Notice of Privacy Practices

Bloom Pediatrics providers and staff are governed by and comply with the federal Health Insurance Portability and Accountability Act (HIPAA). We are required to abide by the terms of our office Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at the time. A copy of our current HIPAA statement is available upon request.

Patients age 18 and older are required to sign a waiver authorizing parental access to their account. Parents of patients over the age of 18 will not be permitted to access any medical or billing information without written consent of patient.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.  We are also required to abide by the terms of the notice currently in effect.  If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.  

Please sign the “Acknowledgement” below to acknowledge that you have received or been given the opportunity to receive a copy of our Notice of Privacy Practices.

Acknowledgement

I have read the above HIPAA Privacy Policies. As indicated above, I know my rights as a parent or as a patient over the age of 18, and also know and agree to the policies and procedures set in place by Bloom Pediatrics.