The HSC Health Care System logo: Blue diamond with a white half heart, yellow stylized stick figures of man, woman, and child standing in the heart and the HSC Pediatric Center written at the bottomThe HSC Pediatric Center, The HSC Health Care System and Health Services for ChildrenA set of three pictures: the one on the left shows a social worker hugging a child, the one in the middle shows a girl smiling and the third one shows a group of standing children clapping
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Notice of Privacy

Notice of Privacy Practices. This notice is effective as of April 14, 2003 (Internal Form 36). If you do not speak and/or read Englsih, please call 202-442-5988 between 8:15 a.m. and 4:45 p.m. A representative will assist you. This same statement is shown in Chinese, Amharic, Vietnamese and Japanese. If you have a hard time understanding this document, please call us at 202-442-5988

The Health Services for Children Health Care System (The HSC Health Care System) and The HSC Pediatric Center (HSC) knows how important it is to keep your health information private. We want you to know that we will make sure that your personal information is used exactly how we say it will be used, according to the law and as we say in this notice. We have the right to change this notice at any time.

Different laws say different things about health information. “Health information” means information about you or your child’s health care. The term “personal information” means health information and any other information that we have received while providing benefits to you or your child, such as your address and Social Security number.

The law says we must give you this notice. It will tell you about the ways in which we may use health information about members. It tells about your rights. It also tells about our responsibilities in the use and disclosure of that information.


In providing health services, we may get health information from you, or other health care providers regarding the patient’s health care services and their coverage including health care claims and encounters. We also may get medical history that includes the results of tests and notes written by doctors and nurses, as well as your name, address and telephone number. Each time you receive care from The HSC Pediatric Center, a record of your visit is made. This record has information like notes about your child’s examination; symptoms, test results, diagnoses, and treatment(s).


We protect patient health information by giving personal information about the patient only to those employees who need to know that information to provide products or services. We keep all personal information safe and secure.

We do need to send information to some people (like doctors or hospitals or other billing departments) without asking permission each time. We do that only when the law allows. By law, the others can not tell anyone else about the information we give them about you or your child.


The law says that we can use health information for “treatment,” “payment,” and “health care operations.” Here are some examples, (but the list doesn’t include every reason that information can be given):

For Treatment. We may give information to doctors, nurses, technicians, office staff or other personnel who provide services.

  • For Payment. We may use and give others health information about the patient when we need to decide on eligibility for coverage, coordinate care, review medical necessity, pay claims or review and respond to complaints. For example, while we work on claims, we get personal information about the patient to find out what services he/she actually received.
  • For Health Care Operations. We may use and give others the patient’s personal information for our health care operations. That may include quality improvement activities; accreditation; responses to inquiries; appeals and review programs. It may also be used for health promotion; case management and care coordination; and general administrative activities. Sometimes it may be used for auditing; administering pharmaceutical programs and payments; or in the facilitation of a sale, transfer or merger of all or a part of The HSC System with another organization. Our authorization form, which you or the patient is asked to sign, usually includes these activities.
  • Other permitted or required uses or disclosures. We may use or disclose health information about the patient without permission for the following reasons, allowed by law:
    • To comply with responsibilities to federal or state oversight agencies who oversee health care. For example, sharing information with District of Columbia Department of Health inspectors.
    • To researchers where all procedures required by law have been taken to protect the confidentiality of the data.
    • To comply with a court order or other lawful process.
    • To persons providing services to us. They have to make sure that they will keep all information safe and secure.
    • To let the patient and authorized caregiver know about treatment alternatives or health-related benefits or services.
    • Sometimes, we are allowed by federal and state law to give an agency health information about the patient without authorization. An example would be information to protect victims of abuse or neglect, to avoid a serious threat to health or safety, to track diseases or medical devices. We may also inform military or veteran authorities if the patient is an armed forces member. We may give information to coroners, medical examiners and funeral directors or for worker’s compensation, national security and anyone the law says we must give it to.
    • We will give health information to organizations that handle organ, eye or tissue transplantation or to an organ donation bank. We will do that to make it easier for organ transplants and organ donation.
    • We are allowed to use health information about the patient in a way that does not personally identify the patient.
    • We may give health information about you to your family members or friends if you agree to it in writing.

If you make a request, we will tell you what information was disclosed. We will also tell you who got it and why.


We will not use or tell anyone about the patient health information for any reason except the ones we have told you about in the sections above unless we have your written Authorization. We must obtain Authorization separate from any Consent we have received from you in the past. If we are given Authorization to use or disclose health information, the authorization may be revoked or stopped in writing, at any time. If the Authorization is stopped, we will no longer use or give anyone else information about the patient for the reasons covered by the written Authorization. We cannot take back any uses or disclosures already made with the patient or authorized caregiver permission.

If we have HIV or substance abuse information about the patient, we cannot release that information without a special signed, written authorization (different than the Authorization and Consent we talked about above). We will have to have both a signed Consent and a special written Authorization, according to law. There are special laws for HIV or substance abuse records.

All consents/authorizations must be obtained from the patient or authorized caregiver.


Patients or authorized caregivers have the following rights regarding health information:

  • Right to look at and copy health information

Patients or authorized caregivers have the right to look at my child’s medical record when accompanied by his/her attending doctor and ask for a copy of the medical record , except for psychotherapy notes or other limited circumstances. We need a written request from you before you may look at and/or receive a copy the patient’s health information. A fee may be charged for the costs of copying, mailing or other associated supplies.

  • Right to change the Record

If patient and/or authorized caregiver believes health information we have is not right, the patient or authorized caregiver may ask us to change the information. If w e do not let you change the information, we will tell you why in writing.

  • Right to an Accounting of Disclosures

Patients and/or authorized caregivers have the right to request an "accounting of disclosures." This is a list of who we have given medical information about the patient for purposes other than treatment, payment and health care operations. To get this list, the patient and/or authorized caregiver must submit a request in writing and state a time period, which may not be longer than six years and may not include dates before April 14, 2003 . We will provide the patient/caregiver with the list free of charge unless we have already provided the patient/caregiver with a list within the same 12 month period. We will temporarily suspend a patient/caregiver’s right to receive an accounting of disclosures in certain circumstances, as defined by law.

  • Right to Request Restrictions (Limits)

The patient/caregiver has the right to request a restriction or limitation on the health information we use or give someone else about the patient for treatment, payment or health care operations. The patient/caregiver also has the right to request a limit on the health information we give about the patient to someone who is involved in the patient’s care or the payment for it. Under the law, we do not have to agree to a requested restriction.

  • Right to Confidential Communications

Sometimes, the patient/caregiver has the right to request that health information be talked about in a particular place or in a certain way. We will agree to all reasonable requests.

  • Right to a Paper Copy of This Notice

The patient/ caregiver has the right to a paper copy of this notice and may ask for it at any time.


We can change this notice, and make the revised or changed notice effective for medical information we already have about the member. Or we can change it for any information we received in the future. We will post a summary of the current notice with its effective date in the top right hand corner. The patient/caregiver can always get a copy of the notice currently in effect.


If you believe that privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with the Secretary, write to: 200 Independence Avenue, S.E., Washington, D.C. 20201, or call 1-877-696-6775. To file a complaint with our office: contact the HSC Privacy Officer at 202-454-1223 or at HSC Foundation 1808 Eye Street, NW, Suite 600, Washington, D.C.


© 2009 The HSC Pediatric Center
1731 Bunker Hill Road, NE • Washington, D.C. 20017 • 202-832-4400 • 1-800-226-4444
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