HIPAA Disclosure & Confidentiality Agreement
Northland Child Psychiatry safeguards the privacy of your health information and provides this notice to explain how that information may be used or disclosed.
Information about your health, health care, and payment for health care is considered Protected Health Information, or PHI.
Protecting Your Health Information
Protected Health Information includes information concerning your health, the health care you receive, and payment for that health care.
Northland Child Psychiatry safeguards your Protected Health Information and provides this notice as a summary of the practice's privacy practices.
The notice explains the circumstances in which medical information may be used or disclosed and the purposes for which those disclosures may occur.
When Protected Health Information May Be Used or Disclosed
Northland Child Psychiatry may use or disclose Protected Health Information without additional permission in the circumstances described below.
Treatment
Health information may be shared with physicians, nurses, and other individuals involved in providing health care.
This may include individuals providing services such as laboratory work or X-rays.
Payment
Health information may be disclosed when necessary to collect payment for health care services that have been provided or are expected to be provided.
Health Care Operations
Health information may be used or disclosed as part of normal health care operations.
Examples include contacting a patient with an appointment reminder or calling a patient's name in the waiting room when the physician is ready.
When Required by Law
Protected Health Information may be disclosed to courts, government agencies, or law enforcement when disclosure is legally required.
Examples may include required reporting involving abuse, neglect, or certain physical injuries.
Public Health Activities
Health information may be reported to government agencies when required for the prevention or control of disease or injury.
Work-related illnesses or injuries may also have to be reported to an employer when required for workplace safety monitoring.
Health Oversight Activities
Health information may be disclosed to government agencies responsible for monitoring or licensing health care providers such as physicians and nurses.
To Prevent a Serious Threat to Health or Safety
When necessary to prevent or lessen a serious threat to health or safety, health information may be disclosed to law enforcement or another person who may be able to prevent or reduce the threat.
Patient Rights Regarding Protected Health Information
Patients may make certain requests regarding their Protected Health Information and how the practice communicates with them.
Request a Copy of Your PHI
In most circumstances, patients may request access to or a copy of their Protected Health Information.
Certain information may not be available for inspection, including information prepared for legal or government proceedings or information that cannot legally be accessed.
Because PHI is maintained electronically, patients may request an electronic copy.
Request Restrictions
Patients may ask Northland Child Psychiatry to limit certain uses or disclosures of their information.
The practice cannot restrict a use or disclosure when that use or disclosure is required by law.
Request Confidential Communication
Patients may request that Northland Child Psychiatry communicate with them at a particular address or through a particular method of communication.
Contact Northland Child Psychiatry
If you have questions about this notice or the practice's privacy practices, please contact the office.
Effective Date: July 1, 2022