Notice of Privacy Practices

Get an electronic or paper copy of your medical record.

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record.

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share.

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

Treat you:

• We can use your health information and share it with other professionals who are treating you.
  

  Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization:

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  

  Example: We use health information about you to manage your treatment and services.

Bill for your services:

• We can use and share your health information to bill and get payment from health plans or other entities.
  

  Example: We give information about you to your health insurance plan so it will pay for your services.

Help with public health and safety issues:

• We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

• We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Do research:

• We can use or share your information for health research.

Comply with the law:

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests:

• We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director:

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests:

• We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions:

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Help train health care workers:

• We can use and share your health information to help us train health care professionals such as medical and nursing students, residents and fellows.

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

This Notice of Privacy Practices explains how Children’s Health℠, its employees, medical/dental staff, volunteers, students and trainees, and all facilities, departments and clinics may use and provide your Protected Health Information (PHI) to others and describes your rights to access and control your PHI.

Children’s Health is a collection of health care organizations, including affiliated covered entities. Children’s Health complies with applicable federal and state laws and does not discriminate on the basis of race, color, sex, age, religion, national origin or disability.

Being an organized health care arrangement (OHCA) allows separate covered entities to share PHI across the covered entities for activities such as providing integrated care, utilization review, quality assessment and improvement activities, or payment activities if the Organized Health Care Arrangement participants share the financial risk for delivering health care.

Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our facilities, and on our web site.

File a complaint if you feel your rights are violated:

• You can complain if you feel we have violated your rights by contacting us using the information below.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877-696-6775

  or visiting the U.S. Department of Health and Human Services site.

• We will not retaliate against you for filing a complaint.

Affiliated Covered Entities

Children’s Health System of Texas (CHST) is the parent corporation of the following Covered Entities, and has defined itself as an ACE for these covered entities:

• CHST d/b/a Children’s Medical Center of Dallas or Children’s Medical Center Dallas

• CHST d/b/a Children’s Medical Center Plano

• CHST d/b/a Children’s Pavilion Surgery Center

• Children's Health Medical Group - Anesthesiology

• CHSR, LLC d/b/a Children’s Health Andrews Institute for Orthopaedics and Sports Medicine

• Complex Care Medical Services Corporation

• Dallas Physician Medical Services for Children, Inc. (multiple physician practices’ d/b/a)

• Pediatric Imaging Associates, LLC d/b/a Children’s Health Imaging Center

• Physicians Quality Alliance of North Texas d/b/a Pediatric Alliance

Organized Healthcare Arrangements

A listing of other Covered Entities with whom Children’s Health System of Texas shares your Protected Health Information as part of an Organized Healthcare Arrangement.

• University of Texas Southwestern Medical Center