Privacy Policy

Patient Privacy

This notice explains how medical information about you may be used and disclosed and how you can access this information.

Please review it carefully. The privacy of your medical information is important to us.

Our legal duty

NOVA Pediatric Airway and Myofunctional Therapy is required by federal and state law to maintain the privacy of your protected health information. We are also required to provide this notice describing our privacy practices, our legal duties, and your rights regarding your protected health information. We must follow the privacy practices described in this notice while it is in effect.

This notice is effective April 14, 2003 and will remain in effect until we replace it.

We may change our privacy practices and the terms of this notice at any time, as permitted by law. If we do, the updated terms may apply to all protected health information we maintain, including information created or received before the change.

You may request a copy of this notice at any time. For questions about our privacy practices or for additional copies of this notice, please contact us using the information listed at the end of this notice.

Uses and disclosures of protected health information

We may use and disclose your protected health information for treatment, payment, and health care operations. Below are examples of the types of uses and disclosures that may occur. These examples are not exhaustive.

Treatment
We may use and disclose your protected health information to provide, coordinate, or manage your care and related services. This can include coordinating your care with another provider or entity. For example, we may share information with another health care provider who is involved in your care, including providers you are referred to, so they have the information needed to diagnose or treat you. We may also share information with specialists or laboratories who assist your provider with your diagnosis or treatment.

Payment
We may use your protected health information as needed to obtain payment for services. This may include activities your health plan may perform before approving or paying for services, such as determining eligibility or coverage, reviewing the medical necessity of services, and utilization review. For example, prior authorization for certain services may require that relevant information be shared with the health plan.

Health care operations
We may use or disclose your protected health information for practice operations. These activities may include quality assessment, staff performance review, training, licensing, and other business functions.

Examples include using a sign in sheet at check in, calling you by name in the waiting room, or contacting you by phone, text, email, or mail to remind you about appointments.

We may share protected health information with third party business associates who perform services for our practice such as billing or transcription. When required, we maintain written agreements that require business associates to protect the privacy of your information.

We may also use or disclose your protected health information to provide information about treatment alternatives or other health related benefits and services that may be of interest to you. We may use your name and address to send a newsletter about our practice and services, or information about products or services we believe may be helpful. You can ask us not to send these materials by contacting us using the information at the end of this notice.

Uses and disclosures with your written authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may authorize us in writing to use or disclose your information to someone else for a specific purpose. You may revoke your authorization in writing at any time. Revocation will not affect uses or disclosures that occurred while the authorization was in effect. Without your authorization, we will not disclose your information except as described in this notice.

People involved in your care
Unless you object, we may disclose protected health information to a family member, relative, close friend, or another person you identify when it relates directly to that person’s involvement in your care. If you are unable to agree or object, we may disclose information when, in our professional judgment, it is in your best interest.

We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care about your location, general condition, or death.

Marketing
We may contact you with information about treatment alternatives that may be of interest to you. We may use a business associate to support these communications. You may opt out of future marketing communications by contacting us using the information at the end of this notice.

Research, decedents, and organ donation
In limited circumstances, we may use or disclose protected health information for research as permitted by law. We may disclose protected health information about a deceased person to a coroner, medical examiner, funeral director, or organ procurement organization for permitted purposes.

Public health and safety
We may disclose protected health information when necessary to prevent or lessen a serious and imminent threat to health or safety, or as required by public health authorities, including reports of abuse or neglect as permitted by law.

Health oversight
We may disclose protected health information to health oversight agencies for activities authorized by law, such as audits, investigations, and inspections.

Abuse, neglect, or domestic violence
We may disclose protected health information to a government authority authorized by law to receive reports of child abuse or neglect. We may also disclose information if we believe you are a victim of abuse, neglect, or domestic violence when permitted by law and consistent with legal requirements.

Food and Drug Administration
We may disclose protected health information to a person or company subject to FDA requirements for reporting adverse events, product defects or problems, biologic product deviations, product tracking, recalls, repairs or replacements, or post marketing surveillance.

Criminal activity and law enforcement
Consistent with federal and state laws, we may disclose protected health information if we believe it is necessary to prevent or lessen a serious and imminent threat to a person or the public, or to assist law enforcement in identifying or apprehending an individual as permitted by law.

Required by law and workers compensation
We may use or disclose protected health information when required by law. For example, we may disclose information to the US Department of Health and Human Services to determine compliance with federal privacy laws. We may also disclose information when authorized by workers compensation or similar laws.

Judicial and administrative proceedings
We may disclose protected health information in response to a court order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances such as a warrant or grand jury subpoena, we may disclose information to law enforcement officials.

Patient rights

Access
You have the right to inspect or obtain copies of your protected health information, with limited exceptions. Requests must be made in writing to the contact person listed below or mailed to the address at the end of this notice.

If you request copies, we may charge a reasonable fee allowed by law for copying, labor, and postage. If you prefer, we can prepare a summary or explanation of your information for a fee. Contact us for details.

Accounting of disclosures
You have the right to receive a list of certain disclosures of your protected health information made by us or our business associates for purposes other than treatment, payment, and health care operations, and other limited exceptions, after April 14, 2003. The accounting will cover the time period allowed by law. We may charge a reasonable fee if you request more than one accounting within a 12 month period.

Request restrictions
You may request additional restrictions on our use or disclosure of your protected health information. We are not required to agree, but if we do agree, we will follow the restriction except in an emergency. Any restriction agreement must be in writing and signed by an authorized representative of our practice.

Confidential communications
You may request that we communicate with you in a specific way or at a specific location to keep communications confidential. Your request must be in writing and must be reasonable and allow us to bill and collect payment.

Amendment
You may request that we amend your protected health information. Your request must be in writing and explain why you believe the information should be amended. We may deny your request in certain circumstances, including if we did not create the information. If we deny your request, we will provide a written explanation. You may submit a written statement of disagreement, which will be included with the information you wanted amended.

If we accept your request, we will make reasonable efforts to inform others, including individuals or entities you name, of the amendment and include the amendment in future disclosures as appropriate.

Electronic notice
If you receive this notice on our website or by email, you are entitled to a paper copy. Contact us using the information below to request a paper copy.

Questions and complaints

If you want more information about our privacy practices or have questions or concerns, please contact us using the information below.

If you believe we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information or another request you made, you may file a complaint with us or with the US Department of Health and Human Services. We will provide information on how to file with HHS upon request.

We support your right to protect the privacy of your protected health information. We will not retaliate against you for filing a complaint.

Name of contact person: Dr. Gema Island

Address: 8605 Westwood Center Dr, Suite 501-B, Tysons, VA 22182   

Phone: (541) 539-4578 

Email: info@novapediatricairway.com