SURF PEDIATRICS AND MEDICNE/SURF URGENT CARE

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY

Effective Date: 01 /01 / 2008

Revised Date: 05/01/2022 

WHO WILL FOLLOW THIS NOTICE

This notice describes the practices of:

• Surf Pediatrics and Medicine and other entities registered under this corporation “doing business as” - such as Surf Urgent Care.  Throughout the document, any mention of Surf Pediatrics and Medicine also includes “dba” divisions of the corporation, as well.

• Any health care professional authorized to enter information into your medical record maintained by Surf Pediatrics and Medicine.

• Any persons or companies with whom Surf Pediatrics and Medicine contracts for services to help operate our practice and who have access to your medical information.

• All these persons, entities, sites, and locations follow the terms of this notice.  In addition, these persons, entities, sites, and locations may share medical information with each other for treatment, payment, or health care operations purposes and other purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive from Surf Pediatrics and Medicine.  We need this record to provide you with quality care and to comply with certain legal requirements. 

This notice applies to all of the records of your care and billing for that care that are generated or maintained by Surf Pediatrics and Medicine, whether made by Surf Pediatrics and Medicine personnel or other health care providers.  Other health care providers may have different policies or notices about confidentiality and disclosure that apply to your medical information that is created in their offices or at locations other than Surf Pediatrics and Medicine.  This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information. 

We are required by law to:

• Make sure that medical information that identifies you is kept private;

• Give you this notice of our legal duties and privacy practices at Surf Pediatrics and Medicine, and your legal rights, with respect to medical information about you; and

• Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information.  For each category of uses or disclosures we will explain what we mean and try to give some examples.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of these categories.

• For Treatment.  We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, medical students, volunteers, or other personnel who are involved in taking care of you at Surf Pediatrics and Medicine.  For example, a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process.  We also may disclose medical information about you to people outside Surf Pediatrics and Medicine who may be involved in your medical care after you have been treated by Surf Pediatrics and Medicine, such as friends, family members, or employees or medical staff members of any hospital or skilled nursing facility to which you are transferred or subsequently admitted.

• For Payment.  We may use and disclose medical information about you so that the treatment and services you receive from Surf Pediatrics and Medicine may be billed by Surf Pediatrics and Medicine and payment may be collected from you, an insurance company, or a third party.  For example, we may need to give your health plan information about treatment you received from Surf Pediatrics and Medicine so your health plan will pay us or reimburse you for the treatment.  We also may disclose information about you to another health care provider, such as a hospital or skilled nursing facility to which you are admitted, for their payment activities concerning you.

• For Health Care Operations.  We and our business associates may use and disclose medical information about you for health care operations.  These uses and disclosures are necessary to run Surf Pediatrics and Medicine and make sure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many patients to decide what additional services Surf Pediatrics and Medicine should offer, and what services are not needed.  We may also disclose information to doctors, nurses, technicians, and other personnel affiliated with Surf Pediatrics and Medicine for review and learning purposes.  We may also combine the medical information we have with medical information from other health care providers to compare how we are doing and see where we can make improvements in the care and services we offer.  We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning the identities of specific patients.  We also may disclose information about you to another health care provider for its health care operations purposes if you also have received care from that provider.

• Appointment Reminders.  We may use and disclose your information to remind you of an appointment at a Surf Pediatrics and Medicine facility.

• Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend different ways to treat you.

• Fundraising Activities.  We may use and disclose medical information about you so that we or a foundation related to Surf Pediatrics and Medicine may contact you in an effort to raise money.  Specifically, we may use information about you to target our fundraising efforts.  For example, if we are raising money for women’s health services, we may focus our fundraising efforts on individuals who have received women’s health services from us in the past.  We release limited information about you, such as your name, address and phone number, age and date of birth, gender, your physician, and the dates you received treatment or services.  You have the right to be removed from any fundraising listing so that you will not be contacted.  If you do not want Surf Pediatrics and Medicine to contact you for fundraising efforts, you must notify Surf Pediatrics and Medicine’s Privacy Officer in writing.  If you do opt out of future fundraising communications, we will no longer disclose your information for fundraising purposes.  However, in the future you may let us know in writing that you would like to receive these fundraising communications.  Your decision whether or not to receive targeted fundraising materials from us will have no impact on your access to health care services or the treatment we provide to you.  Even if you have opted-out, we may send you non-targeted fundraising materials that are sent out to the general community and are not based on information from your treatment.

• Research.  Under certain circumstances, we may use and disclose medical information about you for research purposes.  For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition.  Medical information about you that has had identifying information removed may be used for research without your consent.  We also may disclose medical information about you to people preparing to conduct a research project (for example, to help them look for patients with specific medical needs), so long as the medical information they review does not leave Surf Pediatrics and Medicine.  If the researcher will have information about your mental health treatment that reveals who you are, we will seek your consent before disclosing that information to the researcher.  Unless we notify you in advance and you give us written permission, we will not receive any money or other thing of value in connection for using or disclosing your medical information for research purposes except for money to cover the costs of preparing and sending the medical information to the researcher.

• Individuals Involved in Your Care or Payment for Your Care.  We may release medical information about you to a friend or family member who is involved in your medical care.  This would include persons named in any durable health care power of attorney or similar document provided to us.  We may also give information to someone who helps pay for some or all of your care.  In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.  You can object to these releases by telling us that you do not wish any or all individuals involved in your care to receive this information.  If you are not present or cannot agree or object, we will use our professional judgment to decide whether it is in your best interest to release relevant information to someone who is involved in your care or to an entity assisting in a disaster relief effort.

• As Required or Permitted By Law.  We may disclose medical information about you when required or permitted to do so by federal, state, or local law.

• To Avert a Serious Threat to Health or Safety.  We may use and disclose medical information about you when it appears necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure would be to someone who appears able to help prevent the threat and will be limited to the information needed.

• Marketing of Health-Related Products and Services.  “Marketing” means a communication for which we receive any sort of payment from a third party that encourages you to use a service or buy a product.  Before we may use or disclose your medical information to market a health-related product or service to you, we must obtain your written authorization to do so.  The authorization form will let you know that we have been paid to make the communication to you.  Marketing does not include:  prescription refill reminders or other information that describes a drug you currently are being prescribed, so long as any payment we receive for that communication is to cover the cost of making the communication; face-to-face communications; or gifts of nominal value, such as pens or key chains stamped with our name or the name of a health care product manufacturer.  Communications made about your treatment, such as when your physician refers you to another health care provider, generally are not marketing.  

• Sale of Medical Information.  We cannot sell your medical information without first receiving your authorization in writing.  Any authorization form you sign agreeing to the sale of your medical information must state that we will receive payment of some kind disclosing your information.  However, because a “sale” has a specific definition under the law, it does not include all situations in which payment of some kind is received for the disclosure.  For example, a disclosure for which we charge a fee to cover the cost to prepare and transmit the information does not qualify as a “sale” of your information.  

• Psychotherapy Notes.  Regardless of the other parts of this Notice, psychotherapy notes will not be disclosed outside of  Surf Pediatrics and Medicine except as authorized by you in writing or pursuant to a court order, or as required by law.  Psychotherapy notes about you will not be disclosed to personnel working within Surf Pediatrics and Medicine, except for training purposes or to defend a legal action brought against Surf Pediatrics and Medicine, unless you have properly authorized such disclosure in writing.

SPECIAL SITUATIONS

• Organ and Tissue Donation.  If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

• Active Duty Military Personnel and Veterans.  If you are an active duty member of the armed forces or Coast Guard, we must give certain information about you to your commanding officer or other command authority so that your fitness for duty or for a particular mission may be determined.  We may also release medical information about foreign military personnel to the appropriate foreign military authority.  We may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.

• Workers’ Compensation.  In accordance with state law, we may release without your consent medical information about your treatment for a work-related injury or illness or for which you claim workers’ compensation to your employer, insurer, or care manager paying for that treatment under a  workers’ compensation program that provides benefits for work-related injuries or illness.  

• Public Health Risks.  We may disclose without your consent medical information about you for public health activities.  These activities generally include but are not limited to the following:

• To report, prevent or control disease, injury, or disability;

• To report births and deaths;

• To report reactions to medications or problems with products; 

• To notify people of recalls of products they may be using;

• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and

• To report suspected abuse or neglect as required by law.

• Health Oversight Activities.  We may disclose without your consent medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  The government uses these activities to monitor the health care system, government programs, and compliance with civil rights laws.  

• Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we must disclose medical information about you in response to a court or administrative order.  We also may disclose medical information about you in response to a subpoena or other lawful process from someone involved in a civil dispute.

• Law Enforcement.  We may release without your consent medical information to a law enforcement official:

• In response to a court order, warrant, summons, grand jury demand, or similar process;

• To comply with mandatory reporting requirements for violent injuries, such as gunshot wounds, stab wounds, and poisonings;

• In response to a request from law enforcement for certain information to help locate a fugitive, material witness, suspect, or missing person;

• To report a death or injury we believe may be the result of criminal conduct; and

• To report suspected criminal conduct committed at Surf Pediatrics and Medicine facilities.

• Coroners and Medical Examiners.  We may release without your consent medical information to a coroner or medical examiner.  This may be done, for example, to identify a deceased person or determine the cause of death.  We also may release medical information about deceased patients of Surf Pediatrics and Medicine to funeral directors to carry out their duties.

• National Security and Intelligence Activities.  We may release without your consent medical information about you as required by applicable law to authorized federal or state officials for intelligence, counterintelligence, or other governmental activities prescribed by law to protect our national security. 

• Protective Services for the President and Others.  We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct special investigations.

• Inmates.  If you are an inmate of a correctional institution or in the custody of law enforcement, we may release medical information about you to the correctional institution or law enforcement official who has custody of you, if the correctional institution or law enforcement official represents to Surf Pediatrics and Medicine that such medical information is necessary: (1) to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) to protect the safety and security of officers, employees, or others at the correctional institution or involved in transporting you; (4) for law enforcement to maintain safety and good order at the correctional institution; or (5) to obtain payment