Medical Staff Approval Date:
is committed to providing high-quality healthcare to its patients (the term “patients” includes patients’ legal guardians). The purpose for the use of clinical photography is primarily limited to diagnosis, treatment and professional education. This policy establishes guidelines for managing multimedia imaging of patients. For the purpose of this policy, “clinical photography” includes, but is not limited to, photography, videotaping, audiotaping and any digital recordings of any kind on any device while at any facility under the control of MacKoul Pediatrics
and/or the provision of any medical services by any of MacKoul Pediatrics
personal (employed or under its direction).
Clinical photography of patients may be appropriate for the diagnosis and treatment of medical conditions as well as professional education. Clinical photography can be accomplished through a variety of multimedia technology to collect, analyze, and store patient protected health information. Use of these medias will be carefully controlled and executed in compliance with all state and federal regulations as well as other organizational policies and procedures as they currently exist or may be modified from time to time.
Any disclosure of clinical photography is considered the release of protected health information and must follow all applicable organizational policies and such federal, state and local laws/regulations that may govern such disclosure.
Clinical photography is considered a routine practice of the care and treatment of patients at MacKoul Pediatrics
discretion and is covered within the general admission consent to treat. While not required, MacKoul Pediatrics
will so inform the patient of its use of Clinical photography and gain the permission of the patient prior to its use if such use falls outside its routine parameters and further outlined below.
While it is impossible for MacKoul Pediatrics
to control the number of cell phones that may enter their office by patients and families, the use of cell phones (or other such devises and/or equipment) as an imaging device must follow the guidelines as outlined in this policy. As such, permitted clinical photography, as defined herein, does NOT include independent patient videos or pictures (e.g., filming of a delivery) taken by the patient or person under their control or such other third-party person/entities on any devise and not under the direct control of MacKoul Pediatric
s. Such clinical photography is NOT allowed without the express written permission of MacKoul Pediatrics
. Further, if permitted by MacKoul Pediatrics
, MacKoul Pediatrics
may withdraw its permission at any time it is felt by MacKoul Pediatrics
that such clinical photography is not in the best interest of the patient or organization, at which time such clinical photography must cease. Permission granted herein does not include permission to share such clinical photography with such persons/entities outside the patient’s own family without additional permission from MacKoul Pediatrics
. Failure to comply with these provisions may result in the termination of the patient care relationship or other relationship with the organization.
Use of clinical photography conducted by MacKoul Pediatrics
shall be limited to use within its practice only and can only be used or shared with those outside its practice solely for the direct diagnostic and treatment purposes of the patient (i.e. use with other consulting physicians/practices, clinics, hospitals, therapists, etc.), payment and operations.
Any other use by MacKoul Pediatric
s of such clinical photography (i.e. for public dissemination, law enforcement, social services, medical publications, promotion, artwork, advertising and/or public relations, etc.) is strictly prohibited unless informed written consent by the patient is provided in advance. However, clinical photography shall be disclosed as required by law, such as when mandatory reporting is required (i.e. abuse or neglect) or when subpoenaed or order by a court of law, etc.
It is further understood that clinical photography may be utilized in the following events, which includes, but is not limited to: a) Pictures illustrating abuse, neglect, assaults, or accidents; b) Pictures of pediatric patients taken for the purpose of identification.
Additionally, clinical photography is not allowed by clinical care providers on their individually owned cameras and/or devises of any kinds unless under the direct of MacKoul Pediatrics
and NEVER for their personal use.
The use of clinical photography is considered routine to patient care and is covered under the general admission consent to treat form. Such further consents, as contemplated hereinabove, may be requested from time to time and will be so documented on a separate form.
The patient or responsible party has the right to refuse the use of clinical photography at any time and can further withdraw any consents granted for its use at any time and if done, shall be required to be in writing. Such withdrawal may be done by contacting the compliance officer of MacKoul Pediatrics
at any reasonable time. That person is: _______________________________________.
Clinical photographs are considered a part of the legal health record and can be released as such according to state and federal regulations.
Clinical photographs must be identified as a separate page/section of the patient’s health record with the appropriate patient-identifiable information including patient name, medical record number, account number, date of admission, and attending physician. Images that are sensitive in nature may be stored in a further safeguarded manner as determined by MacKoul Pediatrics
The use of cell phones in certain areas of the hospital may have the ability to affect equipment. For that purpose, cell phones are not allowed in certain areas of MacKoul Pediatric
s office or clinic. These areas are clearly marked and identified via signage.
Failure to follow the clinical photography policy may result in the corrective disciplinary process up to and including termination of either employee or patient. MacKoul Pediatrics
reserves the right to modify, amend, cancel or otherwise change this policy at any time.
The above policy has been explained to and received by the undersigned patient and/or the patient’s legal representative, who agrees to adhere to same:Patient or Patient Representative:
Printed name: ________________________________
Date: ___________________Witnessed by representative of MacKoul Pediatrics:
Printed name: _________________________________