Office Policies & Procedures

• We value the time we have set aside to see and treat your child. If you are not able to keep an appointment, we would appreciate 24-hour notice.
• If you are late for your appointment, we will do our best to accommodate you. However, your wait time might be longer on certain days depending on our schedule.
• We strive to minimize any wait time; however, emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding.
• Walk-in sick visits are welcomed during office hours.

Please understand:

• It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you may be responsible for payment of the visit and to submit the charges to the correct plan for reimbursement.
• If we are your primary care provider, make sure our name or phone number appears on your card. If your insurance company has not yet been informed that we are your primary care provider, you may be financially responsible for your current visit.
• It is your responsibility to understand your benefit plan with regard to, for instance, covered services and participating laboratories. For example,
• Not all plans cover annual healthy            (well) physicals, sports physicals, or hearing and vision screenings. If these are not covered, you will be responsible for payment.
• For children younger than 2 years, there is a limit as to the number of allowable well visits per year. If the number of visits is exceeded, your insurance company will not pay; you will be responsible for payment.
• It is your responsibility to know if a written referral or authorization is required to see specialists, whether preauthorization is required prior to a procedure, and what services are covered.

• Advance notice is needed for all non-emergent referrals, typically 3 to 5 business days.
• It is your responsibility to know if a selected specialist participates in your plan.
• Remember, our providers must approve referrals before they are issued.

• According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances.
• Co-payments are due at the time of service.
• Self-pay patients are expected to pay for services in FULL at the time of the visit.
• If we do not participate in your insurance plan, payment in full is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for reimbursement.
• Patient balances are billed immediately on receipt of your insurance plan’s explanation of benefits. Your remittance is due within 10 business days of your receipt of your bill.
• If previous arrangements have not been made with our billing and accounts office, any account balance outstanding longer than 28 days will be charged a $5 re-bill fee for each 28-day cycle. Any balance outstanding longer than 90 days will be forwarded to a collection agency.
• For scheduled appointments, prior balances must be paid or financial arrangements made with the accounts/billing department prior to the visit.
• If you participate with a high-deductible health plan, we require payment to be made at the time of visit towards the deductible, or copy of the health savings account debit or credit card, or a copy of a personal credit card to remain on file.
• We accept Cash, Visa, Discover, MasterCard, American Express, and Debit Cards.

When requesting or dropping off the following forms, on the day of your child's visit or within 72 hours, there is no charge:

• Immunization records Forms
• Health Inventory Forms
• Lead Certificate Forms

Forms requested outside of 72 hours, as well as requesting or dropping off the following forms, are subject to a  $10.00 per-form fee ($5.00 for computer generated forms:

• Any School Form
• Camp Form
• Sports Form

There is a $15.00 fee for the following form:

• Family and Medical Leave Act Forms

Please Note:  We require 3-7 business day turnaround time.

Payment is due when the forms are dropped off.

• If you transfer to another physician, we will provide a copy of your complete records to your physician free of charge as a courtesy to you, within two weeks of the request. However we will provide a copy of the immunization records and the most recent well exam, within 48 hours if requested.
• For a copy of medical records requested by parents/patients, there is a base fee of $15.00 and .50 cents-per-page fee.
• We provide records of your child visits (including consultations from specialists) rendered here at Goodtime Family Care only. For any previous records, you must request them directly from your previous doctor(s).

• For monthly medication refills, we require 24 hours’ notice, during regular business hours. Please plan accordingly.

Fill out the Insurance Authorization Form.

Goodtime Family Care HIPAA Privacy Notice

Effective Date of this Notice: 01/01/2021

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Goodtime Family Care is dedicated to maintaining the privacy of your identifiable health information. In conducting and performing services to you, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect on the date noted at the top of this page.

To summarize, this notice provides you with the following important information concerning:

How we may use and disclose your identifiable health information.

Your privacy rights in your identifiable health information.

Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our facility. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our facility has created or maintained in the past, and for any of your records we may create or maintain in the future. Our facility will post a copy of our current notice in a prominent location, and you may request a copy of our most current notice at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT:

Goodtime Family Care at 5805 Moravia Road, Baltimore MD 21206 or 7131 Liberty Rd, Ste 103 Gwynn Oak, MD 21207. Phone 410-325-5700

C. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS.

The following categories describe ways in which we may use and disclose your identifiable health information:

Treatment. Our facility may use your identifiable health information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your identifiable health information in order to write a prescription for you, or we might disclose your identifiable health information to a pharmacy when we call and order a prescription for you. Many people who work for our facility - including doctors and nurses - may use or disclose your identifiable health information in order to treat you or to assist others in your treatment. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your spouse, children or parents.

Payment. Our facility may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items.

Health Care Operations Our facility may use and disclose your identifiable health information to operate our business. For example: our facility may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our facility.

Appointment Reminders. Our facility may use and disclose your identifiable health information to contact you and remind you of an appointment.

Treatment Options. Our facility may use and disclose your identifiable health information to inform you of potential treatment options or alternatives.

Health Related Benefits and Services. Our facility may use and disclose your identifiable health information to inform you of health related benefits of services that may be of interest to you.

Release of information to Family/Friends. Our facility may release your identifiable health information to a friend or family member that is helping you pay for your health care or who assists in taking care of you.

Disclosure Required by Law. Our facility will use and disclose your identifiable health information when we are required to do so by federal, state and local law.

D. USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

Public Health Risks. Our facility may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

a. maintaining vital records, such as births and deaths

b. reporting child abuse or neglect

c. preventing or controlling disease, injury or disability

d. notifying a person regarding a potential risk for spreading or contracting a disease or condition

e. reporting reactions to drugs or problems with products or devices

f. notifying individuals if a product or device they may be using has been recalled

g. notifying appropriate government agencies and authorities regarding the potential child abuse

h. notifying your employer under limited circumstances related to workplace injury or illness or medical surveillance.

Health Oversight Activities. Our facility may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include for example, investigations, inspections, audits, surveys, Licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings. Our facility may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party.

Law Enforcement. We may release identifiable information if asked to do so by a law enforcement official:

a. Regarding a crime victim in certain situations, if we are unable to obtain the person=s agreement

b. Concerning a death we believe may have resulted from criminal conduct

c. Regarding criminal conduct at our facility

d. In response to a warrant, summons, court order, subpoena or similar legal process

e. To identify/locate a suspect, material witness, fugitive or missing person

f. In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

Deceased Patients. Our facility may release identifiable information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. When necessary, we also may release information in order for funeral directors to perform their jobs.

Organ and Tissue Donation. Our facility may release your identifiable health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation.

Research. Our facility may use and disclose your identifiable health information for research purposes in certain limited circumstances. We will obtain your written authorization to use your identifiable health information for research purposes except when: (a) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your identifiable health information is solely to prepare protocol or for similar preparatory research, and (iii) the researcher will not remove any of your identifiable health information from our premises; or (b) the identifiable health information sought by the researcher only relates to descendants and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the identifiable health information of the descendants

Serious Threats to Health or Safety. Our facility may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military. Our facility may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

National Security. Our facility may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates. Our facility may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Workers’ Compensation. Our facility may release your identifiable health information for workers’ compensation and similar programs.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the identifiable health information that we maintain about you:

1. Confidential Communications. You have the right to request that our facility communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to [insert name and title of person and telephone number] specifying the requested method of contact, or the location where you wish to be contacted. Our facility is not required to agree to your request. However we will attempt to accommodate a reasonable request.

2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must make your request in writing to the Office Manager at Goodtime Family Care, 5805 Moravia Road, Baltimore MD 21206 or 7131 Liberty Rd, Ste 103, Gwynn Oak, MD 21207. Your request must describe in a clear and concise fashion: (a) the information you wish to restrict; (b) whether you are requesting to limit our facility=s use, disclosure or both; and (c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Office Manager at Goodtime Family Care, 5805 Moravia Road, Baltimore MD 21206 or 7131 Liberty Rd, Ste 103, Gwynn Oak, MD 21207 in order to inspect and/or obtain a copy of your identifiable health information. Our facility may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our facility may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed healthcare professional chosen by us.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete. You may request an amendment for as long as the information is kept by or for our facility. To request an amendment, your request must be made in writing and submitted to the Office Manager. You must provide us with a reason that supports your request for amendment. Our facility will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by us; (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by our facility, unless the entity that created the information is not available to amend the information.

5. Accounting of Disclosures. All of our patients have the right to request an Accounting of disclosures.  An Accounting of disclosures is a list of certain disclosures our facility has made of your identifiable health information other than for treatment or payment. In order to obtain an accounting of disclosures, you must submit your request in writing to the Office Manager at Goodtime Family Care, 5805 Moravia Road, Baltimore, MD 21206 or 7131 Liberty Rd, Ste 103, Gwynn Oak, MD 21207. All requests for an Accounting of disclosures must state a time period, which may not be longer than six years and may not include dates before January 01, 2021. The first list you request within a 12-month period is free of charge, but our facility may charge you for additional lists within the same 12-month period. Our facility will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice ask the front office staff or contact HIM.

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services. To file a complaint with our facility, contact Ronda Herry at 410 325 5700 or email her at ronda@goodtimepeds.com. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures. Our facility will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, ask the clerk to direct you to or ask to speak to a Privacy Representative.