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Office Policies - Consent to Treat

Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about your child. You have the right to receive a copy of and review our notice before signing the Patient Information sheet. As provided in our notice, the terms of our notice may change. If we make changes to the notice, you may obtain a revised copy by asking for an updated copy or contacting the Office Manager.

You have the right to request that we restrict how protected health information about your child is used or disclosed for treatment, payment or health care operations. We are not required to agree to this restriction, but if we do, we are bound by our agreement.

By signing the Patient Information sheet, you consent to our use and disclosure of protected health information about your child for treatment, payment and health care operations. By signing the Patient Information sheet, you confirm you have been offered and/or received Pediatric Health Associates, Ltd. Notice of Privacy Practices. You have the right to revoke this consent, in writing, except where we have already made disclosures in reliance on your prior consent.