HIPAA – Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION
PLEASE READ IT CAREFULLY
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal law that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally are kept properly confidential. This law gives you, the legal guardian, the right to understand and control how your child’s personal health information (“PHI”) is used. HIPAA provides penalties for covered entities that misuse PHI.
As required by HIPAA, we prepared this explanation of how we are to maintain the privacy of your child’s health information and how we may disclose his/her personal information.
Our Uses and Disclosures
We may use and disclose your child’s medical records only for each of the following purposes: treatment, payment and health care operations.
• Treatment means providing, coordinating, or managing health care and related services by one or more healthcare providers. An example of this would include referring your child to an allergy specialist.
• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your child’s visit and/or verifying coverage prior to a surgery.
• Health Care Operations include business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. An example of this would be new patient survey cards.
• The practice may also disclose your child’s PHI for law enforcement and other legitimate reasons, although we shall do our best to assure its continued confidentiality to the extent possible.
How else can we use or share your child’s health information? We are allowed or required to share your child’s information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your child’s information for these purposes.
Help with public health and safety issues. We can share health information about your child for certain situations such as: preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious threat to anyone’s health or safety.
Do research. We can use or share your child’s information for health research.
Comply with the law. We will share information about your child if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
Respond to organ and tissue donation requests. We can share health information about your child 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 your child: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and 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 your child in response to a court or administrative order, or in response to a subpoena.
REQUIREMENTS FOR CERTAIN TYPES OF SENSITIVE HEALTH INFORMATION
• If any federal or state law requires us to apply more stringent protections to your health information than HIPAA, we will follow the more stringent requirement. For example, some laws may give greater privacy protections for certain types of sensitive health information, such as information related to mental health, HIV/AIDS or other communicable diseases, genetic testing, or substance use disorders.
• If the practice receives substance use disorder diagnosis or treatment records about your child from a Part 2 regulated program (“Part 2 Program”) for the purpose of treatment, payment, or health care operations for which your consent was obtained, we may further use and disclose that information consistent with the HIPAA regulations as described in this Notice, except for uses and disclosures for civil, criminal, administrative, and legislative proceedings against your child. In no event will we use or disclose your Part 2 Program records, or testimony that describes the information contained in your Part 2 Program records, in any civil, criminal, administrative, or legislative proceedings by any federal, state, or local authority, against your child, unless authorized by your consent or a lawful court order. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record will be used or disclosed for this purpose.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your child’s information in the situations described below. Talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to: share information with your family, close friends, or others involved in your child’s care or payment for your child’s care; and share information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your child’s information if we believe it is in your child’s best interest. We may also share your child’s information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your child’s information unless you give us written permission: marketing purposes; sale of your child’s information; and most sharing of psychotherapy notes.
In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again. If we have your child’s substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your child’s Part 2 information.
You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
Your Rights
When it comes to your child’s health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
• Request restrictions on certain uses and disclosures. 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,” for example, if it could affect your child’s care. If we do agree to your request, we must abide by it unless you agree in writing to remove it.
• Request confidential communications. You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
• Get an electronic or paper copy of your child’s PHI. Medical record. You can ask to see or get an electronic or paper copy of your child’s medical record and other health information we have about your child. We will provide a copy or a summary of your child’s health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• Ask us to correct your child’s medical record. You can ask us to correct health information about your child that you think is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
• Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your child’s health information for six (6) 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 will 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.
• Be notified of a breach. You have the right to be advised if your child’s unsecured PHI is intentionally or unintentionally disclosed in a manner that compromises the privacy or security of the information.
• Choose someone to act for your child. If someone has authority to act as your child’s personal representative, such as if someone has your child’s medical power of attorney or if someone is your child’s legal guardian, that person can exercise your rights and make choices about your child’s health information. We will make sure the person has this authority and can act for you before we take action.
If you have paid for services “out of pocket”, in full, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
Our Responsibilities
We are required by law to maintain the privacy and security of your child’s protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your child’s 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 child’s information other than as described in this notice 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.
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 your child. The new notice will be available upon request, in our office, and on our website.
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 also file a complaint with the U. S. Department of Health and Human Services Office for Civil Rights by:
Send a letter
200 Independence Avenue SW
Washington DC 20201
Call – 1-877-696-6775
Visit https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.
This notice is effective as of February 16, 2026.
For more Information or to Report a Problem:
If you have questions, would like to file a complaint or would like additional information, you may contact the Privacy Officer for POHNS at:
Pediatric Otolaryngology Head & Neck Surgery Associates, PA
P.O. Box 76479
St. Petersburg, FL 33734
Telephone: (727) 329-5310
Revised 02.16.2026