Children's Health PC Gioia, MD,MPH
Phone 315-253-6257
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Privacy, Germs and Fevers; also Non-Discrimination and Access
NOTICE OF PRIVACY PRACTICES

Privacy Officer- Judy Selover 315 253 6257

Effective Date: September 23, 2013

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.

We understand the importance of privacy and are committed to maintaining the confidentiality of your 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 you 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, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.

TABLE OF CONTENTS
A.How This Medical Practice May Use or Disclose Your Health Information
B.When This Medical Practice May Not Use or Disclose Your Health Information
C.Your Health Information Rights
1.Right to Request Special Privacy Protections
2.Right to Request Confidential Communications
3.Right to Inspect and Copy
4.Right to Amend or Supplement
5.Right to an Accounting of Disclosures
6.Right to a Paper or Electronic Copy of this Notice
D.Changes to this Notice of Privacy Practices
E.Complaints

A.How This Medical Practice May Use or Disclose Your Health Information
This medical practice collects health information about you and stores it in a chart and 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 you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or other health care providers who will provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured, or after you die.

2.Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your 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 you.

3.Health Care Operations. We may use and disclose medical information about you 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 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 and their subcontractors to protect the confidentiality and security of your protected health information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health care costs, their protocol development, case management or care-coordination activities, 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. Appointment Reminders. We may use and disclose medical information to contact and remind you about 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.

4.Sign In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

5.Notification and Communication With Family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your 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 care or helps pay for your 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.

6.Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle and get recommended tests, participate in a disease management program, provide you with small gifts, tell you about government sponsored health programs or encourage you to purchase a product or service when we see you, for which we may be paid. Finally, we may receive compensation which covers our cost of reminding you to take and refill your medication, or otherwise communicate about a drug or biologic that is currently prescribed for you. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization. 

7.Sale of Health Information. We will not sell your health information without your prior written authorization. The authorization will disclose that we will receive compensation for your health information if you authorize us to sell it, and we will stop any future sales of your information to the extent that you revoke that authorization.

8.Required by Law. As required by law, we will use and disclose your 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 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. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.

10.Health Oversight Activities. We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.

11.Judicial and Administrative Proceedings.We may, and are sometimes required by law, to disclose your 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 you 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 health information to a law enforcement official for purposes such as identifying or 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 health information to coroners in connection with their investigations of deaths.

14.Organ or Tissue Donation. We may disclose your 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 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.Proof of Immunization. We will disclose proof of immunization to a school that is required to have it before admitting a student where you have agreed to the disclosure on behalf of yourself or your dependent.

17.Specialized Government Functions. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.

18.Workers' Compensation. We may disclose your health information as necessary to comply with workers' compensation laws. For example, to the extent your care is covered by workers' compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers' compensation insurer.

19.Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.

20.Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate. 
21.Research. We may disclose your health information to researchers conducting research with respect to which your written authorization is not required as approved by an Institutional Review Board or privacy board, in compliance with governing law.

22.Fundraising. We may use or disclose your demographic information in order to contact you for our fundraising activities. For example, we may use the dates that you received treatment, the department of service, your treating physician, outcome information and health insurance status to identify individuals that may be interested in participating in fundraising activities. If you do not want to receive these materials, notify the Privacy Officer listed at the top of this Notice of Privacy Practices and we will stop any further fundraising communications. Similarly, you should notify the Privacy Officer if you decide you want to start receiving these solicitations again.

B.When This Medical Practice May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your 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 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. If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.*

2.Right to Request Confidential Communications. You have the right to request that you receive your 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 health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can't agree and we maintain the record in an electronic format, your choice of a readable electronic or hardcopy format. We will also send a copy to any other person you designate in writing.* We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary.* We may deny your request under limited circumstances. If we deny your request to access your child's records or the records of an incapacitated adult you are representing 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.* If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.  

4.Right to Amend or Supplement. You have a right to request that we amend your 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 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. If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.

5.Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your 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 18 (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.Right to a Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including 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 the terms of this Notice currently in effect. 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.

E.Complaints
Complaints about this Notice of Privacy Practices or how this medical practice 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: 
Linda Colon, Regional Manager; Office for Civil Rights, U.S. Department of Health and Human Services; Jacob Javits Federal Building; 26 Federal Plaza - Suite 3312; New York, NY 10278
Voice Phone (800) 368-1019; FAX (212) 264-3039; TDD (800) 537-7697 or 
 OCRMail@hhs.gov 

The complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf .
  You will not be penalized in any way for filing a complaint.

*From: Regina McNally [mailto:RMCNALLY@mssny.org
Sent: Wednesday, September 18, 2013 10:39 AM
Subject: RE: NY HIPAA - OCR's Model Notices of Privacy Practices, Importance: High
From Don Moy

Here are some of the changes that a medical practice may need to insert if it uses the OCR model NPP. The changes are needed to account for differences in NY law.  

HIPAA allows covered entity 30 days to comply with request for copy of PHI. NYS Public Health Law section 18 requires medical practice to comply within 10 days of the request.  

HIPAA permits a reasonable cost based fee. Public Health law section 18 permits a reasonable charge not to exceed the costs incurred by the provider. The statute states that a reasonable charge for paper copies may not exceed 75 cents per page. In the preamble to the regulations Federal Register December 28, 2000, page 82557, HHS stated that fees for copying and postage provided under state law are presumed reasonable. It is, accordingly, believed that the 75 cents per page for paper copies permitted under NY law, remains effective. PHL section 18 provides, however, that medical records may not be denied solely because of inability to pay. 

Alcohol and Drug Abuse records Federal Regulations, 42 C.F.R. Part 2, restrict the disclosure of alcohol and drug abuse patient records which are maintained in connection with a federally assisted alcohol or drug abuse program. A medical practice is considered to be federally assisted if it receives federal assistance directly or indirectly. A physician who has a DEA registration is considered to be federally assisted, and with limited exceptions, 42 C.F.R. part 2 requires a specific consent to disclose information pertaining to diagnosis, treatment or referral for treatment for current or past drug or alcohol problem.

HIV-Related Information: NYS regulations 10 N.Y.C.R.R. section 63.5 and 63.6 provide, with limited exceptions, that confidential HIV-related information may only be disclosed pursuant to a specific written release of Confidential HIV-related information.  

 Regina McNally, VP
Division of Socio-Medical Economics, Medical Society of the State of New York
   "GASTROENTERITIS"

The Disease
Symptoms are throwing up, loss of appetite, and loose watery and frequent bowel movements with painful cramps; these symptoms are usually caused by an infection.

The germs, viruses or bacteria, infect the intestines or bowels and irritate them. This causes the digestive system to stop or slow down and to cramp. The infection is called GASTROENTERITIS.

The most common infections in our area which cause vomiting and diarrhea are viruses. There are currently few medicines that fight viruses and none for intestinal viruses. Even if bacteria or parasites cause the gastroenteritis, the medicines that fight bacteria such as penicillin and sulfa drugs or the parasites usually only make the disease worse. Hamburger meat often has bacteria in it. Be sure the center of the hamburger is cooked.

An exception is campylobacter fetus jejuni (formerly vibrio fetus jejuni). These bacteria are carried by livestock such as cows and goats and by puppies and kittens. These bacteria often cause bloody diarrhea and fever. In this case treatment with erythromycin helps. Giardia and cryptosporidiosis are common parasites found in our area. 

Usually at the beginning of the infection there is vomiting which lasts one to three days; the diarrhea begins soon after and may continue for two weeks.

Dehydration

The biggest danger with gastroenteritis is that the vomiting and diarrhea will cause excessive water loss and the patient may dry out or dehydrate. Our body is 70% water which is necessary for blood flow and body functions. When the patient is urinating regularly, at least twice daily, then there is probably enough water in the body.

Treatment

To prevent dehydration it is best to give the patient a simple mixture of water, sugar and salt. In this way, the water is best taken in and retained. Foods tend to make the irritation of the bowels worse and cause further water loss. Fruit juices also loosen the stools and should be avoided.



The best mixture of water, sugar and salt to replace the losses of vomiting and diarrhea is: Oral Electrolyte Solution
20 ounces of water, 1/4 teaspoon salt, 1 1/2 tablespoons sugar
A common brand similar to this preparation is Pedialyte or Oralyte or generic oral electrolyte solution (OES).

If the patient is old enough (6 months or older) to have had juices or punch, the oral electrolyte solution may be flavored with those other drinks. The proportion should be one-eighth juice or punch to seven-eighths electrolyte solution.


If the patient is on breast milk, then breast feeding may be tried. If the patient vomits the breast milk, then the oral electrolyte solution should be used again.

If the patient is on formula, then once the patient is keeping down the solution well, a soy formula such as Prosobee, Isomil, or Nursoy feedings may be tried. These soy-bean based formulas lack lactose and therefore cause less diarrhea in the sick patient. Lactofree formula may also be used. When the regular formula or cow's milk is restarted, the diarrhea may begin again. For best results, try the formula or cow's milk for only 2 feedings per day for 2 days before using it for all feedings. For children over 9 months old 1 to 2 tsps. of yogurt with acidophilas each day may help get the intestines back to normal.

For the older patient who has eaten many solid foods, ripe bananas, rice cereal, boiled rice, cooked apples without the skins, and cooked carrots may be tried once the oral electrolyte solution has been taken well. Lactaid milk with reduced lactose may be used until diarrhea is gone. These foods help to firm up the bowel movements.

For the patient over one year old, clear broth, crackers, toast, and hard cheeses may also be tried once the solution has been taken eagerly without vomiting. Kaopectate (1 tablespoon, three times a day), or Immodium AD (1/2 teaspoon 3 times a day) may help slow the diarrhea.

Signs of danger:
  Call the doctor if:
  -- the patient does not urinate at least twice daily;
  -- there is a large amount of blood in the bowel movements;
  -- the patient has a fever (over 101 rectal) for more than  one day;
  -- there is constant abdominal pain lasting more than 4 hours; (this may be a sign of appendicitis)
  -- there is a stiff neck and fever;
  -- the patient is less than 2 months old;
  -- the patient has vomiting for more than 8 hours straight.




FEVER DYNAMICS

Fever is usually a response by the body to infection. Fever helps to fight infections by slowing the growth of the germs (bacteria or viruses).

Temperatures of 107 degrees F(42.7 C) or higher, taken rectally, may cause permanent brain damage. Rapidly rising fevers may cause convulsions or seizures or fits in 5 percent of children 6 months old to 7 years old. When an infection occurs, the body's thermostat is set upward. The average rectal temperature is 98.6 degrees F or 37 C. An infection may set the thermostat to 104 degrees F or 40 C. The body then cuts down on blood flow to the hands and feet to prevent cooling of the blood. This makes the hands and feet feel cool. The body may start shivering to produce more heat to increase the temperature toward the new thermostat value of 104 degrees ( the set point). C stands for Celsius temperature scale of the metric system.

When the infection decreases, the body's thermostat goes back down to 99.5 degrees rectal from 104 degrees rectal. Then the body sweats and the hands and feet get warm in order to get rid of the excess heat in it.

Rectal temperatures are about 1 degree F above oral temperatures and are about 2 degrees F above axillary, or armpit, temperatures. Even adults must avoid exercising vigorously in extreme heat since it may cause temperatures over 107 F or 42.7 C. Automobiles left in the sun in the summer may get to 120 F easily.


WHEN TO CONTROL A FEVER

In the 5 percent of children 6 months old to 7 years old who have febrile seizures, or convulsions, fever control should be initiated at the first sign of fever. Febrile seizures generally have no long term effects but do cause shaking and unconsciousness for 5 to 10 minutes. When a first febrile seizure occurs, call the doctor to be sure what is happening. Children with febrile seizures should use acetaminophen every 4 hours or ibuprofen every 8 hours to prevent further febrile seizures. This should be done whenever there is a question of an illness starting until 7 years of age. Ibuprofen irritates the stomach so it should be avoided if there is vomiting.

In children without febrile seizures or convulsions, fever control may be delayed until the rectal temperature is at 104 degrees (103 degrees oral, 102 degrees armpit) or above in order to benefit from the infection fighting effect of the fever.


Fever page 2
CAUSES OF FEVER

The best way to control a fever is by reducing the infection. If infection is caused by bacteria, an antibiotic such as penicillin or amoxicillin may help. Ear infections, strep throats, pneumonia, and severe skin infections are usually treated by antibacterial medicines. Viruses which cause most colds and most cases of vomiting and diarrhea are not suppressed by antibiotics. If you are unsure of what is causing the fever, especially if the child is less than 12 months old or has a temperature above 104 degrees F or 40 C rectal, you should see a physician in order to check for bacterial causes of fever. If the child is less than 6 months old or has a stiff neck or bleeding under the skin, or straining to breath: a physician should be contacted within the hour.


FEVER CONTROL

The easiest and most comfortable way to control a fever is by setting the body's thermostat back down toward the normal 99.5 degrees F rectal temperature. This is what acetaminophen and aspirin do. Aspirin use for fevers has been found to be associated with Reye's Syndrome, a rare but often fatal disease which occurs after febrile illnesses. Aspirin has long been known to irritate the stomach. Aspirin should be AVOIDED for fever in people less than 21 years old.

Acetaminophen is sold under many name brands: Tylenol and fever reducers. For babies less than 6 mos old: Tylenol or Tempra drops 0.4 mls. or cc's may be given every 4 hours. From 6 mos old to 12 mos old; Tylenol or Tempra drops 1.2 mls may be given every 4 hours. For 12 mos old to 23 mos old; Tylenol or Tempra drops 1.6 mls. every 4 hours. After 2 years old, use dose on bottle. If the baby/child is very congested best to avoid the acetaminophen.  

Ibuprofen or Motrin or Advil should be avoided if the patient has a decreased appetite or vomiting because they irritate the stomach. Otherwise, they need only be used every 8 hours and work well.

By letting the heat leave the child's body and keeping the room moderately cool at 70 degrees F or below, the child's temperature will not rise as fast or as high. Children should only have on diapers or panties. They should not be wrapped up or bundled.

If the acetaminophen or the coolness of the room are not sufficient to keep the temperature less than 106 degrees F (41.8 C.) rectally, then sponging or bathing the child's body with room temperature water should be done. Very cold water or alcohol SHOULD NOT be used since they cool the skin too much and slow the flow of blood to the skin. Alcohol fumes may also be toxic if inhaled.



WHEN YOUR CHILD MUST SEE A DOCTOR

Get immediate medical care when your child has a rapidly life threatening disease.

Breathing problems may get bad quickly especially in children. If an infant is unable to seep or drink and is straining to breath see or call a doctor immediately. If a baby less than 6 months old is choking or gagging or coughing often and unable to sleep or drink call or see a doctor. 

Infections or germs may come on quickly and cause serious damage to children. Young babies have less resistance and must be watched more closely. If a baby less than 2 months old has a fever (temperature over 100.5 F [38 C] rectal or ear, or over 98.5 F [37.1 C] in the armpit) call or see a doctor. If a baby is between 2 and 6 months old call if the temperature is over 103 F (39.4 C) rectal or ear, or over 101 F (38.4 C) in the armpit. Infections deep in the face or skin, bones, joints, or muscles may also cause severe damage and should be checked by a doctor if you suspect them.

Meningitis or an infection around the brain may cause death or severe damage at any age. Sick infants with bulging fontanels or soft spots should be checked by a doctor soon.  

A stiff neck with the baby or child unable to touch her/his neck to her/his chest is a danger signal in a sick child. Call or see a doctor immediately. Babies less than 6 months old may have meningitis even without a stiff neck. Some children may have meningitis even without a fever. Pain in the sides of the neck may be related to sore muscles. Pain in the front of the neck may be do to infected lymph nodes as in tonsillitis. Meningitis pain is usually at the back of the neck with head aches often reported in older children. If your child is sick and unable to touch the chin to the chest call or see a doctor to be sure of the cause and help to protect the brain if needed.

Bleeding under the skin may be a sign of a serious infection or bleeding problem. Either way a doctor should be seen immediately. Bleeding under the skin shows up with purple or red spots which come on without injury in many spots on the body. These spots will fail to go away even briefly when pressed or the skin is stretched. If the spots do fade or blanch then it is not bleeding under the skin but swelling in the capillaries caused by a virus, scarlet fever, hives, or other disease. If the purple/red rash fails to blanch or fade on pressure or you are unsure call or see a doctor immediately. 


When Your Child Must See a Doctor                page 2

Dehydration or persistent vomiting and diarrhea may cause or disability due to very low blood pressure and/or blood sugar. If your baby is less than 6 months old and is unable to keep anything down including Pedialyte or Infalyte or Kaolyte or any other oral electrolyte solutions (OES) for over 4 hours or has severe diarrhea with little wetting of the diapers from urine or pee call or see a doctor. For your child over 6 months old you may watch him/her for 12 hours if he/she is acting well otherwise. If vomiting of even a OES in small amounts of one half ounce continues over 12 hours call or see a doctor. If the child is unarousable or has blood clots in the vomit or in the stools call or see a doctor.  

Constant pain over 4 hours in the abdomen or stomach area may be a sign of a serious infection. Most pain in this area is from spasms or cramps in the intestines. These pains come and go, but constant pains may be from an infection such as appendicitis, or twisted or ruptured bowels or incarcerated or strangulated hernias. All these must be taken care of quickly to avoid death or serious damage. Hernias may also show up as a bulge or swelling in the groin above or in the scrotum. If there is a tender or red swelling in the testes or groin, or constant abdominal pain over 4 hours call or see a doctor.  

Head injuries sometimes may cause bleeding inside the skull with death or brain damage. If your child loses consciousness or is completely knocked out without even eye contact for over 5 seconds after an injury call or see a doctor immediately. Often the child may be sleepy after crying right after the injury. If the child has equal pupils and is able to move both arms and legs you may let the child sleep but then wake the child every 2 hours for 8 hours to be sure that the child still has equal pupils and is able to move both arms and legs. If the child fails to do that call or see a doctor.  


Injuries in children may cause death or significant damage from severe uncontrolled bleeding, breathing problems, or nerve
damage. Severe bleeding may cause very low blood pressure and/or severe anemia causing death or damage to the brain. If bleeding fails to stop after 20 minutes of direct pressure or is severe even while direct pressure is applied immediately see a doctor. If the breathing is strained and damage to the nose, throat, windpipe (trachea) or lungs is suspected then call or see a doctor. When bones are broken nerves may be pinched. Injuries causing severe bone changes with bones sticking out of or near the skin, causing severe pain over 1 hour, or causing weakness or lack of movement for over 1 hour should be examined quickly by a doctor. Call or see a doctor if you are unsure or suspect a serious problem.  

Chest pains in children are rarely life threatening as they often are in adults; however chest pain with: severe breathing problems, large amounts of bleeding, heart defects, fainting, feelings of SEVERE pressure, or pain in the left arm should be brought to the immediate attention of a doctor. 



COLDS AND SORE THROATs

Upper Respiratory Infections (URI's) often cause runny stuffy noses and a mild sore throat. Usually rectal temperatures are less than 101. Often the mucus may be green for up to 1 1/2 weeks with just a virus.

Call the Doctor immediately if the patient strains to breathe and is unable to sleep or drink; has a stiff neck and is unable to touch their chin to their chest due to pain at the back of the neck; has bleeding under the skin with red or purple areas that fail to blanch or whiten up or lose color when the skin is presses or stretched.

Call the Doctor during routine hours if the patient:

  is awake frequently and uncomfortable;
  seems to be in pain frequently;
  has a runny nose over 12 days straight and acts sick;
  has thick eye drainage or eye swelling;
  has much ear drainage;
  has neck pain or swelling (if unable to touch chin to chest call immediately).

If the nose is clogged with thick or dry mucus, you may rinse it out with clean tap water or use salt water nose drops: 1/8 tsp. salt 2 ounces of boiled water cool to body temperature and make fresh daily. If the mucus is thick or dry and nose washing is unsuccessful, you may use a humidifier or vaporizer (keep it away from toddlers) briefly for 2 hours or less. High humidity (>40%) leads to increased dust and mold allergy.

In 2007 cold and cough medications are not recommended for children less than 3 years old. If you must use something you may try Robitussin DM or guaifenesin/dextromethorphan in patients over 6 months old:

  16 lbs to 24 lbs 1/2 tsp.; 25 to 34 lbs 3/4 tsp.;
  35 to 44 lbs. 1 tsp.; 45 to 54 lbs 1 1/4 tsp. every 4 hours.

For severe congestion, try salt water nose drops and elevate the patient's head. If you wish to use a decongestant: pseudoephedrine may be used at these doses
    8 lbs to 14 lbs 0.2 mls or 2 mg.
  15 lbs to 24 lbs 0.4 mls or 4 mg.
  25 lbs to 34 lbs 0.6 mls or 6 mg.
  35 to 44 lbs .8 mls or 8 mg. every 6 hours. 

If this medicine keeps the patient awake or makes the patient hyperactive or fussy, then stop it.
Sore throats causing discomfort over 24 hours or with fever over 101 rectal or with bright red color in the throat should be cultured or seen by the Doctor to check for strep. About 1 in 1000 children who have strep throat untreated within 5 days will go on and get Rheumatic fever in 1 month. Rheumatic fever may cause heart disease and may require bed rest for 1 month.





Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement:Discrimination is Against the Law
Children's Health Specialists (CHS) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Children's Health Specialists (CHS) does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
 CHS (Children's Health Specialists)

 • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
 ○ Qualified sign language interpreters
 ○ Written information in other formats (large print, audio, accessible electronic formats, other formats)
 • Provides free language services to people whose primary language is not English, such as:
 ○ Qualified interpreters
 ○ Information written in other languages

 If you need these services, contact Judy Selover or our Office Manager.
If you believe that CHS has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Office Manager, CHS, 37 W. Garden St. Suite 203, Auburn, NY 13021, 315-253-6257, fax 315 245 8693, chs37@verizon.net . You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Judy Selover or Office Manager, is available to help you.       
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201 
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. 

Individuals With Limited English Proficiency Assistance Services ATTENTION: If you need language assistance services, free of charge, are available to you through our Patient Portal at www.CHealths.com   ​

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística a
www.CHealthS.com   Patient Portal