Privacy Policy - Wolfson Childrens Hospital in Jacksonville, FL

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HIPAA/Privacy Policy

Each time a patient sees a physician, is admitted to a hospital, undergoes outpatient testing, fills a prescription with a pharmacist or sends a claim to a health plan, a record is made of the patient's health information. Until 1996, the confidentiality of patient health information was protected by a patchwork of state laws, which, some people argued, left gaps in the protection of patients' privacy and confidentiality. As part of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Congress recognized the need for national standards for patient privacy. As a result of HIPAA's mandate, the U.S. Department of Health and Human Services issued national patient privacy standards in December 2000, which generally became effective on April 14, 2003.

The privacy of patient health information has always been a high priority of Baptist Health, and Florida law has for many years included significant patient privacy protections. This section of the Baptist Health web site is intended to provide Baptist Health patients and their families with information about their privacy rights and Baptist Health's commitment to protect those rights. The information in this section of the Baptist Health web site will be updated in the event that Baptist Health's privacy practices change in the future.

Our Patient Privacy Practices

Baptist Health insists that our staff observe patient confidentiality and respect our patients right to privacy of health information. Please download the following documents for detailed information on our privacy practices (in PDF format):

English Version

Summary of Baptist Health's Notice of Privacy Practices
Baptist Health's Complete Notice of Privacy Practices

Authorization to Share Medical Information with Others

There may be situations in which you want your Baptist Health medical provider to share information with third parties, such as your family members, loved ones, your other caregivers or attorney. If so, please download the appropriate document below (in PDF format). Otherwise, please let your healthcare team know, and they can assist you in the proper procedure for giving your consent to share specific information with specific people.

Authorization to Release or Obtain Medical Information

Authorization for Release of Information for Psychiatric & Psychological Care

Authorization to Obtain Psychotherapy Notes

Authorization to Release Psychotherapy Notes

Authorization for Release of Radiology/Imaging Films

Request to Restrict the Sharing of Medical Information with Others

You may ask BH not to use or disclose medical information about you for certain purposes, as further described in the Baptist Health's Notice of Privacy Practices.

Disclosures to Health Plan

You may ask BH not to disclose medical information to your health plan in certain circumstances for tests, services or healthcare items for which you paid out of pocket in full. You may request a restriction on such disclosures to your health plan by downloading and completing the following form (in PDF format):
Request to Restrict Disclosure of Protected Health Information to Health Plan

Other Disclosures

Baptist Health is not required to agree to a restriction on other types of disclosures (other than the health plan restriction described above), and even if such a restriction is agreed to by Baptist Health it may ignore such restriction in an emergency. You may request a restriction on other types of disclosures by downloading and completing the following form (in PDF format):
Request to Restrict Use and Disclosure of Protected Health Information

Other Patient Privacy Forms

Attorney's Certification for Subpoena Compliance