Q: What is the purpose of this Notice?
A: This Notice explains how, when and why we typically use and disclose health information, and it details your privacy rights regarding your health information. In our Notice, we refer to our uses and disclosures of health information as our “Privacy Practices.”

Q: What are Children’s T.E.A.M.’s Privacy Practices?
A: Our Privacy Practices strive to do the following:
a) make sure that health information that identifies individuals is kept private;
b) give Notice of our Privacy Practices and legal duties with respect to protected health information;
c) follow the terms of the Notice that is currently in effect.

Q: What are Children’s T.E.A.M.’s duties regarding health information?
A: We are committed to protecting health information and to informing you about your rights regarding such information. We are also required by law to protect the privacy of protected health information and to provide notice of these legal duties.

Q: What type of information is considered protected health information?
A: Protected health information generally includes information that we create or receive that identifies an individual’s past, present or future health status or care or the provision of payment for that health care. We respect the confidentiality of health information and recognize that information about health is personal.

Q: Which healthcare providers are included in this Notice?
A: This Notice describes the privacy practices of the following: a) any Children’s T.E.A.M. office professionals authorized to enter information on an individual’s chart; b) all departments within Children’s T.E.A.M.; c) all of our Children’s T.E.A.M. employees and/or contracted employees.

Q: What healthcare providers are not included in this Notice?
A: Our Notice does not address the privacy practices of an individual’s personal doctor or the practices used by personal doctors in their private or public offices. Our Privacy Practices will not affect the medical decisions made by a personal doctor regarding an individual’s care and treatment.

Q: How will I authorize the use or disclosure of protected health information?
A: Most usage and disclosures of protected health information require your prior authorization. For situations not otherwise described in our Notice, we will ask for your authorization before we use or disclose your health information.

Q: When and how might I revoke my authorization?
A: You may revoke your authorization for the use or disclosure of your protected health information, in writing, at any time in order to stop future disclosures of information. Information previously disclosed, however, will not be requested to be returned, nor will revocation affect any action that has already been taken.

Q: When can protected health information be used or disclosed without my written authorization?
A: There are situations in which we may use and disclose health information without an individual’s authorization.
Specifically, we may use and disclose protected health information as follows:
● For payment of health services we may use and disclose protected health information to bill and receive payment for the health services. For example, your insurance company may request information about your services in order to authorize or pre-approve services, determine medical necessity, or determine a pre-existing condition.
● For your healthcare operations we perform many activities to help assess and improve the services that we provide. Examples of such activities include participating in internships, shadowing programs, performing quality
reviews, conducting patient opinion surveys, developing clinical guidelines and protocols, business management, and insurance or legal compliance reviews. These activities are referred to as “healthcare operations.” We may use and/or disclose health information for purposes of any of these healthcare operations.
● For reasons related to public health, we may use and disclose protected health information to a public health authority that is authorized by law to collect or receive information in order to report, among other things,
communicable diseases and child abuse and to report medical device and product-related events to the FDA.
In certain limited situations, we may also disclose health information in order to notify a person exposed to a communicable disease.
● For reasons related to public and/or individual safety, we may use and disclose health information if we believe that the disclosure is necessary to prevent or lessen a serious threat or harm to the public and/or to prevent or
lessen a serious threat or harm to a single individual.
● For support of law enforcement activities, we may disclose limited health information in response to a law enforcement official’s request for information to identify or locate a victim, a suspect, a fugitive, a material
witness or a missing person (including individuals who have died) or for reporting a crime that has occurred on our premises or that may have caused a need for emergency services.
● For support of judicial and administrative proceedings, we may disclose health information in response to a subpoena, an order of the court or an administrative tribunal.
● For appointment reminders and to provide information about health-related products and services, we may disclose health information by making contact to remind individuals about appointments and/or other scheduled services, to provide information about treatment alternatives and to provide information about other health related products and services.

Q: How can I place restrictions on the use and/or disclosure of health information?
A: You may mail a request for a restriction on how we use or disclose your protected health information for payment of your healthcare services or for activities related to our healthcare operations. You may also request a restriction on what health information we may disclose to someone who is involved in care, such as a family member or friend. We are not required to agree to your request. Additionally, any restriction that we may approve will not affect any use or disclosure that we are legally required or permitted to make under the law. Send written requests to: Children’s T.E.A.M. Administrative Office, 2474 East Joyce Blvd. Suite 2, Fayetteville, AR 72703.

Q: How can I inspect and receive copies of my health information?
A: You may ask to look at and obtain a copy of your health information. We may charge a fee for copying or preparing a summary of requested health information. We will typically respond to your request for health information within 1 week of receiving your request.

Q: How can I request a change in my health information?
A: You may mail a request to change or make an addition to your health information (Children’s T.E.A.M. Administrative Office, 2474 East Joyce Blvd. Suite 2, Fayetteville, AR 72703). Under no circumstances will we erase or otherwise delete original documentation in your health information.

Q: How can I request an accounting of the disclosures of my health information?
A: You may mail a request for the accounting of certain types of disclosures of your health information. The law excludes an accounting of disclosures intended to care for you, to pay for your health services, or in instances where you provided written authorization for the disclosure. You may mail your request to Children’s T.E.A.M. (Administrative Office, 2474 East Joyce Blvd. Suite 2, Fayetteville, AR 72703). Generally, we will respond to your request within 30 days of receiving your written request unless we need additional time.

Q: How do I share complaints or concerns?
A: We welcome an opportunity to address any concern that you may have regarding the privacy of your health information. For questions, concerns, requests or complaints, contact Children’s T.E.A.M. Privacy Officer by calling 479-521-8326 or by mailing a complaint to Children’s T.E.A.M. Administrative Office, 2474 East Joyce Blvd. Suite 2, Fayetteville, AR 72703.

If you believe that the privacy of your health information has been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.