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This notice describes Cook Children's Health Care System's (CCHCS) practices and those of:
The following entities within Cook Children's Health Care System will follow these practices:
These entities, sites and locations follow the terms of this notice and may share protected health information with each other for treatment, payment or operational purposes described in this notice.
Anywhere in this notice where the term “you” is used, it represents either you or your child.
We understand that information about you and your health is personal. We are committed to protecting information about you. We create a record of the care and services you receive at CCHCS in order to provide quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by CCHCS. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your protected health information created in the doctor's office or clinic.
This notice will tell you about the ways in which we may use and disclose protected health information about you and describe your rights and our obligations.
We are required by law to:
If you communicate with a
Cook Children’s health care provider by email for any reason, those communications may become part of your CCHCS medical record covered by this notice.
The following categories describe different ways that we use and disclose protected health information. 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 the categories.
We may use protected health information about you to provide you with medical treatment or services. We may disclose protected health information about you to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different units or practice locations also may share protected health information about you in order to coordinate the different things you need, such as prescriptions, lab work and X-rays. We also may disclose protected health information about you to people outside Cook Children's who may be involved in your medical care, such as family members, clergy or others we use to provide services that are part of your care.
We may use and disclose protected health information about you so that the treatment and service you receive may be billed to and payment may be collected. For example, we may need to give your health plan information about surgery you received so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. You may choose to restrict protected information from being provided to a health plan if (a) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise prohibited by law; and (b) the protected health information pertains solely to a health care item or service for which you, or a person on your behalf, has paid
Cook Children's in full.
For health care operations
We may use and disclose protected health information about you for operations. These uses and disclosures are necessary to run the organization and make sure that all of our patients receive quality care. For example, we may use protected health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine protected health information about many patients to decide what additional services we should offer, what services are not needed and whether certain new treatments are effective. We may also disclose protected health information to doctors, nurses, technicians, medical students and other personnel for review and learning purposes. We may also combine the protected health information we have with protected health information from other health care providers to assess how we are doing and see where improvements can be made in the care and services we offer. We may remove information that identifies you from this set of protected health information so others may use it to study health care and health care delivery without learning specific patients' identities.
CCHCS uses third party business associates to perform certain functions for the organization. Examples of the activities performed include transcription and copying services. To safeguard your protected health information, CCHCS has agreements with these third parties that require them to appropriately protect your information.
We may use and disclose protected health information to contact you as a reminder that you have an appointment for treatment or medical care.
We may use and disclose protected health information to tell you about or recommend possible treatment options or alternatives that may be of interest.
Health-related benefits and services
We may use and disclose protected health information to tell you about health-related benefits or services that may be of interest to you.
We may use certain information, such as your name, address and phone number, as well as the department where services were provided, to contact you in the future to raise money for Cook Children's Health Foundation. The money raised will be used to expand and improve the services and programs we provide the community. If you do not want to be contacted or your protected health information used for fundraising efforts, please notify us by calling our toll-free number 877-686-7722 or by sending an email to firstname.lastname@example.org.
We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, serious, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. If you do not want to be listed in the directory, please contact Patient Registration at
Individuals involved in your care or payment for your care
We may disclose to a family member, other relative, a close personal friend of yours, or any other person identified by you, the protected health information directly relevant to such person's involvement with your care or payment related to your health care. We may also tell your family or friends your condition and that you are receiving treatment. If you do not want us to share your information with these individuals, you may notify us during the registration process or at any future time you make that decision, either by informing your care provider(s) or contacting the patient representative at 682-885-3926. In addition, we may disclose protected health 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.
Medical research is vital to the advancement of medical science. Federal regulations permit use of protected health information in medical research, with either your authorization or when the research study at Cook Children’s Health Care System is reviewed and approved by an Institutional Review Board before any medical research study begins. In some situations, limited information may be used before approval of the research study to allow a researcher to determine whether enough patients exist to make a study scientifically valid.
As required by law
We will disclose protected health information about you when required to do so by federal, state or local law.
To avert a serious threat to health or safetyWe may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and tissue donation
We may release protected health 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.
We may release protected health information about you for workers' compensation or similar programs.
Public health risks
We may disclose protected health information about you for public health activities. These activities generally include the following:
Health oversight activities
We may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government 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 may disclose protected health information about you in response to a court or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release protected health information if asked to do so by a law enforcement official:
Coroners, medical examiners and funeral directors
We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release protected health information about patients of the hospital to funeral directors as necessary to carry out their duties.
National security and intelligence activities
We may release protected health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective services for the president and others
We may disclose protected health information about you to authorized federal officials so they may provide protection to the president, other authorized persons or foreign heads of state or conduct special investigations.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release protected health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety needs or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding protected health information we maintain about you:
Right to inspect and copy
You have the right to inspect and request copies of protected health information that may be used to make decisions about your care. Usually, this information includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to the director/manager of Health Information Management at the address below. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to protected health information, you will receive instructions on how to request that the denial be reviewed. When review is required by law, another licensed health care professional chosen by the organization will review your request and the denial. The person conducting the review will not be the person who denied your request. We will notify you of the outcome of this review and will comply.
Right to amend
If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the organization.
To request an amendment, your request must be made in writing and submitted to the director/manager of Health Information Management, at the address below. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
If we deny your request for amendment, we will notify you and provide reasons for the denial.
Right to an accounting of disclosures
You have the right to request a list of disclosures (also called an accounting of disclosures) we made of protected health information about you.
To request this list or accounting of disclosures, you must submit your request in writing to the director/manager of Health Information Management at the address below. Your request must state a time period which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to request restrictions
You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the director/manager of Health Information Management at the address below. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
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.
To request confidential communications, you must make your request in writing to the director/manager of Health Information Management at the address below. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a paper copy of this notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice by clicking the following link:
To obtain a paper copy of this notice, please contact the director/manager of Health Information Management at the address below.
We reserve the right to change this notice. We reserve the right to make the revised notice effective for protected health information we already have about you, as well as any information we receive in the future. We will post a copy of the current notice in appropriate areas and on our Web site. In addition, each time you register or are admitted for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with Cook Children’s by contacting the patient representative at 682-885-3926 or the secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
Other uses and disclosures of protected health information, not covered by this notice or the laws that apply to us will be made only with your written permission. These uses and disclosures include, but are not limited to, items such as psychotherapy notes, the sale of your protected health information or its use for marketing purposes. If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
CCHCS privacy officer contact:
Director/manager of Health Information Management contact:
Cook Children's Medical Center
801 7th Avenue
Fort Worth, TX 76104
August 1, 2013
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