Our Medical Records/Privacy Policy About
Your Privacy is Important to Us.
At Pediatric Surgical Associates, P.A., we place a high priority on a patient’s right to privacy. We are committed to providing you and your family with exceptional care and forming a relationship that is built on trust. This means that we respect your right to privacy and will endeavor to protect the confidentiality of your and your family’s health information, whether this information is stored in a paper or electronic file.
Sensitive Information:
I understand that the information in my record may include information relating to sexually transmitted diseases, acquired immunodeficiency syndrome (AIDS), or infection with the Human Immunodeficiency Virus (HIV). It may also include information about behavioral or mental health services or treatment for alcohol and drug abuse.
Right to Revoke:
I understand that I have the right to revoke the authorization at any time. I understand if I revoke this authorization I must do so in writing. I understand that the revocation will not apply to information that has already been released based on this authorization.
Expiration:
Unless otherwise revoked, this authorization will expire on the following date, event, or condition: If I do not specify an expiration date, event or condition, this authorization will expire in six months.
Re-disclosure:
I understand that any disclosure of information carries with it the potential for re-disclosure and the information may not be protected by the federal confidentiality rules.
Other Rights:
I understand that authorizing the disclosure of this health information is voluntary. I can refuse to sign this authorization. I do not need to sign this form to assure treatment. However, if this authorization is needed for participation in a research study, I may be denied enrollment in the research study. I understand that I may inspect or obtain a copy of the information to be used or disclosed, as provided in CFR 164.524.
If you have any questions, please call us at (201) 225-9440
Dr. Barry LoSasso is MDs, FACs, and FAAP.
MD designates a Medical Doctor.
FACS designates a physician as a Fellow of the American College of Surgeons. Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.
The FAAP designation after a pediatrician’s name stands for Fellow of the American Academy of Pediatrics. Pediatricians who maintain their FAAP designation have obtained board certification in pediatrics and made an ongoing commitment to lifelong learning and advocacy for children.
Our Commitment to Our Patients
- To provide the best pediatric healthcare without unnecessary tests and medicines.
- To attain optimal mental, physical, and social health and well-being for all infants, children, and adolescents.
- To make your experience a personal one. We will treat your child like we treat our very own. We want to work with parents and help you raise a happy, healthy child.
- We believe in open and direct communications and take the time to understand the child’s health, illness and pediatric needs.
- Our goal is to make a difference in the lives of children by providing quality health care in an environment built on knowledge, innovation, integrity, and fun!