This policy will be prominently displayed in each office, given out with new-patient paperwork, displayed on the website, put in quarterly newsletter, and displayed in each exam room.

All insured and non-insured patients will be charged a $25.00 “no-show” fee on the second and third missed appointments, and dismissal from the practice may result after a subsequent no-show.

Cancellations are requested within 24 hours when possible.

PURPOSE:

To improve scheduling opportunities and encourage patients to call and cancel their appointments in a reasonable amount of time (24-hours when possible), which would allow for better use of patient, staff and physician time.

v    First No-Show – the patient will receive a phone call informing them they missed their appointment and another missed appointment, without notifying the practice, will result in a $25.00 fee.

v    Second No-Show – the patient will receive a letter informing them that they have now missed two (2) appointments without notifying the office and they will be charged a $25.00 fee.

v    Third No-Show – the patient will receive a certified letter informing them that their account has been flagged as habitual no shows and that another no-show may result in dismissal from the practice.  They will be charged a $25.00 fee.

Patients who No-Show a double appointment, (bringing in two children at the same time), will be restricted from scheduling double appointments in the future.  A note will be entered into the Practice Management System.

                         NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD (CHILDREN) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Community Pediatrics, Inc  including staff, physicians and other health care providers on our staff, use and share health information about you or your child (children) for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.  We are committed to protecting health information about you or your child (children).  Your or your child’s health information is contained in a medical record that is the physical property of Raleigh Pediatrics.

HOW WE MAY USE YOUR HEALTH INFORMATION:

FOR TREATMENT.  We may use your or your child’s health information to provide, coordinate or manage medical treatment or related services. Information obtained by a nurse, physician, or other member of the healthcare team will be recorded in the medical record and used to determine the course of treatment that will work best for you or your child. 

FOR PAYMENT.  We may use and disclose health information to bill and collect payment for treatment and services that are received.  For example, a bill may be sent to you or to your insurance company.  The bill will contain information that identifies you or your child (children), as well as the diagnosis, procedures and supplies used in the course of treatment.

FOR HEALTH CARE OPERATIONS.  We may use and disclose health information about you or your child (children) for office operations.  For example, you or your child’s health information may be disclosed to other staff members to:

·       Evaluate the performance of our staff

·       Assess the quality of care

·       Learn how to improve our facilities and services; and

·       Determine how we can make improvements in the care and services we provide

APPOINTMENTS/FOLLOW-UP CALLS. We may use your or your child’s information to contact you as a reminder that you have an appointment for treatment or to follow-up regarding medical care.

INDIVIDUALS INVOLVED IN YOUR CARE.  We may share information with a family member or other person identified by you or who is involved in your or your child’s care or payment related to that care.  We may tell a family member or friend about you or your child’s) condition.  If you do not want that information released to those involved in the care, see instructions for requesting a restriction under YOUR HEALTH INFORMATION RIGHTS.

HOW WE MAY DISCLOSE YOUR OR YOUR CHILD (CHILDREN’S) HEALTH INFORMATION OUTSIDE OF RALEIGH PEDIATRICS:

REQUIRED BY LAW/PUBLIC HEALTH.  We may disclose information about you or your child (children) when required to do so by federal, state or local laws.  For example, we may disclose information for the following purposes:

·       To respond to a court order, subpoena or deposition.

·       To assist law enforcement officials in their duties to locate a suspect, fugitive or missing person.

·       To report information related to victims of child abuse or neglect.

·       To report reactions to medication or recalls of products.

·       To federal and state agencies for oversight activities authorized by law such as investigation, inspections, audits, surveys and licensing.  (Examples may include organizations that ensure the quality/safety of the care we provide).

HEALTH RISKS. You or your child’s health information may be released for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability.  We may disclose your or your child’s health information to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease.

HEALTH AND SAFETY.  We may disclose health information about you or your child (children) to avert a serious threat to the health or safety of you, any other person or the public.  Any disclosure would only be to someone able to help prevent the threat.

DECEASED.  Health information may be disclosed to funeral directors, medical examiners or coroners to enable them to carry out their lawful duties.

ORGAN/TISSUE DONATION. If you or your child (children) are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank.

RESEARCH. We may disclose information for research purposes when Raleigh Pediatrics has reviewed and approved the research proposal.  Medical record information that identities you or your child (children) will only be used when given permission for us to do so.  Additionally, when given permission, RPA may contact you regarding research purposes.

NATIONAL SECURITY. We may disclose your or your child’s health information to federal officials for intelligence, counterintelligence, and national security activities authorized by law.

TREATMENT ALTERNATIVES. We may use and disclose health information to tell you about or recommend possible treatment options or other health-related benefits and services that may be of interest to you.

WORKERS’ COMPENSATION. Your or your child’s health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation or similar programs.  These programs provide benefits for work-related injuries or illness.