Privacy Practices
This notice describes how protected medical and drug-related information about you may be used and disclosed and how you can
get access to this information. Please review it carefully.
General Information
Information regarding your health care, including payment for health care and treatment, is primarily protected by three federal laws:
(i) the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. § 1320d et seq., 45 C.F.R. Parts 160 & 164; (ii)
the additional privacy and security requirements enacted pursuant to Subtitle D of the Health Information Technology for Clinical
Health Act (HITECH), including 45 C.F.R. Sections 164.308, 164.310, 164.312, and 164.316; and (iii) the Confidentiality Law, 42
U.S.C. § 290dd-2, 42 C.F.R. Part 2. Under these laws, Pediatricians of Hyde Park, LLC may not say to a person outside
Pediatricians of Hyde Park, LLC that you are a patient, nor may Pediatricians of Hyde Park, LLC disclose any information identifying
you or disclose any other protected information about you, except as permitted by federal or Ohio law.
How Pediatricians of Hyde Park, LLC May Use and Disclose Medical Information about You
The following list describes the ways Pediatricians of Hyde Park, LLC may use and disclose your medical information without your written authorization. The examples provided serve only as guidance and do not include every possible use or disclosure.
For Treatment: We may use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related service. For example, we may disclose your PHI to other doctors who need the information to provide you with care.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed
and payment may be collected from you, an insurance company, or a third party. We may also tell your health plan about a
treatment or procedure you are going to receive in order to obtain prior approval or to determine whether your plan will cover the
services.
For Health Care Operations: We may use and disclose medical information about you for our operations. For example, we may
use your PHI to assess our treatment and services. These uses and disclosures are necessary to operate Pediatricians of Hyde
Park, LLC in an efficient manner and to ensure that all individuals receive quality care.
Treatment Reminders: We may use and disclose medical information in order to remind you of a scheduled treatment appointment
or procedure.
Business Associates: We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.
Required by Law: We will disclose medical information about you when required to do so by federal or Ohio state laws.
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you to medical or law
enforcement personnel when necessary to prevent a serious threat to your health and safety or the health and safety of the public or
another person.
Sale of Pediatricians of Hyde Park, LLC: We may use and disclose medical information about you to another health care entity in
the sale, transfer, merger, or consolidation of Pediatricians of Hyde Park, LLC, unless your medical information includes information
about substance use disorder treatment services provided to you. Such information will only be transferred to the new entity
pursuant to your written authorization as further described below.
Electronic Disclosure: We may disclose your medical information orally, in paper format or through the use of any electronic
means.
Special Situations
Organ and Tissue Donation: If you are an organ donor, we may disclose your PHI to organizations that handle procurement of
organ, eye, or tissue transplantations
Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by
military command authorities.
Workers’ Compensation: We may release medical information about you for workers’ compensation or similar programs. These
programs provide benefits for work-related injuries or illness.
Qualified Personnel: We may disclose medical information for research or for management audit, financial audit, or program
evaluation, but Pediatricians of Hyde Park, LLC personnel may not directly or indirectly identify you in any report of the research,
audit, or evaluation, or otherwise disclose your identity in any manner.
Public Health Risks: We may disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury, or disability;
- To report births and deaths;
- To report child abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
All such disclosures will be made in accordance with the requirements of federal and Ohio state laws and regulations.
law. Health oversight agencies include public and private agencies authorized by law to oversee health care providers and the
health care industry in general.
such as providing information to the police about the victim of a crime.
when authorized by law (e.g., identify a deceased person or determine cause of death) or to funeral directors.
treatment information about you to the correctional facility or law enforcement official. Such release would be necessary for: (1) the
facility to provide you with proper care; (2) to protect your health and safety or the health and safety of others; and (3) to ensure the
safety and security of the correctional facility.
Pediatricians of Hyde Park, LLC will not use or disclose your medical information for any other purposes (including, without limitation, marketing), unless you give Pediatricians of Hyde Park, LLC your written authorization to do so. If you give Pediatricians of Hyde Park, LLC such written authorization for a purpose not described in this Notice, then you may, in most cases, revoke such authorization in writing at any time. Your revocation will be effective for all your medical information Pediatricians of Hyde Park, LLC maintains, unless our practice has already taken action in reliance on your prior authorization.
(see 42 CFR Part 2) and will only be used or disclosed by Pediatricians of Hyde Park, LLC pursuant to: (1) your written authorization;
(2) a court order or other legal requirement; (3) medical needs in an emergency to qualified medical personnel; or (4) research, audit,
or program evaluation purposes to qualified personnel. This includes use or disclosure of such information in the event of a sale,
transfer, merger, or consolidation of Pediatricians of Hyde Park, LLC. If you do not provide written authorization in such an event,
your information will not be transferred.
crime committed by a patient of Pediatricians of Hyde Park, LLC or a member of our practice workforce, or any information about
suspected child abuse or neglect that is otherwise reportable under Ohio law to appropriate state or local authorities. A violation of
the federal law and regulations that protect the confidentiality of substance use disorder treatment patient records is a
crime. Suspected violations may be reported to appropriate authorities in accordance with 42 CFR Part 2.
used to make decisions about your care, except for information compiled for use in a civil, criminal, or administrative proceeding or in
other limited circumstances.
Compliance Officer. If you request a copy of the information, our practice may charge a fee as established by its licensing authority,
if applicable, for the costs of copying, mailing, or summarizing your medical records.
circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A third-party licensed
health care professional chosen by Pediatricians of Hyde Park, LLC will review your request and denial. This professional will not be
the same person who denied your request. Our practice will comply with the outcome of the review.
correct or amend the information. You have the right to request an amendment for as long as the information is kept by Pediatricians
of Hyde Park, LLC.
Officer. In addition, you must provide a reason that supports your request. Our provider may deny your request for an amendment if
it is not in writing or does not include a reason to support the request.
disclosures made of your medical information for purposes other than treatment, payment, or health care operations.
must state a time period, which may not be longer than six (6) years. Your request should indicate in what form you want the list (for
example, on paper or electronically). The first list you request within a 12-month period will be provided to you by our practice for
free. For additional lists within the 12-month period, you may be charged for the cost of providing the list. Our practice will notify you
of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Hyde Park, LLC uses or discloses about you for treatment, payment, or health care operations. You also have the right to request a
limit on the medical information our practice uses or discloses about you to someone who is involved in your care or the payment for
your care. Our practice is not required to agree to such a request. Should our practice agree to your request, we will comply with
your request unless the information is needed to provide you with emergency treatment.
for the purpose of payment or our operations. We will honor such a request unless law requires us to share that information.
request you may indicate: (1) what information you want to limit; (2) whether you want to limit our practice’s use and/or disclosure;
and (3) to whom you want the limits to apply. For example, you may not want disclosures to be made to your spouse.
with you about medical matters in a certain way or at a certain location. To request that our practice communicate in a certain
manner, you must make your request in writing to the Pediatricians of Hyde Park, LLC Compliance Officer. You do not have to state
a reason for your request. Our practice will accommodate all reasonable requests. Your request must specify how or where you
wish to be contacted.
Pediatricians of Hyde Park, LLC reserves the right to change its privacy and security practices and to make the new provisions
effective for all Protected Health Information that our practice holds or maintains. Should our privacy practices change, we will post
the amended Notice of Privacy Practices in our office and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Pediatricians of Hyde Park, LLC Compliance Officer. To file a complaint with us, you can go to our webpage and do a contact us or you may call the office and ask to speak with our Compliance Officer. You may also file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/ privacy/hipaa/complaints/.
Dr. Gentle
3666 Paxton Avenue
Cincinnati, OH 45208