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This notice describes how medical information we collect about you/your child may be used and disclosed and how you can get access to this information. PLEASE REVIEW IT CAREFULLY.


Each time you or your child visits a healthcare provider, a record of your visit is made. Typically, this record contains child’s symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. We use this information, often referred to as your child’s health or medical record, as a basis for planning his/her care and treatment, a means to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that your child received. In any other situation, we will ask your written authorization before using or disclosing identifiable health information about your child. If you choose to authorize us to disclose information for any other purpose, you can later revoke that authorization to stop any future uses and disclosures. Understanding what is in your child’s record and how your child’s health information is used helps you to ensure its accuracy. It also helps to better understand why others may access your child’s health information.

Cascade Pediatrics, LLP may contact you by phone or mail, to provide appointment reminders or information about test results, treatment alternatives, or other health related benefits and information that the physician thinks may be helpful to you. Immunization notices may be sent if vaccines are overdue or in the event of shortage. It may be necessary to leave a message on the answering machine if you are not at home.


We may change our policies at any time. Before we make a significant change in our policies, we will change our notices and post the new notice in the waiting room. You can also request a copy of our notice at any time. For more information about our privacy practices, please contact the office.



In most cases, you have the right to look at or get a copy of health information about your child that we use to make decisions about your child. If you request copies, we will charge a fee for each page. You also have the right to receive a list of instances when we have disclosed health information about your child for reasons other than treatment, payment or related administrative purposes. If you believe that information in your child’s record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.


You may request in writing that we not use or disclose your child’s information for treatment, payment and administrative purposes except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request but are not legally required to accept it.


This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information.

Please review carefully.


Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for

healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e. name,

address, phone, etc.), that may identify you and relates to your past, present, or future physical or mental health condition and

related healthcare services.


Cascade Pediatrics is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and

disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice

describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your

PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other

purposes that are permitted or required by law. Regarding use of information for health care law, be aware that our office

records and transmits health information, including prescription information, electronically. PHI may be shared with our

Business Associates in order to obtain payment for services you received. They may contact you at any telephone number

associated with your account, including wireless telephone numbers. They may also contact you by sending text messages or emails, using any e-mail address you have provided to us. Methods of contact may include using pre-recorded/artificial voice

messages and/or use of an automatic dialing device, as applicable. Health information is shared and protected electronically

through local, state and national health information exchanges (HIE's) and clinically integrated networks (CIN's) and these HIE's

and CIN's have strict rules on how this information is accessed.


Your Rights Under The Privacy Rule - Following is a statement of your rights, under the Privacy Rule, in reference to your PHI

Please feel free to discuss any questions with our staff.


You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices - We are

required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your

request, we will provide you a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent

to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location

within the practice, and if such is maintained by the practice.


You have the right to authorize other use and disclosure - This means you have the right authorize any use or disclosure of PHI

that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for

marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an

authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken action in

reliance on the use or disclosure indicated in the authorization.


You have the right to request an alternative means of confidential communication - This means you have the right to ask us to

contact you about medical matters using an alternative method (i.e. email or telephone), and to a destination (i.e. cell phone

number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice or

your own, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all

reasonable requests.


You have the right to inspect and copy your PHI - This means you may inspect, and obtain a copy of your complete health record.

We have the right to charge a reasonable fee for paper as established by professional, state, or federal guidelines.

You have the right to request restriction of your PHI - This means you may ask us, in writing, not to use or disclose any part of

your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested

restrictions, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain

cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication

to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of pocket. We are not permitted to deny this specific type of requested restriction.


You may have the right to request an amendment to your protected health information - This means you may request an

amendment of you PHI for as long as we maintain this information. In certain cases, we may deny your request.


You have the right to request a disclosure of accountability - This means that you may request a listing of disclosures that we

have made at your request, of your PHI, to entities or persons outside of our office.


You have the right to receive a privacy breach notice - You have the right to receive written notification if the practice discovers

a breach of your unsecured PHI, and determines through a risk assessment that notification is required.


If you have questions regarding your privacy rights, or would like a more in depth copy of our privacy policy please feel free to

contact our Compliance Officer.



You may file a complaint with us by notifying our Compliance Officer at (616) 940-3168. We will not retaliate against you for filing a complaint.

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