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(512) 270-9446

Notice of Privacy Practices

 

This notice describes how your health information may be used and disclosed, and how you can access your protected health information (PHI).

 

A. Our Commitment to Your Privacy

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Starlight Pediatrics PLLC (“Starlight” or “we”) is dedicated to maintaining the privacy of your protected health information (PHI). In the course of providing care, we create and maintain records about your treatment and services.

This notice explains our privacy practices regarding PHI and applies to all records created or retained by our Practice. We reserve the right to revise or amend this notice at any time, affecting both past and future records. You may request a copy of the most current notice at any time.

 

B. Questions About This Notice

If you have any questions, please contact:

Starlight Pediatrics
drp@starlightpediatrics.com

 

C. How We May Use and Disclose Your PHI

We may use and disclose your PHI in the following ways unless you object:

1. Treatment

  • We may use your PHI to provide medical treatment, including ordering lab tests, writing prescriptions, or coordinating with other healthcare providers.

  • We may disclose PHI to family members or caregivers assisting in your treatment.

2. Payment

  • Although we do not bill insurance, we may use or disclose PHI to obtain payment from responsible parties, such as family members.

3. Health Care Operations

  • We may use your PHI for business operations, including evaluating care quality, developing protocols, training programs, and credentialing.

4. Appointment Reminders

  • We may use your PHI to contact you about upcoming appointments.

5. Release of Information to Family/Friends

  • With your permission, we may release PHI to a friend or family member involved in your care (e.g., a babysitter bringing a child to an appointment).

6. Disclosures Required by Law

  • We may disclose your PHI when required by federal, state, or local laws.

 

D. Special Circumstances for PHI Use and Disclosure

We may also use or disclose PHI in the following situations:

1. Health Oversight Activities

  • For audits, inspections, investigations, or disciplinary actions by authorized agencies.

2. Legal Proceedings

  • In response to a court order, subpoena, or discovery request, after making reasonable efforts to notify you.

3. Law Enforcement

  • When required for:

    • Identifying or locating a suspect, fugitive, or missing person.

    • Reporting crime-related injuries or deaths.

    • Compliance with legal orders.

4. Deceased Patients

  • PHI may be disclosed to a medical examiner, coroner, or funeral director when necessary.

5. Organ and Tissue Donation

  • If you are a registered donor, we may release PHI to facilitate donation and transplantation.

6. Serious Threats to Health or Safety

  • PHI may be used to prevent or reduce a serious threat to an individual or the public.

7. Military and Veterans

  • Disclosure may be required for military personnel per authorized directives.

8. Workers’ Compensation

  • PHI may be disclosed as required for workers' compensation claims.

9. Public Health Risks

  • For reporting:

    • Births and deaths.

    • Communicable disease exposure.

    • Child abuse or neglect.

    • Adverse reactions to medications or product recalls.

 

E. Your Rights Regarding Your PHI

You have the following rights concerning your protected health information:

1. Confidential Communications

  • You may request communications via specific methods (e.g., home phone vs. work phone) by submitting a written request.

2. Requesting Restrictions

  • You may request limitations on how your PHI is used or disclosed. We are not required to agree but will comply when possible.

3. Accessing and Copying Your Records

  • You have the right to inspect and obtain copies of your medical records (except psychotherapy notes) by submitting a written request. A fee may apply for copies.

4. Requesting an Amendment

  • If you believe your records contain incorrect or incomplete information, you may request an amendment in writing. Requests may be denied if:

    • The information is accurate and complete.

    • The request applies to records not created by our Practice.

5. Obtaining a Paper Copy of This Notice

  • You may request a printed copy of this Privacy Notice at any time.

6. Filing a Complaint

  • If you believe your privacy rights have been violated, you may file a complaint at

Starlight Pediatrics
drp@starlightpediatrics.com

  • You will not be penalized for filing a complaint.

7. Authorizing Other Uses and Disclosures

  • Any uses or disclosures not covered by this notice or otherwise permitted by law require your written authorization. You may revoke authorization at any time in writing.

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F. Acknowledgment of Notice of Privacy Practices

I acknowledge that I have received and read Starlight Pediatrics’ HIPAA Privacy Policy Notice.

Patient’s Full Name: ________________________
Date of Birth: _______________
Signature: ________________________
Date: _______________
Printed Name: ________________________
Relationship to Patient: _______________

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