Our Pledge to Protect Your PrivacyLucile Packard Children's Hospital (the Hospital) knows that medical information about you or your child ("you") is personal and is committed to protecting the privacy of your information. As a patient of the Hospital, the care and treatment you receive is recorded in a medical record. So that we may best meet your medical needs, we share your medical record with all the health care providers involved in your care. We share your information only to the extent necessary to conduct our business operations, to collect payment for the services we provide you and to comply with the laws that govern health care. We will not use or disclose your information for any other purpose without your permission.
Our Notice of Privacy PracticesBeginning April 14, 2003, the Hospital will provide you with a Notice of Privacy Practices - English version / Spanish version that explains our privacy practices and your rights regarding your medical information. The first time you receive services on or after April 14, 2003, the Hospital will provide you with a copy of our Notice and ask you to acknowledge its receipt. The Hospital may need to change its privacy policies and practices from time to time and will update the Notice accordingly.
You may ask for a copy of our current Notice at any time in any of the patient registration areas throughout the Hospital, including clinics, and it is publicly posted in a number of places. You may also view and print a copy of our current Notice by clicking on Notice of Privacy Practices - English version / Spanish version.
Throughout these web pages on patient privacy you may click on items that are in italics and underlined and an Adobe PDF file version of a document or form will open for your review. You may also print these documents.
Your Rights Regarding Medical Information About YouAn important part of the Hospital's Notice is the section that explains your rights regarding your medical information. Our Notice explains that you (or your personal representative) have the right to:
Inspect or Obtain a Copy of Your Medical Record: You have the right to inspect or obtain a copy of the medical records that the Hospital uses to make decisions about you and your treatment, subject to certain limited exceptions. This information includes your medical and billing records, but may not include some mental health information. If you request a copy of your records, the Hospital may charge a fee for the cost of providing your records to you.
For more information of how and where to inspect or obtain a copy of medical records and print copies of the necessary forms, please click on Medical Records.
Request a Correction or Add an Addendum to Your Medical Record: If you believe that medical information the Hospital has on file
about you is incorrect or incomplete, you may ask us to correct the medical information in your records. If your medical information is accurate and complete, or if the information was not created by the Hospital, we may deny your request; however, if we deny any part of your request, we will provide you with a written explanation of our reasons for doing so. Requests to make a correction to your records must be in writing and we recommend, but do not require, that you use the Hospital's Request for an Addendum or Correction form. Your written request must describe each item that you want changed (for example: History and Physical on 3/1/2003 and Clinic Visit Note on 4/14/2003) and the reason your are requesting the change.
In addition, an adult patient of the Hospital who believes that an item or statement in his/her medical record is incorrect or incomplete has the right to provide the Hospital with a written addendum to his/her record. The addendum is limited to 250 words per incorrect or incomplete item, and must clearly indicate that the patient wishes it to be made a part of his/her record. Requests to add an addendum must be in writing and we recommend, but do not require, that you use the Hospital's Request for an Addendum or Correction form.
Please send your request to Medical Records - Release of Information, 725 Welch Road, Palo Alto, CA 94304-5654 or fax your request to (650) 498-5120. Copies of the Request Form and assistance are also available at the Hospital's Medical Records Department in room 0511 on the Ground Floor across from the Cafeteria. The Privacy Office will review your request when it is received and process your request within sixty (60) days of receipt. In certain situations, the Privacy Office may require an additional thirty (30) day extension to process your request
An Accounting of Hospital Disclosures of Your Medical Information: You have the right to request an "accounting of disclosures" which is a list describing how we have shared your medical information with outside parties. This accounting is a list of the disclosures we made of your medical information after April 14, 2003 for purposes other than treatment, payment and health care operations as described in our Notice of Privacy Practices - English version / Spanish version.
You may request at no charge an accounting of disclosures once every twelve months. If you make more than one request in a twelve month period, the Hospital will charge a $50.00 processing fee for each additional request.
To request an accounting of disclosures, please print and complete an Request for Accounting of Disclosures Form. You may either mail it to the LPCH Privacy Office, 300 Pasteur Drive - MC 5202, Stanford, CA 94395-5202 or fax it to 650.498.5120. If you have questions about completing the form, please call 650.72HIPAA. Copies of the Request Form and assistance are also available at the Medical Records Department in room 0511 on the Ground Floor across from the Cafeteria.
- Request Restrictions on Certain Uses and Disclosures of Your Medical Information: You have the right to request restrictions on certain uses or disclosures of your medical information. For example, you may request that your name not appear in the Hospital's Patient Directory while you are here as an inpatient. We are not required to agree to your requested restriction. However, if we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or comply with the law. If we cannot accept your request, we will explain to you in writing why we cannot do so.
Some examples of restriction requests that the Hospital cannot honor include:
To make a restrictions request, please print and complete a Request for Restrictions Form. Either mail the form to the LPCH Privacy Office, 300 Pasteur Drive - MC 5202, Stanford, CA 94395-5202 or fax it to 650.498.5120. If you have questions about completing the form, please call 650.72HIPAA. Copies of the Request Form and assistance are also available at the Medical Records Department in room 0511 on the Ground Floor across from the Cafeteria. Alternatively, you may request restrictions during the registration process at the Hospital.
- Requests to restrict medical students or residents from accessing your medical information.
- Requests restricting the Hospital from giving your name to an insurance company that will be asked to pay a portion of your bill.
- Request restricting the Hospital from reporting your identity and condition to an agency or organization where the Hospital is required by law to do so.
To terminate a restriction that the Hospital has accepted, send your request in writing to SHC Privacy Office, 300 Pasteur Drive - MC 5202, Stanford, CA 94395-5202 or fax it to (650) 498-5120. Please include a copy of your original restrictions request or the date, patient name and medical record number that appeared on your accepted request.
The Hospital may terminate a restriction that it had previously accepted, but must inform you in writing of the termination. In this situation, the termination only applies to your personal health information created or received after you have been notified of the termination.
Request Confidential Communications: Lucile Packard Children's Hospital considers all of your medical and billing information to be confidential. You have the right to request that we communicate with you about medical and billing matters by an alternative method or at an alternative locations. For example, you may ask that we only contact you at work rather than at your home. The Hospital's Privacy Office will review all requests and accept those that we may reasonably accommodate. The Hospital will not ask the reason for your request, but we may ask questions regarding how payment will be handled. If your request is accepted, it will apply to all our communications to you regarding treatment you receive from the acceptance date forward. Your request will be in effect until you change or withdraw it by submitting a new copy of the form.
To make a confidential communications request, please print and complete a Request for Confidential Communications Form. Either mail the form to the LPCH Privacy Office, 300 Pasteur Drive - MC 5202, Stanford, CA 94395-5202 or fax it to 650.498.5120. If you have questions about completing the form, please call 650.72HIPAA. Copies of the Request Form and assistance are also available at the Medical Records Department in room 0511 on the Ground Floor across from the Cafeteria. Alternatively, you may request confidential communications during the registration process at the Hospital.
To change or withdraw a prior request for confidential communications you must complete and submit a new Request for Confidential Communications Form and indicate that you are changing or withdrawing a prior request.
Receive a Copy of the Hospital's Privacy Notice: You may ask for a printed copy of the Hospital's Notice of Privacy Practices anytime you are visiting one of our facilities. The Notice is available in any of the admitting and registration areas. You may also print a copy of the Notice from this website by clicking on Notice of Privacy Practices - English version / Spanish version.