As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996

This notice describes how Medical information about you or your child (as a patient of this practice) may be used and disclosed, and how you can get access to your information.


Pediatric Associates of University of Iowa Stead Family Children’s Hospital, LLC is dedicated to maintaining the privacy of your Individual Identifiable Health Information (IIHI). In conducting business, we will create records regarding your child’s treatment and any service we provide to you. We are required by law to maintain confidentiality of the IIHI. We also are required to provide you with this legal notice of our duties and the privacy practices that we maintain in our practice concerning your child’s IIHI. By federal and state law, we must follow the terms of the act listed above.

We realize that these laws are complicated but we must provide you with the following important information:

  • How we may disclose your IIHI.
  • Your privacy rights in your IIHI.
  • Our obligations concerning the use and disclosure of your IIHI.

The terms of this notice apply to all records containing your child’s IIHI that are created or retained by our practice. We reserve the right to revise or amend this notice of privacy practices. Any revision or amendment to this notice will be effective for all your records that our practice has created or maintained in the past, and for any of your child’s records that we will create in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current notice at any time.

If you have any questions, please contact: Alex Galindo, Privacy Administrator.

The following categories describe the different ways in which we may use and disclose your IIHI.


Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice—including, but not limited to our doctors and nurses—may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.


Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and items. If the patient elects in writing to pay out of pocket the entire amount for the service, Pediatric Associates of University of Iowa Stead Family Children’s Hospital, LLC will not bill or make disclosures to the patients health plan.

Health Care Operations

Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.

  • Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
  • Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.

Health-Related Benefits and Services

Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest to you.

Release of Information to Family/Friends

Our practice may release your IIHI to a friend or family member who is involved in your care, or who assists in taking care of your ---. For example, a parent or guardian may ask that a babysitter take a child to the pediatrician’s office for treatment of a cold. In this example, the baby sitter may have access to this child’s medical information—in writing (written) or verbal.

Disclosures Required by Law

Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.


The following categories describe scenarios in which we may use or disclose your identifiable health information:

Public Health Risks

Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for purposes such as:

  • maintaining vital records, such as births and deaths.
  • reporting child abuse or neglect.
  • preventing or controlling disease, injury or disability.
  • notifying a person regarding potential exposure to a communicable disease
  • notifying a person regarding a potential risk for spreading or contracting a disease or condition.
  • reporting reactions to drugs or problems with products or devices .
  • notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
  • notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities

Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights law and the health care system in general.

Lawsuits and Similar Proceedings

Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain a court or administrative order protecting the information the party has requested.

Law Enforcement

We may release IIHI if asked to do so by a law-enforcement official:

  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
  • Concerning a death we believe has resulted from criminal conduct.
  • Regarding criminal conduct at our offices.
  • In response to a warrant, summons, court order, fugitive or missing person.
  • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

Deceased Patients

Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

Organ and Tissue Donation

Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

Serious Threats to Health or Safety

Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

National Security

Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Workers’ Compensation

Our practice may release your IIHI for workers’ compensation and similar programs.

Marketing purposes

Our practice does not use IIHI for marketing purposes. Should a charitable request using IIHI be considered, the patient will receive a written request for said release. No release shall occur without prior written consent of the patient or guardian.


You have the following rights regarding the IIHI that we maintain about you:

Confidential Communications

You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Alex Galindo, Privacy Officer, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting Restrictions

You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request. However, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in writing to Alex Galindo, Privacy Officer. Your request must describe in a clear and concise fashion:

  • the information you wish restricted;
  • whether you are requesting to limit our practice’s use, disclosure or both; and
  • to whom you want the limits to apply.

Inspection and Copies

You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Alex Galindo, Privacy Officer in order to inspect and/or obtain a copy of your IIHI. Our practice will charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances. However, you may request a review of our denial.


You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to Alex Galindo, Privacy Officer. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

Right to a Paper Copy of This Notice

You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Alex Galindo, Privacy Officer.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Alex Galindo, Privacy Officer 1-319-351-1448. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures

Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the purposes described in the authorization. Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact [Alex Galindo, Privacy Officer].

Psychotherapy Notes

Any requests for psychotherapy notes will require specific authorization from parent/guardian, unless otherwise granted by law or state requirement.

Fund Raising

At no time will Pediatric Associates of University of Iowa Stead Family Children’s Hospital, LLC engage in any fund raising (outside of normal business operations) and/or use IIHI of any patient

Breach Notification

In the event of IIHI being breached, Pediatric Associates of University of Iowa Stead Family Children’s Hospital, LLC will undertake complete notification of the affected patients and assist in their securing of IIHI released to the extent required by law.