4012 Raintree Road, Suite 200A
Chesapeake, VA 23321
(757) 488-2223

Monday - Thursday 8AM - 6PM
Friday 8AM - 5PM
Saturday (Walk-ins) 9AM - 11AM

We offer same day appointments for sick patients.



Renaissance Pediatrics, P.C. NOTICE OF PRIVACY PRACTICES


Effective Date: 9 / 23 / 2013

If you have any questions about this notice, please contact the Renaissance  Pediatrics,  P.C.  Privacy Officer.


This notice describes the practices of:

•    Renaissance Pediatrics, P.C.

•    Any health care professional authorized to enter information into your medical record maintained by Renaissance  Pediatrics, P.C.

•    Any persons or companies with whom Renaissance Pediatrics, P.C. contracts for services to help operate our practice and who have access to your medical  information.

•    All these persons, entities, sites, and locations follow the terms of this  notice.  In addition,  these persons, entities, sites, and locations may share medical information with each other for treatment, payment, or health care operations  purposes and other purposes described in this  notice.


We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive from Renaissance Pediatrics, P.C. We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care and  billing for that care  that are generated or maintained by Renaissance Pediatrics, P.C., whether  made  by  Renaissance  Pediatrics, P.C. personnel or other health care providers. Other health care providers may have different policies or notices about confidentiality and disclosure that apply to your medical  information  that  is created in their offices or at locations other than Renaissance  Pediatrics, P.C.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

•    Make sure that medical infonnation that identifies you is kept private;

•    Give you this notice of our legal duties and privac y practices at Renaissance Pediatrics, P.C., and  your legal rights, with respect to medical  infonn ation about  you; and

•    Follow the tenns of the notice that is currently in effect.



The following categories describe different ways that we use and disclose medical information . For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to  use  and disclose information will fall within one of these categories.

*For Treatment.  We may use medical information  about you to provide you with medical treatment or services.  We may disclose medical  information  about  you to doctors, nurses, technicians,  medical stu dents, volunteers, or other personnel who are involved in taking care of you at Renaissance Pediatrics, P.C. For example, a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process. We also may disclose medical information about you to people outside Renaissance Pediatrics, P.C. who may be involved in your medical  care after you have been treated by Renaissance Pediatrics, P.C., such as friends, family members , or employees or medical staff members of any hospital or skilled nursing facility to which you are transferred or subsequently admitted.

*For Payment. We may use and disclose medical information about you so that the treatment and services you receive from Renaissance Pediatrics, P.C. may be billed by Renaissance Pediatrics, P.C. and payment may be collected from you, an insurance company, or a third party.  For example,  we may need to give your health plan information about treatment you received from Renaissance Pediatrics, P.C. so your health plan will pay us or reimburse you for the treatment. We also  may disclose information about you to another health care provider, such as a hospital or skilled nursing facility to which you are admitted, for their payment activities concerning you.

*For Health Care Operations. We and our business associates may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run Renaissance Pediatrics, P.C. and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and  to  evaluate  the performance of our staff in caring for you. We may also combine medical information about many patients to decide what additional services Renaissance Pediatrics, P.C. should  offer,  and  what services are not needed. We may also disclose information to doctors, nurses, technicians, and other personnel affiliated with Renaissance Pediatrics, P.C. for review and learning purposes. We may also combine the medical information we have with medical  information  from other health care providers to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning the identities of specific patients. We also may disclose information about  you  to  another  health care provider for its health care operations  purposes if you also have received care from that provider.

*Treatment Alternatives. We may use and disclose medical information to tell you about or recommend different ways to treat you.

*Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition . Medical infonnation about you that has had identifying infonnation removed may be  used  for research without your consent. We also may disclose medical infonnation about you to people preparing to conduct a research project (for example, to help them look for patients with specific medical needs) , so long as the medical infonnation they review does not  leave  Renaissance Pediatrics, P.C. If the researcher will have infonnation about your  mental  health  treatment  that reveals who you are, we will seek your consent before disclosing that information to the researcher. Unless we notify you  in advance and you give us written pennission, we will not  receive any money or other thing of value in connection for using or disclosing your medical information for research purposes except for money to cover the costs of preparing and sending the medical information to the researcher.

*Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. This  would include persons named in any durable health care power of attorney or similar document provided to us. We may also give information to someone who helps pay for some or all of  your  care. In addition , we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. You can object to these releases by telling us that you do not wish any or all individuals involved in your care to receive this information. If you are not present or cannot agree or object, we will use our professional judgment to decide whether it is in your best interest to release relevant information to someone who is involved in your care or to an entity assisting in a disaster relief effort.

*As Required or Permitted By Law.  We may disclose medical  information  about you when required or  permitted  to do so  by federal, state, or local  law.

*To Avert a Serious Threat  to Health or Safety.  We may use and  disclose medical  information  about you when it appears necessary to prevent  a  serious threat  to your health and safety or the health and safety of the public or another person.  Any disclosure  would  be to someone who appears  able to help prevent  the  threat and will be  limited to the  information needed.


Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

*Active Duty Military Personnel and Veterans. If you are an active duty member of the armed forces or Coast Guard, we must give certain information about you to your commanding officer or other command authority so that your fitness for duty or for a particular mission may be determined. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.

*Workers' Compensation. In accordance with state law, we may release without your consent medical information about your treatment for a work-related injury or illness or for which you claim workers' compensat io n to your employer, insurer, or care manager paying for that treatment under a workers' compensation program that provides benefits for work-related injuries or illness.

*Public Health Risks. We may disclose  without  your  consent  medical  information  about you  for public health activities .  These activities generally  include but are not limited to the following:

•    To report, prevent or control disease, injury, or disability;

•    To report  births and deaths;

•    To  report  reactions to medications or problems with products;

•    To notify people of recalls of products they may be using;

•    To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading  a disease or condition; and

•    To  report suspected abuse or neglect as  required by law.

*Health Oversight Activities. We may disclose without your consent medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example , audits, investigations, inspections, and licensure. The government uses these activities 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 must disclose medical information about you in response to a court or administrative order. We also may disclose medical information about you in response to a subpoena or other lawful process from someone involved in a civil dispute.

*Law Enforcement. We may release without your consent medical information to a law enforcement official:

•    In response to a court order, warrant, summons, grand jury demand, or similar process;

•    To comply with mandatory reporting requirements for violent injuries, such as gunshot wounds, stab  wounds, and poisonings;

•    In response to a request from law enforcement for certain information to help locate a fugitive, material  witness, suspect, or missing person;

•    To  report  a death or injury we believe may be the result of criminal conduct; and

•    To report suspected criminal conduct committed at Renaissance Pediatrics, P.C. facilities.

*Coroners and Medical Examiners. We may release without your consent medical information to a coroner or medical examiner. This may be done, for example, to identify  a  deceased  person  or determine the cause of death. We also may release medical information about deceased patients of Renaissance Pediatrics, P.C. to  funeral directors to carry out their duties.

*National Security and Intelligence Activities. We may release without your consent medical information about you as required by applicable law to authorized federal or state officials for intelligence, counterintelligence, or other governmental activities prescribed by law to protect our national security.

*Protective Services for the President and Others.   We  may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.

*Inmates. If you are an inmate of a correctional  institution or in the custody of law e nforcement, we may release medical information about you to the correctional institution or law enforceme nt official who has custody of you, if the correctional institution or law enforcement official represents to Renaissance Pediatrics, P.C. that such medical information is  necessary:  (1)  to  provide  you  with health care; (2) to protect your health and safety or the health and safety of others; (3) to protec t the safety and security of officers, employees, or others at the correctional institution or involved in transporting you; (4) for law enforcement to maintain safety and good order at the correctional institution; or (5) to obtain payment  for services provided to you.



You  have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy. You have the right to inspect and receive a copy of your medi cal record unles s your attending physician determines that information in that record, if disclosed to you, would be harmful to your mental or physical health. If we deny your request to inspect and receive a copy of your medical information on this basis, you may request that the denial be reviewed. Another licensed health care professional chosen by Renaissance Pediatrics, P.C. will review your request and the denial. The person conducting the review will not be the person who denied your request. We will do what this reviewerdecides.

If we have all or any portion of your medical information in an electronic format, you may request an electronic copy of those records or request that we send an electronic copy to any person or entity you designate in writing.

Your medical information is contained in records that are the property of Renaissan ce Pediatrics, P.C. To inspect or receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to Renaissance Pediatrics, P.C.' s Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request, and we may collect the fee before providing the copy to you. If you agree, we may provide you with a summary of the information instead of providing you with access to it, or with an explanation of the information instead of a copy. Before providing you with such a summary or explanation, we first will obtain your agreement to pay and will collect the fees, if any, for preparing the summary or explanation.

*Right to Amend.  If you feel that medical information we have about you in your record 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 Renaissance Pediatrics, P.C..

To request an amendment, make your request in writing to Renaissance Pediatrics, P.C.' s Privacy Officer. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment 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:

•    Was not created by us, unless  the person or entity  that  created  the  information is  no longer available to make the amendment;

•    Is not part of the medical information kept by or for Renaissance Pediatrics, P.C.

•    Is not part of the information that you would be permitted to inspect and copy or

•    Has been determined  to be accurate and complete.

If we deny your request for an amendment, you may submit a written statement of disagreement and ask that it be included in your medical record.

*Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of medical information  about you during the past six years.

To request this list or accounting of disclosures, submit your request in writing to Renaissance Pediatrics, P.C.'s Privacy Officer and state whether you want the list on paper or elec tronic ally. Your request must state a time period that may not be longer than six years. The first  list  you  request  within a 12-month period will be free. For additional lists, we may charge you  for  the costs  of providing the list. We will notify you of the cost involved and  you  may choose to withdraw  or modify your request at that time before any costs are incurred. We may collect  the  fee  before providing  the list to you.

*Right to Request  Restrictions.  Except  where we are required  to disclose the information  by  law, you have the right to request a restriction or limitation on the medical information we use or disclose about you. For example, you could revoke any and all authorizations you previousl y gave us relating  to disclosure  of your  medical information.

We are not required to agree to your request, with  the exception  of restrictions  on  disclosures  to your health plan, as described below. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

To request restrictions, make your request in writing to Renaissance Pediatrics, P.C.' s Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

You may request that we not disclose your medical information to your health insurance  plan for  some or all of the services you receive during a visit to any Renaissance Pediatrics,  P.C. location.  If you pay the charges for those services you do not want disclosed  in full  at  the time of such service, we are required to agree to your request. "In full"  means the amount we charge  for the service,  not your copay, coinsurance, or deductible responsibility when  your insurer  pays for your care.  Please note that once information about a service has been submitted to your health plan, we cannot agree to your request. If you think you may wish to restrict the disclosure of your medical information for a certain service, please let us know as early in your visit as possible.

*Right to Request Confidential Communications. You have  the  right  to  request  that  we communicate with you about medical  matters in a certain  way or at a certain location.  For example, you can ask that we only contact you at work or by mail, or at another mailing address other than your home address.   We will  accommodate  all  reasonable  requests.   We will not ask you the  reason  for your request. To request confidential communica tions, make your request in writing to the Privacy Officer and specify how or where you wish to be contacted.

*Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice or any revised notice. You may ask us to give you a copy of this notice at any time. Even 1f you have agreedto receive this notice electronically, you are still entitled to a paper copy of this notice.

To obtain a paper copy of this notice, request a copy from Renaissance Pediatrics, P.C.'s Privacy Officer in writing.


We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at Renaissance Pediatrics, P.C.' s office. The notice will contain the effective date on the first page, in the top right-hand corner.  If  the notice changes, a copy will be available to you upon request.


We will investigate any discovered unauthorized use or disclosure of your medical information to determine if it constitutes a breach of the federal privacy or security regulations addressing such infonnation. If we determine that such a breach has occurred, we will provide you with notice of the breach and advise you what we intend to do to mitigate the damage (if any) caused by the breach, and about the steps you should take to protect yourself from potential harm resulting from the breach.


If you believe your privacy rights have been violated, you may file a complaint with Renaissance Pediatrics, P.C. or with the Secretary of the United States Department of Health and Human Services. To file a complaint with Renaissance Pediatrics, P.C., contact our Privacy Officer by mail at 4012 Raintree RD, Chesapeake, VA 23321. All complaints must be submitted in writing.

You will not be penalized for filing a complaint


Other uses and disclosures of medical information not covered by this notice may be made only with your written authorization or as required by law. If you authorize us to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. Your revocation will be effective  as of the end of the day on which you provide it in writing to Renaissance Pediatrics, P.C.' s Privacy Officer. If you revoke your permission, we will no longer use or disclose medical information about you for the purposes that you previously had authorized in writing. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.