Pediatric Practice Privacy Policy Template

Introduction

At [Practice Name], we understand the importance of protecting your child's medical information. This notice describes how medical information about your child may be used and disclosed and how you can get access to this information.

Our Legal Duty

We are required by law to:

• Maintain the privacy of your child's protected health information (PHI)
• Provide you with this notice of our legal duties and privacy practices
• Follow the terms of this notice currently in effect

How We May Use and Disclose Health Information

Treatment

• Share information with other healthcare providers involved in your child's care
• Coordinate services with specialists and laboratories
• Contact you about appointment reminders

Payment

• Bill and collect payment from you, your insurance company, or other third parties
• Verify insurance coverage and benefits

Healthcare Operations

• Conduct quality assessment activities
• Review the competence of healthcare professionals
• Manage our practice operations

Your Rights Regarding Your Child's Health Information

1. Right to Inspect and Copy
2. Right to Amend
3. Right to an Accounting of Disclosures
4. Right to Request Restrictions
5. Right to Request Confidential Communications
6. Right to a Paper Copy of This Notice

Special Situations

Minors and Personal Representatives

Parents/guardians generally have the right to control the privacy of health information about minors (children under 18). There are exceptions for certain types of healthcare services.

Changes to This Notice

We reserve the right to change this notice. Any revised notice will be effective for medical information we already have about your child as well as any information we receive in the future.

Contact Information

Privacy Officer: [Name] Phone: [Phone Number] Address: [Practice Address]

Effective Date

This notice is effective as of [Date].