Children's Clinic Privacy Policy

Recently, laws were passed that have been designed to ensure the patient's medical information is kept confidential and only used (within the office) or disclosed (to outside entities) to facilitate appropriate care and efficient billing for services rendered. These laws require us to explain to our patients the normal procedures we have for use and disclosure of patient health information. 

Under these rules, you have the right to:

  • Request restrictions on the use and disclosure of your child's health information
  • Receive confidential communications concerning your child's medical condition and treatment
  • Inspect and/or receive a copy of your child's medical chart
  • Request that the chart be amended or corrected if you feel the information does not accurately reflect the child's condition
  • Receive an accounting for how health information was shared and to whom



Your child's health information will be used by all the providers in the practice to assist with evaluation and treatment of your child. In addition, the records may be used by office staff as reference for any pertinent health question or concern you may have such as: dates of last immunization, last check-up, refills for medications, etc. The provider may also discuss your child's care with other healthcare professionals such as specialists, or emergency room personnel for purpose of ordering tests or receiving results. this communication may be over the phone, fax or internet by email. All of these communication usually become part of the child's chart. Upon request, we may disclose to your child's school immunization, or fax permission to administer medications, or discuss health issues with the school nurse, teachers or school counselor. 



Billing for services will require release of information to the insurance company related to each specific visit, including date, diagnosis and services provided. General information may be disclosed to insurance companies to determine eligibility for services, justification of charges for services provided, or for utilization review conducted by insurance plans. 


Law Enforcement

In some situations, we are required by law to disclose information to law enforcement when the child's health is at risk. In this case you will be contacted.


Public Health Concerns

We are required by law to disclose health information with certain diseases, such as tuberculosis, pertussis, etc. which pose a public health threat.


Audio/video recording

To ensure confidentiality and privacy, any type of electronic recording is strictly prohibited at any location in the office.


Other Disclosures

Any disclosures of personal health information other than the above would require specific permission by you in writing.

We may periodically review and make changes in our privacy policy as needed/required by law. If you have questions or concerns about these policies, or specifically how your child's health information is shared, please feel free to contact:

Jane Hicks, CPNP (our privacy officer)

Call our office during regular business hours.

For further information: Department of Health and Human Services
Phone: 877-696-6775