MARK B. LEVIN, M.D.
JOHN M. COTTON, M.D.
TIMOTHY J. PATRICK-MILLER, M.D.
LOUIS J. TESORO, M.D.
HELEN M. ROSE, M.D.
THE PEDIATRIC GROUP, P.A.
66 Mt. Lucas Road,
Princeton, N.J. 08540-2733
tel: (609) 924-4892, fax: (609) 921-9380, web: www.pedgroup.com
HIPAA INFORMATION
To avoid deletion because of confusion with junk mail, please clearly identify your email with the word PATIENT in the subject line. Find the email address you want from the list below and copy/paste it to the address line in the email you are sending.
Dr. Levin: levin@pedgroup.com
Dr. Cotton: cotton@pedgroup.com
Dr. Patrick-Miller: pmiller@pedgroup.com
Dr. Tesoro: tesoro@pedgroup.com
Dr. Rose: rose@pedgroup.com
Billing: billing@pedgroup.com
Information: information@pedgroup.com
We are happy to answer any general questions about medical topics and about ouor practice. We can answer specific questions only regarding patients who are currently enrolled in our practice.
______________________________________________________________________
To our patients:
As a result of the federal law entitled the Health Insurance Portability and Accountability Act (HIPAA), all medical offic es are now required to obtain written permission to be able to transmit any health or financial information on any patient anywhere if any information is ever transmitted electronically (even by fax). Therefore, we are asking all of our parents (or the patient if over 18 years old or other authorize responsible party) to sign the following consent for their children the next time any family member comes into our office. If you have any concerns or questions about this procedure or our policy, please feel free to contact one of the physicians.
Specific Consent for the Pediatric Group, P.A.
I hereby authorize any agent of The Pediatric Group, P.A. (TPGPA) to make appointments at TPGPA or with consultants to whom they may make referral or from whom they may request consultation for me or for the minor for whom I am the responsible or authorized party. Furthermore, I authorize any agent of TPGPA to examine, diagnose and treat, to perform laboratory tests or diagnostic tests, to administer medications and immu n izations, to write, fax, telephone or electronically transmit prescriptions, and to disclose information as necessary to me, my designate and medical, educational, or ancillary medical consultants on behalf of the patient(s) named herein and any future de pendents for whom I am the responsible party to carry out payment or when TPGPA believes such action is in the best interest of the patient. \par I have been given the opportunity to review the Privacy Notice of TPGPA. I understand that I may revoke or amend this authorization at any time or request to restrict the disclosure of the personal health or financial information as set forth herein. \par }\pard \sb100\sa100\nowidctlpar\adjustright {This authorization will expire when no family member is under the active care of TPGPA or the family\rquote s association with TPGPA has been explicitly terminated.
Privacy Statement of The Pediatric Group, P.A.
The Pediatric Group, P.A. has the utmost concern for patient privacy and confidentiality. We strive to maintain this privacy by following the guidelines listed below.
1. All email to anyone via the Pediatric Group's web site (pedgroup.com) is treated confidentially as would any medical record direct inquiry to our practice.
2. We do not maintain lists of web site visitors. Nor do we sell or otherwise distribute or divulge any information, including identity, regarding our patients or web site visitors. We will not release patient information for marketing or monetary gain.
3. Web site visitors who make entries on our Guest Book do so at their own risk of exposure. Any entries to that page are open to public view. Registering on our Guest Book is optional and registrants may request to have their entry removed at any time.
4. The Pediatric Group, P.A. undertakes to honor or exceed the legal requirements of medical/health information privacy that apply in the country and state where the web site is located.
5. We maintain the patient records confidentially in our office. These records are only available to our employees in order to carry out their specific duties. All employee s are instructed in patient confidentiality issues. In no circumstance is an employee permitted to discuss any facet of patient records outside of the offices of The Pediatric Group, P.A.
6. We will not release any information to third parties by any metho d, electronic or otherwise, without the signed written consent of the patient, responsible adult party if the patient is a minor, or authorized patient's representative unless required to do so by the law (usually requiring a court order). The only except i ons to this rule are release of prescriptions to pharmacies and records to a consultant for the clinical benefit of the patient. In the last instance, only clinically relevant information will be released. If we must release records because of legal requi rement, we will so advise the patient, responsible adult party or authorized patient's representative.
7. The patient, patient's responsible adult party if the patient is a minor or authorized patient's representative has the right to revoke permission for or prohibit record release if records have not already been released.
8. Our treatment of any patient is not predicated on whether permission to release records is revoked or granted.
9. We will not leave clinical information on answering devices unless requested to do so.
10. We will answer clinical questions from our patients by email provided the specific patient is identified and the person requesting the information is identified as the patient, the patient's responsible party if the patient is a mino r or authorized patient's representative.
11. With the advance consent of the patient, responsible adult party if the patient is a minor, or authorized patient's representative we may release clinical information devoid of identifiers to coordinators of cl inical studies in which we are participating.
12. Any patient, adult responsible party if the patient is a minor or authorized patient's representative may request amendment of any portion of this Privacy Policy. The Pediatric Group, P.A. reserves the righ t to accept or deny such an amendment proposal.
13. Any patient, adult responsible party if the patient is a minor or authorized patient's representative has the right to complain to the Privacy Officer of The Pediatric Group,. P.A. or a designate or to any governmental agency regarding HIPAA compliance. No retaliation can or will be made as a result of such a complaint.
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