PROTECTED HEALTH INFORMATION

       Information about your child's health is called "protected health information." It includes any information that DAVENPORT PEDIATRICS, PA receives or creates that identifies (or could identify) your child and deals with your child's physical and/or mental health, and any medical care we provide your child and/or payment for such medical care.

       DAVENPORT PEDIATRICS, PA understands the importance of privacy and is committed to maintaining the confidentiality of your child's medical information. We make a record of the medical care provided to your child and may receive other medical records from others. We use these records to provide and enable us and other healthcare providers to provide quality medical care, to obtain payment for medical services provided to your child and to enable us to meet our professional and legal obligations to properly operate our medical practice. We have a "Notice of Privacy Practice" (the "Notice"). The Notice describes in great detail how we might use or disclose protected health information. The notice also discusses your rights and our duties with respect to protected health information. You have the right to review the Notice before signing this consent. This notice is available on our website @www.davenportpediatrics.com or you may request a copy from our front office staff.