We accept a wide variety of PPO plans and of course, can work with you if you have a healthcare savings account or wish to pay cash. We accept Visa, Mastercard, American Express, personal checks or cash. Payment of your co-pay, deductible, or co-insurance is due at the time of service/each visit.
If your pediatrician orders a lab test that is not done on site (as we perform some but not all within our office), you will receive a seperate bill from the lab chosen. This includes cultures that may be collected in the office or blood drawn by your doctor that is transported out to a lab other than our own.
We do not accept MediCal, TriCare, or HMO plans of any type.
For your convenience, from 8—8:45 am, and from 4:30—5:30 pm Monday through Friday, you may “drop in” for a quick visit if your child is acutely ill, injured, or in distress. We provide these blocks of time as a service to our families. We do request, however, that if your child has a chronic or lengthy complaint that requires more of the doctor’s time, that you arrange a scheduled appointment.
Otherwise, same day or next day appointments are always available for your child. Physical examinations, completion of forms and rechecks cannot be done during drop-in hours. Drop-in hours are not available on Saturdays.
Is it time for your child’s infant, kindergarten, camp or college checkup?
Well-care requires an appointment. From birth to three years of age, your doctor will outline the frequency of physical examinations your child requires. After that point, we will perform physical examinations on a yearly basis.
We allocate 20 minutes for well checkups in order that we may fully examine your child, and allow ample time for individualized advice and a discussion of your concerns. We ask that you plan to arrive at least 10 minutes before your scheduled appointment, so that our staff can perform pre-physical screening and get your child ready his/her visit.
Arriving more than 10 minutes late for a well-care appointment could mean having to reschedule. Realizing that your time is as valuable as ours, we make every effort to be on time for you and your child. Of course, conditions do arise where there may be occasional delays because of a patient emergency. Our staff will always do its best to inform you, and if necessary, make alternate arrangements with another pediatrician if such a delay occurs.
Boulevard Pediatrics asks that you schedule your child’s next well-care appointment at your earliest convenience. Our appointment books are open 3 months in advance so that you can have your child’s appointment on the date and time that is most convenient to you.
Acute Illness: Should your child need to be seen for an acute illness, same day or next day appointments are always available with one of our pediatricians. Lengthier consultations for concerns about chronic symptoms or other long-standing can also be arranged with your doctor.
Camp and School Forms
We are happy to complete your child(ren)’s forms for schools, camps and other activities.
There will be a $15 charge per form. Payment is due at the time of service, and is not covered by insurance. Please bring the forms in at the time of your child’s routine visit, as they can often be completed at that time. Should you want to mail in your forms, please send an addressed, stamped envelope and $15/form to the office, and your form should be returned within 3-5 working days. If you email or fax in your form to (818) 783-3115, please direct us to where the form should be sent (eg. fax number, camp/school/home address or pick up from office), and you will be sent an invoice for payment.
Please note if there is a need for a same day turn around of a school or camp form, there will be a $5 extra charge secondary to the volume of forms our office receives on a daily basis. Thank you for your understanding.
Our office staff is well-trained to steer you through most minor illnesses, answer simple questions and help determine if an appointment is needed. Please let them assist you when necessary. For questions that are beyond their specific training, one of our doctors is always consulted for an answer. Please be assured that, if you need to speak with your pediatrician personally, our staff will take a message and we will get back to you as quickly as possible.
16550 Ventura Boulevard, Suite 414
Encino, CA 91436
Privacy Official: Carolyn Beilfuss (818) 783-3110
NOTICE OF PRIVACY PRACTICES
Effective Date: June 1, 2010
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD(REN) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We understand the importance of privacy and are committed to maintaining the confidentiality of your child(ren)’s medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to your child(ren) as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. This notice describes how we may use and disclose your child(ren)’s medical information. It also describes your rights and our legal obligations with respect to your child(ren)’s medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.
A. How this Medical Practice May Use or Disclose Your Health Information
This medical practice collects health information about you and stores it on a computer. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:
1. Treatment. We use medical information about your child(ren) to provide their medical care. We disclose medical information to our employees and others who are involved in providing the care your child(ren) need. For example, we may share your child(ren)’s medical information with other physicians or other health care providers who will provide services which we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to your child(ren), or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help your child when he/she is sick or injured.
2. Payment. We use and disclose medical information about your child(ren) to obtain payment for the services we provide. For example, we give your child(ren)’s health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to your child(ren).
3. Health Care Operations. We may use and disclose medical information about your child(ren) to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your child(ren)’s medical information with our "business associates", such as our billing service, that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality of your medical information. Although federal law does not protect health information which is disclosed to someone other than another healthcare provider, health plan or healthcare clearinghouse, under California law all recipients of health care information are prohibited from re-disclosing it except as specifically required or permitted by law. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you or your child(ren), when they request this information to help them with their quality assessment and improvement activities, their efforts to improve health or reduce health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts. We may also share medical information about you with the other health care providers, health care clearinghouses and health plans that participate with us in "organized health care arrangements" (OHCAs) for any of the OHCAs' health care operations. OHCAs include hospitals, physician organizations, health plans, and other entities which collectively provide health care services. A listing of the OHCAs we participate in is available from the Privacy Official.
4. Appointment Reminders. We may use and disclose medical information to contact and remind you about your child(ren)’s appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.
5. Sign in sheet. We may use and disclose medical information about your child(ren) by having you sign in when you arrive at our office. We may also call out your child(ren)’s name when we are ready to see you.
6. Notification and communication with family. We may disclose your child(ren)’s health information to notify or assist in notifying a family member, your child(ren)’s personal representative or another person responsible for their care about your child’s location, his/her general condition or in the event of your child’s death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your child(ren)’s care or helps pay for their care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
7. Marketing. We may contact you to give you information about products or services related to your child(ren)’s treatment, case management or care coordination, or to direct or recommend other treatments or health-related benefits and services that may be of interest to your child(ren), or to provide your child(ren) with small gifts. We may also encourage you to purchase a product or service when we see you. We will not otherwise use or disclose your medical information for marketing purposes without your written authorization.
8. Required by law. As required by law, we will use and disclose your child(ren)’s health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
9. Public health. We may, and are sometimes required by law to disclose your child(ren)’s health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
10. Health oversight activities. We may, and are sometimes required by law to disclose your child(ren)’s health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and California law.
11. Judicial and administrative proceedings. We may, and are sometimes required by law, to disclose your child(ren)’s health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about your child(ren) in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
12. Law enforcement. We may, and are sometimes required by law, to disclose your child(ren)’s health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
13. Coroners. We may, and are often required by law, to disclose your child(ren)’s health information to coroners in connection with their investigations of deaths.
14. Organ or tissue donation. We may disclose your child(ren)’s health information to organizations involved in procuring, banking or transplanting organs and tissues.
15. Public safety. We may, and are sometimes required by law, to disclose your child(ren)’s health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
16. Specialized government functions. We may disclose your child(ren)’s health information for military or national security purposes or to correctional institutions or law enforcement officers that have your child in their lawful custody.
17. Worker’s compensation. Not applicable
18. Change of Ownership. In the event that this medical practice is sold or merged with another organization, your child(ren)’s health information/record will become the property of the new owner, although you will maintain the right to request that copies of your child(ren)’s health information be transferred to another physician or medical group.
B. When This Medical Practice May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Boulevard Pediatrics will not use or disclose health information which identifies your child(ren) without your written authorization. If you do authorize this medical practice to use or disclose your child(ren)’s health information for another purpose, you may revoke your authorization in writing at any time.
C. Your Health Information Rights
1. Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your child(ren)’s health information, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will notify you of our decision.
2. Right to Request Confidential Communications. You have the right to request that you receive your child(ren)’s health information in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
3. Right to Inspect and Copy. You have the right to inspect and copy your child(ren)’s health information, with limited exceptions. To access your child(ren)’s medical information, you must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. We will charge a reasonable fee, as allowed by California and federal law. We may deny your request under limited circumstances. If we deny your request to access your child's records because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision.
4. Right to Amend or Supplement. You have a right to request that we amend your child(ren)’s health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your child(ren)’s health information, and will provide you with information about this medical practice's denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. You also have the right to request that we add to your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect.
5. Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your child(ren)’s health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 16 (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
6. You have a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.
D. Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. We will also post the current notice on our website at www.boulevardpediatrics.com.
Complaints about this Notice of Privacy Practices or how Boulevard Pediatrics handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You will not be penalized for filing a complaint.
HEALTH CARE PRACTITIONER INFORMATION
Jena K. Liddy MD
CA License A 74371 Academic Degrees: BA, MD
Board Certification: NBME/AAP
Jeremy F. Shapiro MD
CA License A 81091 Academic Degrees: BA/BS, MPH, MD
Board Certification: NBME/AAP
Katrin Lalezarzadeh DO
CA License 20A 10295 Academic Degrees: BA, MHPE, DO
Board Certification: NBME/AAP
Keith Bayan MD
CA License A93872 Academic Degrees: BS, MD
Board Certification: NBME/AAP