This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
During treatment at Pediatric Surgical Associates doctors, nurses, and other caregivers may gather information about your medical history and health. This notice will explain how such information may be used and shared with others. It will also explain privacy rights regarding this kind of information.
Most patients of Pediatric Surgical Associates are children. When we refer to “you” or “your” in this notice, we refer to the patient. When we refer to types of disclosures of information to “you,” we mean disclosures to the patient, the patient’s guardian, or person legally authorized to receive information about the patient.
Medical information may be used for the following purposes:
We will use the patient’s information to provide, coordinate, and manage care and treatment. For example, a physician may share medical information with another physician for consultation or a referral.
We will use information to receive payment for the services we provide. For example, we will disclose information in order to submit bills or claims to insurance companies and Medicare or Medicaid.
Health care operations:
We will use information for certain activities related to the functioning of Pediatric Surgical Associates. For example, we may use or disclose information for quality assurance activities.
Appointment reminders and other health information:
We may use information to send you reminders about future appointments. Information may be used to provide you with information about new or alternative treatments or other health care services that may be of interest to you.
We may use information to notify you about fund-raising campaigns or other charitable events.
Family members or other responsible people:
We may disclose information to people who will be taking care of the patient or are responsible for paying bills, such as other family members. Pediatric Surgical Associates will only disclose medical information that these people need to know. We may also use information to let other family members or other responsible people know where the patient is and what their general medical condition is. If the patient is able to make his or her own health care decisions, Pediatric Surgical Associates will ask permission before using medical information for these purposes. If the patient is unable to make health care decisions, Pediatric Surgical Associates will disclose relevant medical information to family members or other responsible people if we feel it is in the patient’s best interests to do so. For example, we may provide limited medical information to allow another family member to pick up a prescription or X-ray for the patient.
Under emergency conditions, we may disclose information about you to the government or other groups that assist in emergencies or disasters.
Other uses or disclosures:
Pediatric Surgical Associates may disclose or use information in the following cases: when required by law; for public health activities; relating to victims of abuse, neglect, or domestic violence; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroners, medical examiners, and funeral directors, as permitted by law; for organ donation purposes; for research purposes under certain circumstances; to avert a serious threat to health or safety; for certain specialized government functions, such as military discharge and national security and intelligence; and for workers’ compensation purposes.
Under certain circumstances, we may use and disclose medical information about you for research purposes. In some cases, we will only disclose information about you for research purposes with your authorization. In other cases, where there is only a minimal risk to your privacy, for example a research project comparing the health and recovery of all patients who received one medication to those who received another, for the same condition, we may disclose information about you without your authorization. All research projects are subject to a special approval process, which evaluates each proposed research project and its use of medical information. We will only disclose information about you for research without your authorization when the special approval process results in a determination that there is only a minimal risk to your privacy, and we have initiated processes to protect your privacy to the greatest extent possible.
Pediatric Surgical Associates will not use or disclose medical information in any other way unless you allow us to do so in writing. If you do give us permission to use or disclose the patient’s medical information for another purpose, you have the right to change your mind and revoke the permission at any time.
Restrict use and disclosure:
You may request that Pediatric Surgical Associates not use medical information in certain ways or for certain purposes. You may also request that Pediatric Surgical Associates not provide medical information to certain people. However, Pediatric Surgical Associates has the right to refuse your request. Pediatric Surgical Associates may use or disclose the patient’s medical information in situations requiring emergency treatment, in which case we will ask the person(s) who receive the information not to further use or disclose the information.
You may request that Pediatric Surgical Associates provide you with your medical information in a confidential manner. For example, you can request that we send appointment reminders, bills, and other mailings to a different address or that we notify you of this kind of information in another way, such as by telephone call. You must make this request in writing and specify another address or means of communication. We must agree to your written request. We may also ask you to give us information about how you will pay your bills.
Inspection and copy:
You may ask to see and copy your medical records, unless that information is protected by law. You must make these requests in writing. If your request to look at or copy the patient’s medical records is denied, you have the right to have the denial reviewed by a health care professional. We will act upon your request within 30 days and may charge you a legally acceptable amount for copying costs.
Change information or amend medical records:
You may ask us to change information in the patient’s medical records. If your request is denied, you can write a statement of disagreement with the denial that we will keep with your medical information.
Accounting of disclosures:
You may ask us to provide you with information about certain disclosures of your medical information we made in the past. Requests for accounting will not be made prior to April14, 2003. Your request can go back six years after April 14, 2009.
If you have received this notice of medical information privacy rights electronically, you may ask us to provide you with a paper copy.
If you feel your medical information privacy rights have been violated, you may file a complaint with the Secretary of Health and Human Services and/or with the Pediatric Surgical Associates privacy official listed below. Filing a complaint will not affect the quality of the services you receive from Pediatric Surgical Associates and you will not be retaliated against for filing a complaint.
The U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
Toll free 1-877-696-6775
Electronic Mail: HHS.Mail@hhs.gov
Pediatric Surgical Associates Privacy Official:
You may contact the designated privacy official at Pediatric Surgical Associates:
Privacy Officer Paul Louiselle, Executive Director
2530 Chicago Ave. Suite 550
Minneapolis, MN 55404
Electronic Mail: email@example.com
The effective date of this notice is April 14, 2003. Pediatric Surgical Associates is required by law to maintain the privacy of protected health information and to provide individuals with this notice of its legal duties and privacy practices with respect to health information. Pediatric Surgical Associates is required to abide by the terms of the notice currently in effect. Pediatric Surgical Associates reserves the right to change the terms of this notice and to make new notice provisions effective for all protected health information maintained by Pediatric Surgical Associates. If the terms of this notice are changed, Pediatric Surgical Associates will provide individuals with a revised notice: at the time of treatment or upon request, by posting the revised notice in designated locations at Pediatric Surgical Associates.
Pediatric Surgical Associates (PSA) will not disclose any information about you to third parties. All third party vendors used by PSA to assist in the development, hosting, or maintenance of this website must agree not to disclose any information. PSA, in its own judgment, may release information to third parties in special cases, such as compliance with valid legal requirements.
Protection of Information
Pediatric Surgical Associates uses all reasonable physical means to secure and protect its site from unauthorized persons. PSA does not warrant or represent that the information is protected against misuse or alteration by third parties.
Information and communications related to this website are transmitted over media that may be outside of the administration of PSA. Therefore, PSA has no liability for occurrences resulting during such transmissions.
Medical Content Disclaimer
The content and information on this website are for your informational use only. Our site provides general child health and parenting information. Our site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you read on this website.
Pediatric Surgical Associates Liability
The use of this website and its content is at your own risk. The content is provided on an “as is” basis. PSA disclaims all warranties, either express or implied, statutory or otherwise, including but not limited to the implied warranties or merchantability, non-infringement of third parties’ rights, and fitness for a particular purpose.
PSA follows the Health On the Net (HON) code of ethics in the development of the medical content of this site, but makes no representations or warranties about the accuracy, reliability, completeness, currency, or timeliness of the content.
In no event shall Pediatric Surgical Associates be liable for any damages (including, without limitation, incidental and consequential damages, personal injury/wrongful death, lost profits, or damages resulting from data or business interruption) resulting from the use or inability to use the content of this website whether based on warranty, contract, tort or any other legal theory, and whether or not PSA is advised of the possibility of such damages. Pediatric Surgical Associates is not liable for any claim, whatsoever, caused by your use or misuse of the website.
Any use of this website or the information contained in the website is at your own risk. We will not be responsible for the consequences of your decision to use the information contained in this website.
The medical information provided in this site is for educational purposes only; it is not intended nor implied to be a substitute for professional medical advice. Always consult your physician or healthcare provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Our office is committed to the right to privacy for our patients and website visitors. When a person visits our website we may collect and track data from our site’s server. This information helps us to improve upon the content provided on our site. Information collected may include how long you spend on our site, the pages you visit, your browser and operating system types and the name of your Internet service provider.
Our website provides the capability to request information online. To process your request, we may require that you provide us with personal identifying information. All information collected is held in complete confidence. It is our policy not to share the information with third parties for any reason, unless legally required to do so or as necessary to process your requests.