notice of privacy for our pediatric practice

Notice of Use and Disclosure of Protected Health Information (PHI)

The World of Pediatrics uses and/or discloses certain protected health information (PHI) about patients for very specific purposes as outlined below and only with the consent of the patient, parent, or legal guardian. Failure to authorize release of PHI may prevent the exchange of vital information associated with care delivery.

The World of Pediatrics uses and/or discloses the following health information:

The information will be used and/or disclosed for the following purposes:

The World of Pediatrics, also, will call your home or other location and leave a message on voice mail or in person in reference to any items that assist the practice in carrying out TPO. These messages may include, but are not limited to appointment reminders, insurance items, and any calls pertaining to clinical care, including lab and radiology results.

The World of Pediatrics will mail to your home or other location any items that assist the practice in carrying out TPO, such as reminder cards and statements.

The purposes of disclosing PHI have been provided, so that you may make an informed decision whether to allow release of information or not. 

The World of Pediatrics will not receive payment or other remuneration from a third party in exchange for disclosing PHI, however there are fees associated with copying medical records, filling out forms, and/or preparing letters at the request of the patient.

The patient, their parents, or their legal guardian do not have to authorize release of PHI to receive treatment at The World of Pediatrics.  The patient, their parents, or their legal guardian, also, have the right to revoke their authorization at any time by written request to the Privacy Officer of The World of Pediatrics.

Remember that authorization for the disclosure or release of PHI is used simply to carry out treatment, receive payment, collaborate with other physicians or healthcare entities, to carry out health care operations (TPO), to comply with laws, to comply with regulations, or at the request of the patient, their parents, or their legal guardians.

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3005 Royal Blvd. S., STE 110, Alpharetta, GA 30022
Office Hours Monday through Friday 9:00am - 7:00pm, Saturday for sick only 10:00am - 12:00pm
Call 770-442-5437 for an Appointment
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