Living Tree Pediatrics, PLLC | Notice of Privacy Practices

This notice describes how medical information about you or your child may be used and disclosed and how you can get access to this information. Please review it carefully.

What is Protected Health Information (PIH)?

Protected health information is any health or personal information that could identify a patient and that concerns a patient’s past, present, or future health care.

Why this is important

This Notice of Privacy Practices describes how we may use and disclose you protected health information to carry out treatment, obtain payment for services, direct health care operations, or for other purposes permitted or required by law. It also describes your rights regarding access to and control of this information.

We are required to abide by the terms outlined in this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practice at any time and will provide you with an updated version upon request.

Routine uses and disclosures

This section discusses the ways Protected Health Information may be routinely used or disclosed for treatment, payment, and healthcare operations. These are examples of the situations in which we may use and/or disclose health information without direct consent.


We will use and/or disclose you or your child’s health information to provide, coordinate, or otherwise manage you or your child’s care. This may include discussions with a third party that also has access to your protected health information. Examples of persons or organizations involved in you or your child’s care include:

  • You or your child’s primary care physician and associated clinic staff
  • Medical specialists, therapists, counselors, audiologists, pharmacists, or others who may need you or your child’s medical information in order to provide proper treatment
  • Suppliers contracted and authorized to provide medical services and supplies to you or your child
  • Nursing, physician assistant (PA), medical, or other students that may receive a portion of their clinical training at Living Tree Pediatrics
  • Service coordinators with the ARKids program or other agencies that may be involve in your or your child’s care
  • Family members, friends, or others who are authorized to accompany you or your child at Living Tree Pediatrics.


You or your child’s health information may be disclosed, as needed, to obtain payment for the services you or your child receive at Living Tree Pediatrics. We will share information with:

  • ARKids or other government-sponsored program needing information to approve services and authorize payment for you or your child’s care
  • Commercial insurers needing information to approve services and authorize payment for you or your child’s care
  • Family members, friends, private organizations, or others who help you pay for you or your child’s care

Healthcare operations

We may use or disclose you protected health information in order to support the business activities of the clinic. For example, we may use you or your child’s protected health information to:

  • Assess the quality of healthcare provided by your physicians or staff and for training of students
  • For legal professionals who advise us in our health care operations
  • Conduct quality improvement assessments and implement plans to better serve patients
  • Remind you of you or your child’s appointments
  • Provide you with information, as needed, regarding treatment alternatives or other health-related benefits and services that may be of interest to you.

Other permitted and required uses and disclosures that may be made without your direct consent, authorization, or opportunity to object

Health Oversight

We may be required to share protected health information with:

  • Government agencies who monitor health such as the Centers for Disease Control, the Arkansas Department of Health, or the Vaccine Adverse Events Reporting System (VAERS)
  • Government benefits programs (ARKids)
  • Public Health and Safety – We are required to share information with

Public health authorities such as state or local departments of health.

These disclosures are for the purpose of controlling and/or preventing disease or injury

  • An individual who may have been exposed to a communicable disease or who may be at risk of contracting or spreading the disease
  • The Food and Drug Administration (FDA) if there is a problem with a medication, medical product, or equipment
  • State agencies such as Child Protective Services, if there is concern of abuse, neglect, or domestic violence to a patient or family member

Law Enforcement

We would be required to disclose protected health information to law enforcement or court officials

  • If a crime has occurred on the premises
  • To report medical emergencies not occurring on the premises and it is likely that a crime occurred
  • If there is suspicion of death that has occurred as a result of criminal conduct
  • If we believe that disclosure is needed to prevent or control a serious threat to public health and safety

Emergency treatment

We may use or disclose protected health information if it is needed for emergency treatment of a patient

Medical Examiners, Funeral Directors

We may disclose protected health information to medical examiners and funeral directors as authorized by law to permit them to carry out their duties

Uses and disclosures of Protected Health Information that require separate and specific permission from you

Marketing activities

We cannot use your or your child’s health information, personal information, or picture to publicize clinic services unless you have given us specific written permission

HIV/AIDS, substance abuse, genetic testing, court-ordered mental or psychological testing

We may not disclose Protected Health Information about these things without your specific written permission

Your rights regarding protected health information

Right to receive a paper copy of this notice

You can get a copy from the front desk or our privacy officer. You may also print a copy of this policy from our website (

Right to review and copy your information

  • You have the right to look at or copy your or your child’s health information and billing records. There may be a cost for copying these records
  • Under federal law, you are not automatically permitted to look at psychotherapy notes, information compiled for civil, criminal or administrative action, or if prohibited by law.

Right to amend your or your child’s information

If you believe that the information that we have is incorrect or if there is missing information, you have the right to ask that this be corrected or the missing information added. The request must be in writing. The clinic will consider your request and respond in writing. However, we are not legally required to agree to it if we believe that it is not in your or your child’s best interest. We will allow addendums to the record, we to not permit changes to the medical record

Right to limit our use or disclosure of your or your child’s information

You may request that certain portions of your or your child’s health information to not be disclosed to anyone or to a specific party. You must submit the request in writing. We will respond in writing, but are not legally obligated to agree to it if we believe that it is not in your or your child’s best interest

Right to request that confidential information be sent in a certain way

You may request that we remind you about appointments with us in a certain way. You may request that we send information about your child’s care to you at a place or in a way that is more convenient to you than the way we regularly to this. We are not required to agree to your request, but will consider it.

Right to an accounting of our disclosure of your or your child’s information

You have a right to receive a list of the times and details regarding the times we have disclosed your or your child’s health information to persons for reasons other than treatment, payment, or health care operations. This request must be made in writing. You may receive one copy of this list / information per year at no cost. There will be a nominal fee for an additional list provided within the same year

Our duties regarding your health information

  • We are required to establish policies and procedures that protect your or your child’s information and are required to provide and follow this Notice of Privacy Practices
  • We are required to disclose only what is absolutely necessary when using or disclosing your health information to outside sources
  • We may change our policies and procedures for protecting your health information. We are required to change our Notice of Privacy Policy to reflect these changes in policies and procedures and will post this or make copies available to you

Making a complaint about how your information is used

If you believe that we have not protected your or your child’s health information, or if you disagree with a decision we made regarding your protected health information, you may contact the clinic privacy officer at the address and phone number below. Alternatively, you can file a complaint with the US Department of Health and Human Services Office for Civil Rights. Please contact our privacy officer to obtain this contact information if this is desired. Filing a complaint will not affect your or your child’s care.

Notice regarding social media, e-mail, and protected health information

Facebook, Twitter, and other such social media programs are not considered secure and should not be used for specific communication regarding you or your child’s medical care. Although e-mail is considered a more secure means of communication, and although we make every effort to ensure that our transmissions comply with HIPPA regulations, these communications may not be entirely secure. In addition, texting, although convenient, is also not the preferred method of communication between you and the Living Tree Pediatrics team. We at Living Tree Pediatrics prefer that correspondence between you and our providers and/or staff take place in person or via phone call.

How to receive more information about Living Tree Pediatrics’ Privacy Policies

Contact our privacy officer by calling 479-282-2966 and asking to speak with the clinic’s privacy officer. Alternatively, you may write to:

Living Tree Pediatrics
1502 SE 28th Street, Suite 2
Bentonville, AR 72712


This Notice of Privacy Policies published and effective 1 April 2016