New Patient Online Forms
Please call our office to schedule your child’s first appointment, then you can submit your child’s paperwork through our secure online form and save time when you arrive at your first appointment!Submit
About The Children's Clinic
Our clinic is specifically designed for children and adolescents and includes a separate wellness center and a research division.Learn More
Meet Our Providers
We are committed to protecting and promoting the growth, development, and health of all children.
Appointments Monday – Friday
Patients are seen from 9:00 am to 4:30 pm by appointment. Call 870-935-6012 to schedule your appointment.
Inclement Weather Policy
THE SAFETY OF OUR PATIENTS, STAFF, AND PROVIDERS ALWAYS COME FIRST!
The Children’s Clinic rarely closes completely during inclement weather. We evaluate the roads at 6:30 am the morning of and decide on clinic hours.
Our Walk-in Clinic will be open during the clinic hours for that day. If your provider is unable to make the drive, you may be seen in our Walk-in Clinic.
Please watch our facebook page for special hours.
NURSE & LAB APPOINTMENTS
Nurse and Lab appointments can be made Monday – Friday from 8 am to 4:30 pm. Please call ahead for an appointment.
Calls are answered by our answering service and forwarded to a pediatric RN at Arkansas Children’s Hospital. If our physician is needed, they will contact them. All refill requests need to be made during normal office hours. Please note: The Children’s Clinic does not give referrals to urgent treatment centers or walk-in clinics.
In the case of an emergency, always call 911.
Our goal is to provide quality medical care in a timely manner. In order to do so, we have had to implement an appointment/cancellation policy.
Cancellation/Rescheduling of an Appointment
In order to be respectful to all our patients, please call our office promptly if you are unable to keep an appointment. We require at least 2 hours’ notice so your appointment can be given to someone else. Our operators take calls 8 a.m.-5 p.m., and we will be closed at 12-1 p.m. for lunch.
Late cancellations will be considered a “no show”.
“No Show” Policy for Regular Appointments
A “no show” is when a patient misses an appointment without canceling 2 hours in advance or fails to arrive at the time of a scheduled appointment. Both of these will be recorded in the patient’s chart as a “no show”.
The first and second time there is a “no show”, the patient will be notified by mail and/or messenger.
The third no-show will result in the patient being permanently dismissed from our practice.
An open letter to all our valued families:
The providers of The Children’s Clinic care deeply about the health and safety of the children in our care. One of the most vital steps in keeping them healthy is to be current with their childhood vaccines. Our clinic follows the recommendations of the American Academy of Pediatrics and the Centers for Disease Control and Prevention by encouraging our patients to be immunized according to their published schedule.
Unvaccinated children are at higher risk for becoming ill with a host of preventable diseases that can have very serious and sometimes devastating consequences. In addition, unvaccinated children can potentially spread a preventable disease to another child who may be too young to be vaccinated or whose medical condition prevents them from receiving immunizations. The vaccines our children receive have each been thoroughly tested for safety and effectiveness and we have given them to our own children.
With those important issues in mind, and for the safety of all the children in our care, we are providing our families with The Children’s Clinic’s policy statement regarding vaccine status:
Effective immediately, The Children’s Clinic will no longer accept new patients who are unvaccinated or on an alternative vaccine schedule. Parents of unvaccinated children ALREADY IN OUR CARE, will be provided a 30 days’ notice in which to enroll with a different primary care physician. Parents who would like to start immunizations, are encouraged to discuss catch-up immunizations for their child. In addition, we discourage adoption of alternative vaccine schedules for our patients. Parents who choose to use an alternative schedule, are asked to have vaccines completed within the recommended time ranges specified by the American Academy of Pediatrics and CDC.
We would encourage you to speak with your provider about this important matter. We will try to address any questions and concerns you may have. We will also be happy to provide you with the current AAP/CDC recommended vaccine schedule. We at The Children’s Clinic look forward to providing your children with the best possible medical care and guidance, and we value your trust and confidence.
In the case of an emergency, please call 911.
The Children’s Clinic has sick call clinic available from 8am to 9am Monday – Friday for acute care needs.
We have an on-call physician at St. Bernards Medical Center who makes rounds a week at a time.
Our clinic telephone is answered 24 hours a day 7 days a week. Starting at 5 pm on weekdays and all weekend we have nurses from Arkansas Children’s Hospital Kids Care available to answer any concerns a parent has no matter the time of night.
You should take your child to the emergency room if:
- your child has difficulty breathing or shortness of breath
- your child has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to rouse, disoriented, or confused
- your child has a cut in the skin that is bleeding and won’t stop
- your child has a stiff neck along with a fever; if your child has a rapid heartbeat that doesn’t slow down
- your child accidentally ingests a poisonous substance or too much medication
- your child has had more than minor head trauma.
Poison Control Center – 1-800-222-1222
This policy is executed to assure the financial resources necessary to maintain this health care practice. We strive to have a team approach to health care with the physicians, patient care staff, and the business office staff working together to provide excellent service to our patients. Our goal is to treat each patient with dignity, respect, and courtesy and to serve all of Northeast Arkansas with the highest quality health care available.
Patients are responsible for full payment of services rendered at the time of service. The exceptions are patients covered by Medicaid or an insurance plan with which we have a participating agreement to accept assignment of benefits. Personal checks, Bank Debit cards, Mastercard and Visa and Discover are accepted.
Hospital Charges are due and payable with the receipt of the monthly statement. We will file the insurance claim form on all hospital charges.
The Children’s Clinic of Jonesboro, P.A. currently has a participating agreement with Medicaid, ARKids First and the following insurance companies: Blue Cross/Blue Shield, USAble, First Source, Health Advantage, and groups participating in the SHARP network and many others If you are unsure if we participate with your plan, please check your benefit manual or contact your insurance company or employer. For those patients we expect payment at time of service of any co-pay, co-insurance and deductible. We will file an insurance claim with these carriers and the insurance payment will be made to the clinic.
Our doctors are on active staff at St. Bernards Medical Center. If your insurance plan requires you to use NEA Baptist Hospital then we are probably not “in-network” for your plan. Please call your insurance company to verify which hospital is covered.
Medicaid and ARKids First patients are expected to bring their current card on the date of service. If one of our physicians is not the Primary Care Physician (PCP), a referral is required from your PCP prior to service being provided. If Medicaid shows the coverage to be inactive for the date of service, the patient is responsible for payment of that day’s charges.
Financial Counseling is available with a patient account representative if you need assistance in complying with our financial policy. We will not discontinue services to patients who make appropriate, timely, monthly payments on their account. Accounts over 150 days old may be sent to an outside agency for collections if payment arrangements have not been made with one of our account representatives. Failure to make appropriate, timely, monthly payments will result in the account being sent to an outside agency for collections and may result in dismissal from The Children’s Clinic.
BALANCES ARE DUE IN FULL UPON RECEIPT OF YOUR MONTHLY STATEMENT.
Download The Children’s Clinic Financial Policy
All payment, including copay or deductible, is expected at the time of appointment. If payment arrangements need to be made, please contact our billing department prior to appointment.
We accept the following forms of payment:
- Credit Card (Visa, Master Card, Discover, American Express)
- FLEX Card
- Debit Card
You can also make payments online.
In preparation of the arrival of your baby, there are several resources in the area. St. Bernard’s Medical Center offers Childbirth Classes as well as a Breastfeeding Resource Center. They also have a new Neonatal Intensive Care Unit. You will need to have a properly installed child safety seat for your automobile before leaving the hospital with your newborn. Arkansas State Police has prepared this helpful brochure on car seat safety.
The Children’s Clinic’s physicians will see your newborn after discharge from the hospital with your hospital pediatrician recommending how quickly you should be seen in clinic.
Following your discharge home, you will need to bring your newborn in for wellness visits and immunizations.
In the case of an emergency, we have after-hours calls answered by our answering service and forwarded to a pediatric RN at Arkansas Children’s Hospital. If our physician is needed, they will contact them. Please do not hesitate to call our offices at 870-935-6012.
Please refer to your Parent’s Medical Handbook provided by SHARP, inc or the resource section of this website for general information.
Can I choose which provider my child sees?
Absolutely! Many parents prefer to see the same provider or providers. From a clinic standpoint, we agree this helps provide better continuity of care for the child. Monday-Friday 9 am – 430 pm parents can schedule appointments for their child with the provider of their choice.
I placed a call for the nurse and why haven’t they called me back yet?
If a parent requests to speak to one of our nurses, the information is initially taken by our telephone operator. Then it is sent to one of our staff nurses. Understandably, our nurses get a lot of telephone calls as well as other duties in the office with assisting our providers, and sometimes telephone calls take a couple of hours to have an official response from our providers. However, if you should ever place a call to one of our nurses and not have a call back from our staff within 90 minutes, please call again!
When should my child be seen for well-visits?
Ages for routine wellness exams are as follows: newborn, 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, and yearly at ages 2-18 (some insurance companies vary so please check with your specific carrier).
Should I take my child to the ER?
Our clinic telephone is answered 24 hours a day 7 days a week. Starting at 5 pm on weekdays and all weekend we have nurses from Arkansas Children’s Hospital Kids Care available to answer any concerns a parent has no matter the time of night: if your child has difficulty breathing or shortness of breath; if your child has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to rouse, disoriented, or confused; if your child has a cut in the skin that is bleeding and won’t stop; if your child has a stiff neck along with a fever; if your child has a rapid heartbeat that doesn’t slow down; if your child accidentally ingests a poisonous substance or too much medication; or if your child has had more than minor head trauma.
How long can I come to The Children’s Clinic?
The Children’s Clinic will see children through birth to adolescence. When a child turns 18 or graduates from high school we will recommend and help you find an adult provider.
What services do you offer in-house?
We offer digital x-ray, laboratory, EKG, spirometry, and vaccinations. We do not participate in the VFC program and ask those patients to go to their local health unit for vaccinations. We will help in this process by scheduling vaccine appointments at the health units upon request.
What if a provider outside of The Children’s Clinic wants me to have labs drawn, can I come there?
No. We refer those laboratory requests to St. Bernards Reference Lab which is located in the same building as The Children’s Clinic. It is located in Suite 202 and is open Monday – Friday from 8 am – 5 pm and no appointment is needed.
What if a provider from The Children’s Clinic wants me to have labs drawn, can I come there?
Absolutely! We ask that you schedule an appointment if it is a lab that our providers ask you to come back for. Sometimes our providers request “FASTING” labs. This is defined as a patient who cannot eat or drink anything after midnight before the labs are drawn. We accommodate this request and schedule these labs first thing in the morning.
Also, it is important that if a patient is having to have labs drawn by a venous sample (not a finger poke) that parents encourage their child to be well hydrated as this helps plump their veins up and make the whole experience go better.
Also if you are asked to bring back a urine or stool sample it is important that the specimens are refrigerated but not older than 24 hours.
Special Requests From Our Providers
Physician offices are sometimes a scary place for young children. They are often not familiar with the processes and have some stranger anxiety as well. Our staff and providers understand this and are patient and comfortable walking the children through these processes. We do ask that parents please do not threaten your child with them having to get a shot or labs drawn when they are anxious or misbehaving at an appointment. This only makes the anxiety escalate.
Please call 870-934-3165 for Medical Records. Or, you can fill out the form below.
THE CHILDREN’S CLINIC
NOTICE OF PRIVACY PRACTICES
Effective Date: June, 2015
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU NEED MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER:
Mary Jo Wiles
Mailing Address: 800 South Church, Suite 400, Jonesboro, AR 72401
About This Notice
We are required by law to maintain the privacy of Protected Health Information and to give you this Notice explaining our privacy practices with regard to that information. You have certain rights – and we have certain legal obligations – regarding the privacy of your Protected Health Information, and this Notice also explains your rights and our obligations. We are required to abide by the terms of the current version of this Notice.
What is Protected Health Information?
Protected Health Information is information that individually identifies you and that we create or get from you or from another health care provider, a health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health or conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care.
How We May Use and Disclose Your Protected Health Information
We may use and disclose your Protected Health Information in the following circumstances:
For Treatment. We may use Protected Health Information to give you medical treatment or services and to manage and coordinate your medical care. For example, we may disclose Protected Health Information to doctors, nurses, technicians, or other personnel who are involved in taking care of you, including people outside our practice, such as referring or specialist physicians.
For Payment. We may use and disclose Protected Health Information so that we can bill for the treatment and services you get from us and can collect payment from you, an insurance company, or another third party. For example, we may need to give your health plan information about your treatment in order for your health plan to pay for that treatment. We also may tell your health plan about a treatment you are going to receive to find out if your plan will cover the treatment. If a bill is overdue we may need to give Protected Health Information to a collection agency to the extent necessary to help collect the bill, and we may disclose an outstanding debt to credit reporting agencies.
For Health Care Operations. We may use and disclose Protected Health Information for our health care operations. For example, we may use Protected Health Information for our general business management activities, for checking on the performance of our staff in caring for you, for our cost-management activities, for audits, or to get legal services. We may give Protected Health Information to other health care entities for their health care operations, for example, to your health insurer for its quality review purposes.
Appointment Reminders/Treatment Alternatives/Health-Related Benefits and Services. We may use and disclose Protected Health Information to contact you to remind you that you have an appointment for medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
Minors. We may disclose the Protected Health Information of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.
Personal Representative. If you have a personal representative, such as a legal guardian (or an executor or administrator of your estate after your death), we will treat that person as if that person is you with respect to disclosures of your Protected Health Information.
Research. We may use and disclose your Protected Health Information for research purposes, but we will only do that if the research has been specially approved by an institutional review board or a privacy board that has reviewed the research proposal and has set up protocols to ensure the privacy of your Protected Health Information. Even without that special approval, we may permit researchers to look at Protected Health Information to help them prepare for research, for example, to allow them to identify patients who may be included in their research project, as long as they do not remove, or take a copy of, any Protected Health Information. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research. But we will only disclose the limited data set if we enter into a data use agreement with the recipient who must agree to (1) use the data set only for the purposes for which it was provided, (2) ensure the security of the data, and (3) not identify the information or use it to contact any individual.
Medical Residents and Medical Students. Medical residents or medical students may observe or participate in your treatment or use your Protected Health Information to assist in their training. You have the right to refuse to be examined, observed, or treated by medical residents or medical students.
As Required by Law. We will disclose Protected Health Information about you when required to do so by international, federal, state, or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Protected Health Information when necessary to prevent a serious threat to your health or safety or to the health or safety of others. But we will only disclose the information to someone who may be able to help prevent the threat.
Business Associates. We may disclose Protected Health Information to our business associates who perform functions on our behalf or provide us with services if the Protected Health Information is necessary for those functions or services. For example, we may use another company to do our billing or consulting services for us. All of our business associates are obligated, under contract with us, to protect the privacy of your Protected Health Information.
Organ and Tissue Donation. If you are an organ or tissue donor, we may use or disclose your Protected Health Information to organizations that handle organ procurement or transplantation – such as an organ donation bank – as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release Protected Health Information as required by military command authorities. We also may release Protected Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may use or disclose Protected Health Information for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Protected Health Information for public health activities. This includes disclosures to: (1) a person subject to the jurisdiction of the Food and Drug Administration (“FDA”) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity; (2) prevent or control disease, injury or disability; (3) report births and deaths; (4) report child abuse or neglect; (5) report reactions to medications or problems with products; (6) notify people of recalls of products they may be using; (7) a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (8) the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence and the patient agrees or we are required or authorized by law to make that disclosure.
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, licensure, and similar activities that 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 in response to a court or administrative order. We also may disclose Protected Health Information in response to a subpoena, discovery request, or other legal process from someone else involved in the dispute, but only if efforts have been made to tell you about the request or to get an order protecting the information requested. We may also use or disclose your Protected Health Information to defend ourselves if you sue us.
Law Enforcement. We may release Protected Health Information if asked by a law enforcement official for the following reasons: in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if; about a death we believe may be the result of criminal conduct; about criminal conduct on our premises; and in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
National Security. We may release Protected Health Information to authorized federal officials for national security activities authorized by law. For example, we may disclose Protected Health Information to those officials so they may protect the President.
Coroners, Medical Examiners, and Funeral Directors. We may release Protected Health Information to a coroner, medical examiner, or funeral director so that they can carry out their duties.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose Protected Health Information to the correctional institution or law enforcement official if the disclosure is necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.
Uses and Disclosures That Require Us to Give You an Opportunity to Object and Opt Out
Individuals Involved in Your Care or Payment for Your Care. We may disclose Protected Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend, to the extent it is relevant to that person’s involvement in your care or payment related to your care. But before we do that, we will provide you with an opportunity to object to and opt out of such a disclosure whenever we practicably can do so.
Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practicably can do so.
Your Written Authorization is Required for Other Uses and Disclosures
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 authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
Special Protections for HIV, Alcohol and Substance Abuse, Mental Health, and Genetic Information
Special privacy protections apply to HIV-related information, alcohol and substance abuse, mental health, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these kinds of Protected Health Information. Please check with our Privacy Officer for information about the special protections that do apply. For example, if we give you a test to determine if you have been exposed to HIV, we will not disclose the fact that you have taken the test to anyone without your written consent unless otherwise required by law.
Your Rights Regarding Your Protected Health Information
You have the following rights, subject to certain limitations, regarding your Protected Health Information
Right to Inspect and Copy. You have the right to inspect and copy Protected Health Information that may be used to make decisions about your care or payment for your care. But you do not have a right to inspect or copy psychotherapy notes. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state or federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Security Breach. We are required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breach of your Unsecured Protected Health Information as soon as possible, but in any event, no later than 60 days after we discover the breach. “Unsecured Protected Health Information” is Protected Health Information that has not been made unusable, unreadable, and undecipherable to unauthorized users. The notice will give you the following information:
- a short description of what happened, the date of the breach and the date it was discovered;
- the steps you should take to protect yourself from potential harm from the breach;
- the steps we are taking to investigate the breach, mitigate losses, and protect against further breaches; and
- contact information where you can ask questions and get additional information.
If the breach involves 10 or more patients whose contact information is out of date we will post a notice of the breach on our website or in a major print or broadcast media.
Right to Request Amendments. If you feel that Protected Health Information we have 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 us. A request for amendment must be made in writing to the Privacy Officer at the address provided at the beginning of this Notice and it must tell us the reason for your request. We may deny your request 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 (1) was not created by us, (2) is not part of the medical information kept by or for us, (3) is not information that you would be permitted to inspect and copy, or (2) is accurate and complete. If we deny your request, you may submit a written statement of disagreement of reasonable length. Your statement of disagreement will be included in your medical record, but we may also include a rebuttal statement.
Right to an Accounting of Disclosures. You have the right to ask for an “accounting of disclosures,” which is a list of the disclosures we made of your Protected Health Information. We are not required to list certain disclosures, including (1) disclosures made for treatment, payment, and health care operations purposes, (unless the disclosures were made through an electronic medical record, in which case you have the right to request an accounting of those disclosures that were made during the 3 years before your request), (2) disclosures made with your authorization, (3) disclosures made to create a limited data set, and (4) disclosures made directly to you. You must submit your request in writing to our Privacy Officer. Your request must state a time period which may not be longer than 6 years before your request. Your request should indicate in what form you would like the accounting (for example, on paper or by e-mail). The first accounting of disclosures you request within any 12-month period will be free. For additional requests within the same period, we may charge you for the reasonable costs of providing the accounting. We will tell what the costs are, and you may choose to withdraw or modify your request before the 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 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 for your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request unless we terminate our agreement or the information is needed to provide you with emergency treatment.
Out-of-Pocket-Payments. If you paid out-of-pocket in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
Right to Request Confidential Communications. You have the right to request that we communicate with you only in certain ways to preserve your privacy. For example, you may request that we contact you by mail at a special address or call you only at your work number. Your must make any such request in writing and you must specify how or where we are to contact you. We will accommodate all reasonable requests. We will not ask you the reason for your request.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. You can get a copy of this Notice at our website: http://www.jbrkids.com.
How to Exercise Your Rights
To exercise your rights described in this Notice, send your request, in writing, to our Privacy Officer at the address listed at the beginning of this Notice. We may ask you to fill out a form that we will supply. To exercise your right to inspect and copy your Protected Health Information, you may also contact your physician directly. To get a paper copy of this Notice, contact our Privacy Officer by phone or mail.
Changes To This Notice
The effective date of the Notice is stated at the beginning. We reserve the right to change this Notice. We reserve the right to make the changed Notice effective for Protected Health Information we already have as well as for any Protected Health Information we create or receive in the future. A copy of our current Notice is posted in our office and on our website.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the United States Department of Health and Human Services.
To file a complaint with us, contact our Privacy Officer at the address listed at the beginning of this Notice. All complaints must be made in writing and should be submitted within 180 days of when you knew or should have known of the suspected violation. There will be no retaliation against you for filing a complaint.
To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. Call (202) 619-0257 (or toll free (877) 696-6775) or go to the website of the Office for Civil Rights, www.hhs.gov/ocr/hipaa/, for more information. There will be no retaliation against you for filing a complaint.