Patient Privacy

Our Pledge to Protect Your Privacy
Lucile Packard Children’s Hospital (LPCH) the “Hospital” values and is committed to protecting the privacy of health information we create or receive about you. Health Information that identifies you (“protected health information,” or “health information”) includes your medical record and other information relating to your care or payment for care.

Our Notice of Privacy Practices
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 health information. The first time you receive services on or after September 23, 2013, the Hospital will provide you with a copy of our current 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 Health Information About You
An important part of the Hospital's Notice is the section that explains your rights regarding your health information. Our Notice explains that you (or your personal representative) have the right to:


•   Inspect or Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information. We reserve the right to charge a fee to cover the cost of providing your health information records to you.

•   Request an Amendment or Addendum: If you believe that the health information the Hospital has on file about you is incorrect or incomplete, you may ask us to amend the health information. To request an amendment you must file an appropriate written request with the Health Information Management Services (HIMS) Department. In addition, you must provide a reason that supports your request. The Hospital can only amend information that we created or that was created on our behalf. If your health information is accurate and complete, or if the information was not created by the Hospital, we may deny your request to amend. If we deny your request, we will share with you in writing with our reasons for doing so.  Requests to amend your health information 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 you are requesting the change.

Even if we deny your request to amend, you have the right to submit a written addendum to the Health Information Management Services (HIMS) Department. Addendums may not exceed 250 words for each item or statement in your record you believe is incomplete or incorrect. Requests for 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 Health Information Management Services, 4700 Bohannon Drive, Mail Code: 5900, Menlo Park, CA 94025. Copies of the Request Form and assistance are also available at the Hospital's HIMS Department at 750 Welch Road, Suite 214, Palo Alto, CA 94304. The HIMS Department 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: You have the right to request an “accounting of disclosures” which is a list describing how we have shared your health information with outside parties. This accounting is a list of the disclosures we made of your health information for purposes other than treatment, payment, health care operations, and certain other purposes consistent with law. You may request an accounting of disclosures for up to six years before the date of your request. If you request an accounting more than once during a twelve month period, we will charge a reasonable fee.
 
To request an accounting of disclosures, please print and complete the Request for Accounting of Disclosures Form. You may mail it to Health Information Management Services, 4700 Bohannon Drive, Mail Code: 5900, Menlo Park, CA 94025.  If you have questions about completing the form, please call (650) 497-8334. Copies of the Request Form and assistance are also available at HIMS Department at 750 Welch Road, Suite 214, Palo Alto, CA 94304.


•  Request Restrictions:  You have the right to request restrictions on certain uses or disclosures of your health information. For example, you may request that your name not appear in the Hospital's Patient Directory while you are here as an inpatient. Requests for restrictions must be in writing. In most cases, 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 do not accept your request, we will reply to you in writing with the reason.

We are legally required to accept certain requests not to disclose health information to your health plan for payment or health care operations purposes as long as you have paid out-of-pocket and in full in advance of the particular service included in your request. If the service or item is part of a set of related services, and you wish to restrict disclosures for the set of services, then you must pay in full for the related services.  It is important to make the request and pay before receiving the care so that we can work to fully accommodate your request. We will comply with your request unless otherwise required by law.

Some examples of restriction requests that the Hospital cannot honor include:

•   Requests to restrict medical students or residents from accessing your health information.
•   Requests restricting the Hospital from giving your name to an insurance company that will be asked to pay a portion of your bill.
•   Requests 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 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 5780, Stanford, CA 94395-5202 or fax it to (650) 723-3628. If you have questions about completing the form, please call (650)724-2572. Copies of the Request Form and assistance are also available at the HIMS Department at 750 Welch Road, Suite 214, Palo Alto, CA 94304. Alternatively, you may request restrictions during the registration process at the Hospital.

To terminate a restriction that the Hospital has accepted, send your request in writing to LPCH Privacy Office, 300 Pasteur Drive - MC 5780, Stanford, CA 94395-5202 or fax it to (650) 723-3628. 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:  You have the right to request that we communicate with you about your health information or medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, rather than at your home. We will not ask you the reason for your request. We will work to accommodate all reasonable requests. Your request must be in writing and specify how and where you wish to be contacted.

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 5780, Stanford, CA 94395-5202 or fax it to (650) 723-3628. If you have questions about completing the form, please call (650) 724-2572. Copies of the Request Form and assistance are also available at the HIMS Department at 750 Welch Road, Suite 214, Palo Alto, CA 94304. 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 Notice of Privacy Practices: 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.

Additional Documents
•   Notice of Privacy Practices  English version / Spanish version
•   Acknowledgement of Notice of Privacy Practices
•   Request for an Addendum or Correction Form
•   Request for Accounting of Disclosures Form
•   Request for Restrictions Form
•   Request for Confidential Communications Form