Our New MMR Vaccination Policy

As some have seen in the news, there is an alarming trend in Pediatric offices toward strong-arming parents into vaccinating their children and giving them their marching orders to find a new Pediatrician. Those who know me will tell you that I’m a strong proponent of vaccinations. I believe that vaccines are safe and effective. As a world medical traveler, I’ve had all mine and then some, including the smallpox vaccine as a child.

However, I refuse to try and dictate to parents what they will or won’t do with vaccines. A pinch of caring and compasion I think will go further than a pound of forceful ‘persuasion.’ I will try to persuade parents through a good patient-physician relationship where they can trust that the vaccine information I present to them is sound and reasonable. I must and will, however, put this decision in their hands as the parents of children that they love deeply.

There are three groups of children that I think we need to consider here. The children in the first group are those who are ill and cannot receive vaccinations as a result. Their parents want them to be able to attend school and try to live as normal a life as possible free from the risk of infection with viruses like measles and such wherever they go. The children in the second group are those whose parents are wary, even fearful, of the vaccines harming their children, and elect to refuse some or all of the vaccines, or opt for a different vaccine schedule than the current recommendations. The children in the third group are those whose parents are already planning to vaccinate per published recommendations.

Children in the first group who can’t receive vaccinations are at risk everywhere in society unfortunately. Much as I would like, I cannot protect them wherever they are. I sometimes wonder if the same parents who demand that all other children be vaccinated to protect their children, are also careful about taking them out to large venues. For example, I suspect that some 50,000 people a day may pass through WalMart’s 24-hour facilities. I am suspicious that everything that a child could touches in these places puts them at risk of infection. I have no studies to back this up, but that is my suspicion, nonetheless. I care for children with significant immune deficiencies myself, and their parents and I always have the discussion about these risk factors, and I am very aware of the needs of these children.

Children in the second group who may receive only few or no vaccines are at risk of getting the infections when they are exposed to others who bring in the infections across our borders. Unlike Yellow Fever, where visitors to endemic countries must be vaccinated prior to travel, and who must also present a Yellow Fever certificate before regaining entry back into the United States, we have no such screening for any other contagious infections. Even Ebola screenings where death rates are upwards of 70% or more, is not properly done before a person reenters from an endemic Ebola area by simply measuring a temple temperature.

Children in the third group are those who are being vaccinated according to schedule. With respect to the MMR vaccination and measles, these children however are at risk for a period of up to the first year where they have limited or no immunity. The MMR is not routinely given until on or after the first birthday. This is because the seroconversion rate, which is the measure of vaccine effectiveness, after the one year measles vaccination is around 95%.

While the solution for the first group lies in exposure prevention on a day to day basis, and for the second group in convincing parents to vaccinate, there is something more I can do to help the third group, and perhaps very significantly. It may also help to limit the exposure of immuncompromised children more effectively than trying mandate that all children receive the present schedule of vaccines.

Children can get the MMR vaccine before their first birthday. However they will still be required to get vaccinated according to the regular two-dose schedule at and beyond age one year. It has been demonstrated that 74% of children who get MMR at 6 months do seroconvert and become immune to measles. Over 89% of those vaccinated at 8 months have been shown to acquire measles immunity.

It is already recommended that unvaccinated children as young as 6 months get the MMR prior to travel to endemic areas of the world or during local outbreaks of measles. I am now officially recommending that parents of my patients consider giving their children their first MMR at age 6 months. Currently here in Georgia they will still have to have two more MMRs at or beyond their first birthday for entities that require the official form 3231 for attendance. This will, I think, significantly reduce the susceptible population of young children, and indirectly reduce some of the risks to the first group of children, whose parents are particular concerned about exposure.

What about immnity to measles in the first 6 months of life then? Because the largest antibody transfer from mother to child occurs at some point prior to delivery, I’m recommending that all women who have low measles, mumps, or rubella titers, be vaccinated prior to pregnancy. Pregnant women or those planning to soon get pregnant within 28 days should first discuss MMR vaccination with their obstetrician.

The CDC recommendations against live viruse MMR vaccination during pregnancy are also based, according to the AAP Redbook, on theoretical risks of infection to the unborn baby. Women have been unknowingly vaccinated during pregnancy without negative effects. Many physicians caring for expectant mothers are starting to check for the presence of measles antibodies. Women thinking about becoming pregnant or who are pregnant need to discuss MMR vaccination with their obstetrician.

Prenatal transfer a measure of their measles antibdoy to the children of mothers who are measles seropositive, which can last up until perhaps 4 months of age. Breast feeding does transfer some antibodies but I don’t think that the quantitative effect is really known there, and it cannot be relied on in lieu of prenatal seropositivity.

This policy should help significantly to narrow the susceptibility of healthy children who are being vaccinated. The problem with forcing the current vaccination schedule on all children seems politically driven rather than well-reasoned, though I understand the fear behind it. It will certainly not stop the entry of measles into our country across the border which is how the virus is getting here. Until we demand verifcation of an approved MMR vaccination by all citizens and non-citizens coming through customs, and until we fully control illegal entry at our borders, we will continue to be at risk for measles. Mandatory vaccination will gain nothing but the control of one group of people over another, and it will further limit the shrinking freedoms we as Americans have traditional enjoyed and fought and died for.

Those who are interested in MMR vaccination before the first birthday should call our office and discuss all the particulars of insurance coverage, risks, etc. More information about the current MMR recommendations are found at these web sites below to support the data that I have presented.

http://www.ncbi.nlm.nih.gov/pubmed/24837773

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm

http://www.cdc.gov/vaccinesafety/Vaccines/MMR/MMR.html

http://www.cdc.gov/vaccines/vpd-vac/measles/vacc-in-short.htm

Ron Smith, MD, Pediatrics

ronsmithmd.com

School Letters Policy

Because of stricter guidelines for attendance at schools, parents are required to provide school notes for any days of school that will be considered “excused”. Most schools will allow parents to write notes for minor illnesses, but have a limited number of “non-excused” absences. For this reason, we are asked to supply school notes for various reasons. Therefore, we have put in place the following policies for school notes that we will write.

  1. Absence due to illnesses: We will provide an excuse for any patient who is seen in our office that is sick. If you child is running a fever the date of his office visit, he may not return to school until he is fever-free for 24 hours. If the student tests positive for illnesses such as strep or mono, we will adjust the days of excused absences accordingly. If you choose to keep your child at home additional days, then you may attach a parent’s letter to our office letter for the school office.
  2. If your child was seen in the ER or after-hours care, or by a specialist’s office, even if referred by our office, you must request a school note from that doctor or office. We cannot write school excuses for other providers.
  3. Some schools and daycares have begun asking parents to get “special request” letters from their doctor’s office. These letters include special diet requests, reduced activity requirements, special bathroom privileges, etc. These requests will be written for patients seen in the last 12 months and only if deemed medically necessary by the provider and documented in your child’s chart. For instance, if your child has a known food allergy, etc, that requires a special diet plan, that allergy must be noted in your child’s medical chart in our office in order for us to write a school note.
  4. If your child participates in sports at school, sports physicals can be done in conjunction with your child’s annual physical (well check). The sports participation forms required by schools can be provided at the end of the physical. These are good for only one calendar year. We can fax the forms, but please be aware that the forms have a page that must be completed by the parent.

Thank you for your understanding and help with this matter.

Osha Blood Borne Pathogen Occupational Exposure Policy

Section A. Occupational Exposure Policy

1. The purpose of this policy is to prevent the occupational exposures of the staff to the following potentially infections materials: blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, plural fluid, amniotic fluid, pericardial fluid, peritoneal fluid, saliva in dental procedures, and human tissue.

2. Occupational exposure means contact with skin, eyes, mucus membrane, or parenteral exposure by the potentially infectious materials.

3. Information and training: all employees involved in work that would involve occupational exposure must participate in a training program which must be provided at no cost to the employee, during working hours. The training shall be provided at the initial time of assignment and at least annually thereafter. Any new standards of or techniques shall be taught at the time of their inclusion into the program. The training program shall include:

  • a general explanation of the epidemiology and symptoms of blood borne diseases and their modes of transmission;
  • an explanation of the employer’s control plan and a copy of the control plan;
  • and explanation of which activities involve exposure to potentially infectious materials and the methods which will prevent or reduce exposure to them;
  • the proper handling and disposal of potentially infectious materials and protective equipment;
  • all necessary information on the hepatitis vaccination
  • information on what action is to be taken in case an emergency occurs, or an exposure incident occurs; and
  • information on post-exposure follow-up.

4. Training session records shall include: the date of the session; a summary of the session; the names and titles of all persons attending the session. These records shall be kept for at least three years from the time of the session and shall be made available to the appropriate person(s) if requested. These records shall be available for transfer as required by the Director (the Director, Department of Labor, Occupational Safety and Health Administration). If the business ceases and there is no one to transfer the records to them the Director shall be notified and he shall receive the records; if he so desires.

5. The employer shall establish and maintain an accurate record for each employee with occupational exposure which shall include:

  • the name and social security number of the employee;
  • a copy of their hepatitis B vaccination status; a copy of all results of medical exams and testing;
  • a copy of the health care professional’s written opinion of the situation; and
  • a copy of information provided to the health care professional.

The employee’s medical record shall be kept confidential and not divulged except with the written consent of the employee. These records shall be kept for the duration of the employee’s employment plus 30 years.

6. Definitions of contamination and decontamination: If something is contaminated it has the presence of a potentially infectious material on it. Examples of potentially contaminated items include laundry and sharpes (sharpes are any objects that can penetrate the skin). To decontaminate something means by the use of physical or chemical means to inactivate or to destroy infectious materials on the item to the point where they can’t transmit disease.

7. Personal protection equipment (which shall be impermeable to all potentially infectious materials) will be worn when there is a risk of occupational exposure to potentially infectious materials. This equipment included the following: gloves, gowns protective equipment shall be available at the work site whenever there is risk of occupational exposure. When the employee leaves the work area, the equipment shall be removed and stored, cleaned, or disposed of by the employer. If a protective garment is penetrated by a potentially infectious material it shall be removed as soon as feasible. If gloves are penetrated they shall be replaced as soon as feasible. Disposable gloves shall not be reused. If an employee declines to use protective equipment this event has to be documented and a wavier has to be signed by the employee. Masks and goggles shall be used whenever there is danger of contamination of the face or eyes by potentially infections materials.

8. Handwashing facilities shall be available in every work site. If these are not readily available an appropriate antiseptic hand cleaner in conjunction with appropriate clean clothe or paper towels shall be available. Employees shall wash their hands as soon as feasible after removing protective equipment. If they come in contact with potentially infectious material they shall wash their skin with soap and water and flush mucous membranes with water. The work site shall be maintained in a clean and sanitary condition. All equipment and working surfaces shall be cleaned and decontaminated after contact with potentially infectious materials as soon as feasible. Such equipment includes bins and pails. Broken glassware which may be contaminated shall not be directly picked up with you hands. Housekeepers need to use gloves and other appropriate equipment when cleaning a work site. Use appropriate antiseptics. Bleach at 1:10 or metri spray-cetylcide or autoclave for instruments.

9. Eating, drinking, and applying cosmetics are prohibited in work areas where contamination is possible. Food and drinks shall not be kept in these hazardous areas. All procedures involving potentially infectious materials shall be done as carefully as possible to minimize splashing, spraying, spattering, and droplets of these materials. Mouth pipetting is prohibited.

10. Contaminated needles shall not be recapped but carefully placed in the appropriate container. These containers shall be OSHA approved. All potentially infectious materials shall be disposed of in the appropriate OSHA approved containers. The containers shall be closed prior to removal from the work area and prior to shipment to the appropriate facility for disposal. Disposal containers shall be available in each work area. Contaminated laundry shall be transported in the appropriate bags which can be closed and are leak proof for all potentially infectious materials. The bags shall then be transported to the appropriate facility for disposer. Protective gloves shall be worn when handling such materials if there is risk to the face.

11. Hepatitis B vaccination shall be offered to all employees who are at risk of exposure. This shall be offered to them within ten working days of employment. The schedule for vaccinations is as given by the state health department recommendations for Hepatitis B.

12. Post-exposure evaluation and follow-up: following a report of an exposure incident, the employer shall make available to the employee a confidential medical evaluation and follow-up including the following documents:

  • documentation of the route of exposure and the circumstances under which the incident occurred; and
  • identification and documentation of the source individual if feasible.

The source individual’s blood shall be tested as soon as feasible for HBV and HIV infectivity if consent is obtained (unless consent is not needed) from the individual. Results of the source individual’s testing shall be made available to the exposed employee. If consent is obtained the exposed employee’s blood shall be tested as soon as feasible. All of the above are to be documented (as well as results of medical exams and blood testing) Within fifteen days of the completion of the evaluation the employee shall be given a written opinion of the evaluation.

13. Dates: this plan is currently effective in all aspects for all office locations.

14. Hepatitis B vaccination schedule: per current health department recommendations. Post-exposure management policy is included in the training also.

15. Gowns- at least 12, masks- at least 12, goggles- at least 4 per office.

Section B. Application Of The Occupational Exposure Policy

1. A Staff Exposure Assessment List will be kept on the premises and will include:

  • A list of all staff and those who are at risk
  • Indication of those who have reviewed the occupational exposure policy and discussed it
  • Indication of those who have been offered the Hepatitis B vaccine
  • Indication of those who were given the opportunity to sign any necessary waivers concerning vaccinations and protective equipment
  • Indication of those who have had occupational exposure incidents

2. Regular inspection and replacement of any defective equipment shall be on a monthly basis and more often as needed.

3. Sharpes containers shall be replaced when full and picked up by a licensed disposal company. They shall be sealed while waiting to be picked up. Needles can be removed from syringes and deposited in sharpes containers and the syringes disposed of in the regular garbage if no blood was drawn into syringe. If blood was drawn into the syringe the syringe and the needle are to be disposed of in a sharpes container. The needle is to be removed from the syringe with a hemostat or other appropriate device. Do not bend, shear or break contaminated needle. Needles are never to be recapped. Broken glass is to be cleaned up with a dust pan and brush. Capillary tubes need to be put into sharpes containers.

4. Any containers that may be contaminated or leak must be placed in a second container: containers must be maintained in an upright position during transport..

5. The work areas that are contaminated will be cleaned as soon as feasible after a procedure and then daily by the cleaning crew. Appropriate antiseptic will be used.

6. Contaminated laundry is to be bagged in labeled containers using gloves (and gowns if necessary). It is then to be transported to the laundry facility where it is again handled with gloves. It is then washed and brought back to the office where it is autoclaved before additional surgical use.

7. The following categories associate tasks with the required protective equipment.

Job Category Nature Of Task Personal Protective Equipment
Available Worn
I Direct contact with blood or other body fluids to which universal precautions apply Yes Yes
II Activity performed without blood exposure but exposure may occur in emergency Yes No
III Task/activity does not entail predictable or unpredictable exposure to blood No No

8. Urine slide covers will be disposed of in sharpes containers, and slides will be cleaned and soaked in antiseptic and reused. Cotton swabs and tongue depressors will be disposed of in the regular garbage. Used gloves, masks, and gowns will be disposed of in the regular garbage.

9. Throat cultures and urine cultures will be disposed of in red bags marked as hazardous waste.

10. Documentation for the following will be maintained:

  • Vaccination forms
  • Training forms
  • Incident forms and follow-up
  • Inspection (monthly) forms
  • Annual training forms

Section C. Hepatitis B Vaccination Policy

1. Hepatitis B vaccination will be made available to all employees who are at risk for occupational exposure to bloodborne pathogens. The vaccine will be offered in accordance with existing employee health protocols:

  • within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis B vaccine series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
    • A prescreening program is not a prerequisite for receiving the Hepatitis B vaccination.
    • If the employee initially declines Hepatitis B vaccination but at a later date decides to accept the vaccination while still employed and still at risk for occupational exposure to bloodborne pathogens, the Hepatitis B vaccination will still be available.
    • The employees who decline to accept Hepatitis B vaccination offering will sign a statement of refusal.
    • Routine booster doses of Hepatitis B vaccine which are recommended by the US Public Health Service at some later date will be made available to employees free of charge.
  • and after the employee has received the required training, including information on Hepatitis B vaccine safety, efficacy, method of administration, vaccine benefits, and its provision to the employee free of charge.

2. Hepatitis B vaccine will be administered in accordance with existing employee health protocols for administration of the vaccine..

3. Our office has administrative responsibility for overall compliance with this protocol.

4. Hepatitis B Vaccine. Please read the following carefully. Employees will have the opportunity to ask questions and have them answered to their satisfaction before making a decision about receiving the Hepatitis B vaccine.

  • Hepatitis B is an inflammation of the liver caused by the Hepatitis B virus. You may not be very ill with the virus or you may have severe symptoms that require hospitalization.
  • The symptoms of Hepatitis B include loss of appetite, fatigue abdominal discomfort or pain, an enlarged liver, jaundice (yellow skin tone) and abnormal liver function tests (blood tests).
  • People who have Hepatitis B can develop long term consequences that include chronic active Hepatitis, cirrhosis, and liver cancer.
  • Health care workers are 20 times more likely to contract the virus than the general public.
  • Everyone who has contact with blood or body fluids is a risk. Your job description signifies whether you are at risk.
  • The Hepatitis B virus can survive for seven days in dried blood. Every contact with the Hepatitis B virus is capable of causing infection.
  • You have as high as a 30% chance of contracting Hepatitis B from a single contaminated needlestick.
  • Shot-term consequences of Hepatitis B include an average of seven weeks lost from work, and the risk of permanent liver damage.
  • Long-term consequences include chronic active hepatitis and cirrhosis of the liver, as well as a 12-300 times greater risk of developing liver cancer.
  • Every week 4 to 5 health care workers die of Hepatitis B or its complications.
  • The vaccine, Engerex-B, is a noninfectious synthetic vaccine, containing no blood or blood products.
  • Three doses of the vaccine administered appropriately (IM in the deltoid_ over a six month period will provide protection to over 90% of recipients. Immunity is thought to be for life.
  • Local reactions may include soreness, redness, and swelling at the injection site.
  • Contraindications to receiving the vaccine include; sensitivity to yeast, sensitivity to thimerosal (vaccine prior to the middle of 2000), pregnancy, breastfeeding, cortisone therapy.
  • The vaccine will only protect you from Hepatitis B.
  • You may donate blood if you receive the vaccine.
  • The Hepatitis B vaccine is offered free of charge to all employee who are at risk for occupational exposure to blood and/or body fluids.

Section D. Bloodborne Pathogens Exposure & Post-exposure Policy

1. Exposure Incident will be defined as a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

  • Blood will be defined as human blood, human blood components, and products made from human blood.
  • Bloodborne pathogens will be defined as pathogens microorganisms that are present in human blood an can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV).
  • Potentially infectious materials will be defined as the following human body fluids:
    • semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
    • any unfixed tissue or organ (other than intact skin) from a human (living or dead);
    • HIV-containing cell or tissue cultures, organ cultures, and HIV or HIV-containing culture medium or other solutions.

2. Medical evaluation, procedures, and follow-up will be:

  • Made available at no cost to the employee through the practice
  • Made available to the employee at a reasonable time and place.
  • Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional.
  • Provided according to recommendations of the US public health service current at the time these evaluations and procedures take place. The doctor will review and update post-exposure management guidelines as new directives are issued, but at least annually.
  • All lab tests will be conducted by an accredited laboratory at no cost to the employee.

3. Post-exposure evaluation and follow-up will include at least the following elements:

  • Documentation of the route(s) or exposure, and the circumstances under which the exposure incident occurred
  • Identification and documentation of the source individual, unless identification is infeasible
    • The source individual’s blood will be tested as soon as feasible for HBV; and as soon as consent is obtained, for HIV infectivity. Individuals who will not consent can be tested in accordance with policy.
    • When the source individual is already know to be infected with HBV or HIV, tested for the source individual’s known HBV or HIV status need not be repeated.
    • Results of the source individual’s blood, if available, will be made available to the exposed employee, and the employee will be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
  • Collection and testing of blood or HBV and HIV serological status of the employee:
    • The exposed employee’s blood will be collected as soon as feasible and tested after consent is obtained.
    • If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.
  • Post-exposure prophylaxis, when medically indicated, will be as recommended by the US public health services, to include counseling and evaluation of reported illnesses.

4. Information provided to the healthcare professional responsible for the employees Hepatitis B vaccination and/or the employees evaluation after an exposure incident will include at least the following:

  • A copy of the OSHA regulation 29cfr part 11910.1030 Occupational Exposure To Bloodborne Pathogens; Final Rule
  • A description of the exposed employee’s duties as they relate to the exposure incident
  • Documentation of the route(s) of exposure and circumstances under which exposure occurred
  • Results of the source individual’s blood testing, if available
  • All medical records relevant to the appropriate treatment of the employee including vaccination status

5. The healthcare professional’s written opinion will be obtained and provided to the employee within 15 days of the completion of the evaluation.

  • The healthcare professional’s written opinion for post-exposure evaluation and follow-up will be limited to the following information:
    • Whether Hepatitis B vaccination is indicated for the employee has received such vaccination
    • That the employee has been informed of the results of the evaluation
    • That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.
  • All other findings or diagnoses will remain confidential and will not be included in the written report.

6. Medical recordkeeping: the office of Ron Smith MD will establish and maintain an accurate record for each employee with occupational exposure to include:

  • The name and social security number of the employee
  • A copy of he employee’s Hepatitis B vaccination status including the dates of all the Hepatitis B vaccinations and any medical records relative to the employee’s ability to receive vaccination
  • A copy of all results of examinations, medical testing, and follow-up procedures
  • The employer’s copy of the healthcare professionals’ written opinion
  • A copy of the information provided to the healthcare professional
  • All medical records will be kept confidential and will not be disclosed or reported without the employee’s express written consent to any person within or outside the workplace expect as required be law, and will be maintained for at least the duration of employment plus 30 years.

Section E. Post Test

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Treatment of Minors

All patients below the age of 16 must be accompanied by a person of majority.  If the patient is accompanied by a person of majority who is not a legal guardian of the patient, then a legal guardian must inform this office verbally that the accompanying adult has the legal guardian’s permission to have the patient examined and treated. The legal guardian must supply the date of birth of a legal guardian to verify identity.

Patients who are between 16 and 18 years of age may be examined without the accompaniment of a person of majority contingent upon there being a signed copy of our “Permission to Have Minor Examined” form in the patient’s record.

All minor patients must be accompanied by a legal guardian or an approved person of majority to receive any treatment  or procedure performed in this clinic.

Mutual Satisfaction Policy

In order to give the very best care to our patients it is important for parents as well as staff to have a satisfying experience in our clinic. I employ very high quality medical caregivers and office staff and they work diligently to train and improve themselves. They want nothing less than to give parents and children their best. An example of their attention to detail is the creation of the Nursing Nook to accommodate nursing mothers with a pleasant and private place to nurture their breastfeeding infants.

We welcome all who would enjoy the experience we’ve created.

We are very patient and understand that parents with sick children can be stressed, and we strive to be sympathetic and caring in each and every situation. However there are occasions, albeit rare, when parents just do not seem to fit with our practice. Though we hate it, there can be times when it is best for parents to locate other Pediatric providers for their children.

Some of the reasons for which we do this can include one or more of the following.

  • Irreconcilable personality conflict issues
  • Chronic verbalization of displeasure with our practice policies and/or conduct
  • Abusive language and/or behavior directed toward providers and/or staff
  • Use of profanity in the office (this is in fact a felony offense in a Pediatric office)
  • Blatant disregard for provider’s advised plan of care for a very sick child
  • Habitual failure to show up for scheduled appointments
  • Misuse of, or suspicion of misuse of, prescription drugs
  • Parental request of providers and/or staff to commit insurance fraud
  • Non-payment of account balances
  • Inappropriately revealing clothing or consistently poor hygiene

Respectfully,

Ron Smith MD

Appointment Scheduling Policies

The purpose of these policies is to ensure that there are enough appointment slots available to take care of the sick children & to safeguard the schedule so that you and your children are in and out of the clinic in a reasonable amount of time.

You can help us accomplish this by following these requests:

  1. Please be here 10 minutes early so that you can get through the Check-in process in time for your appointment.
  2. In order to make sure that we have enough sick-visit slots each day, we have a limited number of well-visit (physical exam) appointments available and those are booked at least 48 hours in advance. So I hope that you will understand that we cannot fit in an extra well-visit exam at the last minute.
  3. Late arrivals cause an unpleasant ripple effect in the schedule. So please understand that if you are late for your appointment you will likely have to be rescheduled for a later time.
  4. Please schedule sick-visit appointments for each child that you want seen by the provider. “Squeezing in” an extra exam can be time consuming and can cause a schedule backlog.

We are endeavoring to make your visits here as pleasant an experience as possible. Thank you for your cooperation.

Sincerely,

Linda Fabre, Practice Manager

Financial Policy

*Co-payments are collected prior to services being rendered.

*Any outstanding billed balances(amounts that have been deemed patient responsibility by the insurance company) must be paid prior to services being rendered unless there is a payment plan in place.

*A co-insurance amount of $50 will be collected prior to services being rendered for all high-deductible plans where there is no proof of the deductible being met, unless there is verification that the plan has a health savings account attached to it.
* We reserve the right to charge a $35 fee for missed well-visit appointments unless the appointment is cancelled 24 hours in advance of the appointment time.

*Should an insurance company refuse to pay a claim because of ineligibility, the charges will become the guarantor’s responsibility.

*There is a $30 charge for returned checks.  If more than one check is returned for non-payment, all future payments must be made in cash, or by credit or debit card.

Privacy Policy

Privacy Policy effective date September 2004.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact Linda Fabre, who is our Practice Manager/Privacy Officer.

How this Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

  1. Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians, or other health care providers who will provide services which we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured.
  2. Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
  3. Health Care Operations. We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your medical information with our “business associates,” such as our billing service, that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality of your medical information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their efforts to improve health or reduce health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
  4. Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
  5. Sign in sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
  6. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
  7. Marketing. We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments or health-related benefits and services that may be of interest to you, or to provide you with small gifts. We may also encourage you to purchase a product or service when we see you. We will not use or disclose your medical information without your written authorization.
  8. Required by law. As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
  9. Public health. We may, and are sometimes required by law to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
  10. Health oversight activities. We may, and are sometimes required by law to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and Georgia law.
  11. Judicial and administrative proceedings. We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
  12. Law enforcement. We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
  13. Coroners. We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths.
  14. Organ or tissue donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
  15. Public safety. We may, and are sometimes required by law, to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
  16. Specialized government functions. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
  17. Worker’s compensation. We may disclose your health information as necessary to comply with worker’s compensation laws. For example, to the extent your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
  18. Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
  19. Research. We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.]
  20. Fundraising. We may use or disclose your demographic information and the dates that you received treatment in order to contact you for fundraising activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this Notice of Privacy Practices.

When This Medical Practice May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, this medical practice will not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

Your Health Information Rights

  1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will notify you of our decision.
  2. Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
  3. Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. We will charge a reasonable fee, as allowed by Georgia law. We may deny your request under limited circumstances. If we deny your request to access your child’s records because we believe allowing access would be reasonably likely to cause substantial harm to your child, you will have a right to appeal our decision. If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.
  4. Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about this medical practice’s denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. You also have the right to request that we add to your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect.
  5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 16 (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
  6. You have a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.

Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and will offer you a copy at each appointment.

Complaints

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: Department of Health and Human Services, Office of Civil Rights

You will not be penalized for filing a complaint.

Complaints submitted to the DHHS Office for Civil Rights should be directed to:

Office for Civil Rights/U.S. Department of Health & Human Services
61 Forsyth Street, SW. – Suite 3B70/Atlanta, GA 30323
(404) 562-7886; (404) 331-2867 (TDD)
(404) 562-7881 FAX

Dr. Smith and his Staff Want You to Know How We Will Protect Your Private Health Information.

When you visit our office it is very important that you feel safe in telling your doctor personal information that may be required to fully diagnose or treat a problem. As medical professionals, please be assured that our practice has always had strict policies and procedures to protect the confidentiality of the information that you have entrusted to us. However, on April 14, 2003, new regulations became effective under a federal law called the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA regulations cover physicians and all other health care providers, health insurance companies and their claims processing staffs. In general, HIPAA was enacted to establish national standards to:

  1. Give patients more control over their health information;
  2. Set boundaries for the use and release of health records;
  3. Establish safeguards that physicians, health plans and other healthcare providers must have in place to protect the privacy of health information;
  4. Hold violators accountable, with civil & criminal penalties; and
  5. Try to balance need for individual privacy with requirement for public responsibility that requires disclosures to protect the public health.

The HIPAA rules require that our practice provide all of our patients that we see after September 2004 with the attached Notice of Privacy Practices. The Notice describes how the medical information we receive from you may be used or disclosed by our practice and your rights related to your access to this information.

You are entitled to a personal copy of the Notice at any time to review and keep for your records. If you have any questions about our Privacy Practices, please feel free to contact Linda Fabre, our Practice Manager/Privacy Officer.