Nicklaus Children’s Health System
Notice of Privacy Practices and Telehealth Addendum
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Right to Request Restrictions - You have the right to request limits on the use of your medical information for either treatment, payment or health care operations. You also have the right to request a limit on medical information we disclose to someone who is involved in your care or the payment of your care, such as a family member or friend. For example, you could ask that we not disclose information about a surgery you had. To request restrictions, the request must be made in writing to the Nicklaus Health Information Management Department. We are not required to agree to your request except in limited circumstances where you paid out of pocket and in full for the items or services and have requested that we not disclose your PHI to a health plan. If we do agree we will comply with your restrictions unless the information is needed to provide emergency treatment.
Right to Request Confidential Communications - You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. To request restrictions, the request must be made in writing to the Health Information Management Department.
Right to Inspect and Copy - You have the right to inspect and/or receive a copy of any medical information maintained about you that may be used to make decisions about your care or payment for your care. Typically, this will include your medical and billing records, but not psychotherapy notes. If your PHI is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy be given to you or transmitted to another individual or entity.
To inspect and/or get a copy of your medical or billing records you must submit your request in writing to:
Nicklaus Children’s Health System
Health Information Management Department
3100 S.W. 62 Avenue
Miami, Florida 33155 - 3009
We may charge a reasonable fee for copying and mailing the records. We may deny your request in certain limited circumstances. If your request is denied, you may request that your denial be reviewed. Such reviews will be performed by an independent licensed healthcare professional chosen by our Privacy Officer. We will comply with the outcome of the review.
Right to Amend - If you feel that information about you is incorrect, you may ask us to amend the record. To request an amendment, the request must be made in writing to the Health Information Management Department at the address noted above. In addition, you must provide a reason that supports your request. We are not obligated to comply with your request to amend your record.
Right to Revoke your Authorization - If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission and we are required to retain our records of the care that we provided to you. A form of written revocation is available upon request from our Health Information Management Department.
Breach Notification - In certain instances, you have the right to be notified in the event that we, or one of our Business Associates, discover an inappropriate use or disclosure of your health information. Notice of any such use or disclosure will be made in accordance with state and federal requirements.
Accounting of Disclosures - You have the right to request an “accounting of disclosures.” This is a list of disclosures that we have made of your PHI. We are not required to list cert ain disclosures, including (1) disclosures made for treatment, payment, and health care operations purposes, (2) disclosures made with your authorization, (3) disclosures made to create a limited data set, and (4) disclosures made directly to you. You must submit your request in writing to our Health Information Management Department. Your request must state a time period which may not be longer than 6 years before your request. Your request should indicate in what form you would like the accounting (for example, on paper or by e-mail). The first accounting you request within any 12 - month period will be free. For additional requests, we may charge you for the reasonable costs of providing the accounting. We will notify you of the costs involved and you may choose to withdraw or modify your request before any costs are incurred.
Right to a Paper Copy of this Notice - You have a right to a paper copy of this Notice, even if you agreed to receive it electronically. Please contact us as directed below to obtain this Notice in written form.
Foreign Language Version - If you have difficulty reading or understanding English, you may request a copy of this Notice in Spanish or Creole.
Questions or Concerns
If you would like more information about our privacy practices or have questions or concerns about this Notice, please contact our Privacy Officer at the number listed below.
If you believe your privacy rights have been violated, you may file a complaint, in writing, to the Nicklaus Privacy Officer located at:
Nicklaus Children’s Hospital Privacy Officer
3100 S.W. 62 Avenue
Miami, Florida 33155-3009
Telephone: (786) 624-3838
or you may contact the Secretary of the U.S. Department of Health and Human Services (HHS). You will not be penalized or retaliated against in any way for making a complaint.
NICKLAUS CHILDREN'S HOSPITAL FACILITIES AND AFFILIATED ENTITIES
This Notice applies to the privacy practices of the following Nicklaus Children’s Hospital facilities and Affiliated Entities:
- Miami Children’s Health System, Inc.
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Dan Marino Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Doral Outpatient Center
- Variety Children’s Hospital d/b/a / Miami Children’s Hospital Miami Lakes Outpatient Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Rehabilitation Services – Miami Lakes
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Midtown Outpatient Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Nicklaus Care Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Nicklaus Outpatient Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital Palmetto Bay Outpatient Center
- Variety Children’s Hospital d/b/a/ Miami Children’s Hospital West Kendall Outpatient Center
- NCHS Anywhere
- Miami Children’s Health System Foundation, Inc.
- Miami Children’s Hospital Research Institute, Inc.
- Miami Children’s Hospital Ambulatory Surgery Center, LLC
- Miami Children’s Hospital PRPG, LLC
- Children’s Health Ventures, Inc.
- Kidzstuff, Inc.
- Miami Children’s Health System Management Services, LLC
- Pediatric Specialty Group, Inc.