accompanying subpoena or similar legal mandate compelling disclosure.
PHI that is potentially related to reproductive health care is prohibited from being disclosed for purposes of investigating or imposing liability on any person for the mere act of seeking, obtaining, facilitating, or providing lawful reproductive health care.
Attestation - Any person requesting disclosure of PHI potentially related to reproductive health care for purposes of health oversight, law enforcement, judicial or administrative proceedings, or about decedents to coroners or medical examiners will be required to submit an attestation signifying that the PHI will not be used for prohibited purposes (see above section).
Privacy Complaints
You have the right to complain to us or directly to the Secretary of the Department of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.
You may ask questions about your privacy rights, file a complaint, or submit a written request (for access, restriction, or amendment of your PHI or to obtain a disclosure accountability) by notifying our Privacy Manager at 317-621-9000.
Effective Date 7/1/2013
Last Update 6/12/2025
