Anne Berens MD PC

Privacy Policy

Health Insurance Portability and Accountability Act provisions

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. Please review this document carefully.

Protecting your privacy

The following information provides details about the provisions of HIPAA and your/your child’s rights concerning privacy and your child’s medical records.

The following individuals are required by HIPAA to comply with the privacy rules:

  • Treating physician

  • Any clinic administrative staff who may have limited access to your or your child’s identifying information (e.g. name, address, telephone number)

  • Any billing agency or collection agency that handles information about you (e.g. name and address, diagnostic codes, treatment codes, consultation dates, but not actual clinical records).

Your rights regarding medical information about your child

As a patient or client of Anne Berens MD PC, you have the following rights:

1) The right to inspect and obtain a copy of your child’s medical record.

Professional records constitute an important part of the treatment and assessment process and help with continuity of care. According to the rules of HIPAA, your child’s treatment, consultations, and assessments with Dr. Berens are recorded in the clinical record, which is a required document that includes the dates of your child’s medical care, reasons for seeking medical care, diagnosis, assessment or treatment goals, progress, medical and social history, treatment history, functional status, any past records from other providers, as well as any reports to your child’s insurance carrier.

2) The right to request a correction or add an addendum to your child’s medical record.

  • Correction: if you believe that there is an inaccuracy in your child’s clinical record, you may request a correction. If the information is accurate, or if it has been provided by a third party (e.g., a previous clinician), it may remain unchanged and the request denied. In this case, you will receive an explanation in writing with a full description of the rationale.

  • Addendum: you also have the right to request an addition to your child’s record if you think it is incomplete.

3) The right to an accounting of disclosures of your child’s medical information to third parties.

You have the right to know if, when, and to whom your child’s medical information has been disclosed (exclusive of treatment, payment, and health care operations.) However, you likely would already be aware of this as you would have signed consent forms allowing such disclosures (such as to other therapists, physicians). The accounting must extend back for a period of six years.

4) The right to request restrictions on how your child’s information is used.

You have the right to request restrictions on certain uses or disclosures of your child’s medical information. These requests must be in writing, and most likely will be honored, although in some cases they may be denied. This office does not use or release your child’s protected health information for any purpose other than treatment, payment, healthcare operations, and other exceptions specified in this notice.

5) The right to request confidential communications.

You have the right to request that your child’s physician communicate with you about your child’s treatment in a certain way, or at a certain location. For example, you may prefer to be contacted at work instead of at home, or on a cell phone, in order to schedule or cancel an appointment. Or, you may wish to receive billing statements at a Post Office Box, or some other address.

6) The right to a copy of this notice upon request.

You have the right to have a copy of this notice of privacy practices.

7) The right to file a complaint.

You have the right to file a complaint if you believe your or your child’s privacy rights have been violated. You must do so in writing and may address it directly to Dr. Berens or to the Secretary of the Department of Health and Human Services (address: Office of Civil Rights, 200 Independence Ave, S.W., Washington D.C. 20201). Filing a complaint will not change the health care provided by this office in any way. If you have questions or concerns about this notice or your/your child’s health information privacy, please do not hesitate to contact Dr. Berens at (408) 438-5179.

How this office may use/disclose medical information about you

1) For Treatment/Assessment

Dr. Berens will access your child’s record and use medical information about your child to assist in the continuity of medical services. This information is not shared with other health care professionals, unless, however you specifically request it or agree to it, and sign a consent form to that effect.

2) For Payment

This office may use and disclose medical information about you for billing purposes. This generally is restricted to your child’s name and other personal identifiers (address, relevant identifying information, or other needed information), diagnostic and treatment codes, dates of service, and similar information.

3) For Health Care Operations

Dr. Berens may share basic identifying information with a secretary or other office staff to assist in scheduling and treatment procedures. This normally would not include the content of your child’s medical record.

4) As Required by Law

It is possible (though unlikely) that the Department of Health and Human Services may review whether this office complies with the regulations of HIPAA. In such a case, your child’s personal health information could be revealed as part of providing evidence of compliance.

5) Business Associates

This office may contract a billing agency or attorney to attend to business issues on an as-needed basis. In this case, there will be a written contract in place with the agency requiring that it maintain the security of your child’s information in compliance with the rules of HIPAA.

6) Research

If any research is conducted through this office, you would be informed of the nature of the research, have an opportunity to read and review an Informed Consent describing the research study thoroughly, and ultimately have the opportunity to accept or decline participation. You would never be obliged to agree for your child to participate in a research project and your choice to decline research involvement would not affect your child’s treatment in any way.

Changes to this notice

Please note that this privacy notice may be revised from time to time. You will be notified of changes in the laws concerning privacy or your/your child’s rights as we become aware of them. In the meanwhile, please do not hesitate to raise any questions or concerns about confidentiality with Dr. Berens.