How we use and disclose your child's protected health information.

Our pledge

Mountain Ridge Pediatrics is committed to protecting medical information about your child. We are required by federal law (the Health Insurance Portability and Accountability Act of 1996, "HIPAA") and Virginia state law to keep protected health information ("PHI") private, to give you this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.

"Protected health information" means information about your child that may identify them and that relates to your child's past, present, or future physical or mental health, the care provided, or the payment for that care.

How we may use and disclose PHI

The categories below describe the ways we use and disclose PHI. Not every use or disclosure will be listed, but every permitted use or disclosure will fall within one of the categories.

For treatment

We use and share PHI to provide, coordinate, or manage your child's medical care. For example, we may share PHI with specialists, hospitals, labs, or pharmacies that are involved in your child's care.

For payment

We use and share PHI to bill and collect payment for the care we provide. For example, we may give your insurance company information about a visit so it will pay us. We may also tell your health plan about a treatment your child is going to receive to get prior approval.

For healthcare operations

We use and share PHI for the day-to-day operation of our practice. Examples include quality review, training residents and other staff, accreditation, certification, licensing, and care coordination.

Appointment reminders, care recalls, and patient communications

We may contact you to remind you of an appointment, recall your child for a well-child visit or vaccine, or share other practice news. These communications may go by phone, text message, email, or through the Develo Family Portal, depending on the contact preferences you provided.

To family members involved in your child's care

Unless you tell us otherwise, we may share PHI with a family member, other relative, or close personal friend who is involved in your child's care or payment for that care.

As required or permitted by law

We may use and disclose PHI when required or permitted by law. This includes reports for public health, communicable disease, child-abuse or neglect, vital statistics, FDA-regulated product safety, workers' compensation, law-enforcement requests with proper authority, judicial and administrative proceedings, organ donation, coroners and funeral directors, certain research subject to oversight, and to avert a serious threat to health or safety.

Uses and disclosures that require your written authorization

Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing, and disclosures that constitute a sale of PHI require your written authorization. You may revoke your authorization at any time in writing, except to the extent that we have already acted on it.

Your rights regarding PHI

Although your child's health record is the physical property of Mountain Ridge Pediatrics, the information in it belongs to you (or to your child, depending on age and Virginia state law). You have the following rights:

• Right to inspect and copy — You may request access to your child's medical and billing records. We may charge a reasonable, cost-based fee for copies as permitted by Virginia law.
• Right to amend — You may request that we correct information you believe is incorrect or incomplete. We may deny a request under certain limited circumstances; if we do, we will explain why in writing.
• Right to an accounting of disclosures — You may request a list of certain disclosures we have made of your child's PHI in the prior six years (excluding disclosures for treatment, payment, healthcare operations, and a few other categories).
• Right to request restrictions — You may ask us to restrict how we use or share PHI for treatment, payment, or healthcare operations. We are not required to agree, except where you have paid in full out of pocket for a service and ask us not to disclose information about that service to your health plan.
• Right to request confidential communications — You may ask that we contact you only by certain means or at certain locations (for example, only by mail at a specific address). We will accommodate reasonable requests.
• Right to a paper copy of this notice — You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• Right to be notified of a breach — You will be notified of any breach of your unsecured PHI as required by federal law.

A note on minors and adolescents

Under Virginia state law, an adolescent may have the right to consent independently to certain types of care (for example, treatment for sexually transmitted infection, substance use, contraception, mental health, or pregnancy-related care). When state law makes the minor the only person who may consent to a treatment, that minor has the right to control information about that treatment, including who may see it. Please ask us if you have specific questions about how this applies in your child's situation.

Changes to this Notice

We reserve the right to change this Notice and the privacy practices it describes at any time. Changes apply to PHI we already hold as well as PHI we receive in the future. We will post the current Notice in the office and on this website. The effective date appears at the bottom of this page.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office at the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.

Effective date: May 2026. This Notice supersedes any earlier version.