Text Box: Kansas Orthopaedic Center, P.A. (KOC) NOTICE OF PRIVACY PRACTICES (NPP) Effective Date: April 7, 2003 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. OUR PLEDGE REGARDING YOUR HEALTH INFORMATION Each time you visit a healthcare facility, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for your past, present or future care or treatment, and billing-related information. Such records are necessary for the healthcare provider to provide you with quality care and to comply with certain legal requirements. We are committed to protecting the confidentiality of our records containing information about you. This notice applies to all records of your care created or received by KOC. Other healthcare providers from whom you obtain care and treatment may have different policies or notices regarding the use and disclosure of your health information created or received by that provider. Also, health plans in which you participate may have different policies or notices concerning information they receive about you. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to maintain the privacy of your health information; to give you this notice of our legal duties and privacy practices and make a good faith effort to obtain your acknowledgement of receipt of this notice; and to follow the terms of the notice that is currently in effect. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION Right To Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy your health information, you must complete an Authorization for Disclosure of Protected Health Information (PHI) form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Medical Information Services Coordinator at 838-2020 ext. 215. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request. We may require you pay such fee prior to receiving the requested copies. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by KOC will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Right to Request Amendment. If you believe our records contain information about you to be incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for KOC.

How We Safeguard Your Privacy

 
Text Box: To request an amendment, you must complete a Request for Amendment of PHI form providing information we need to process your request, including the reason that supports your request. To obtain this form or to obtain more information concerning this process, please contact the Medical Information Services Coordinator at 838-2020 ext. 215. We may deny your request for an amendment if you fail to complete the required form in its entirety. In addition, we may deny your request if you ask us to amend information that: • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; • Is not part of the health information kept by or for KOC; • Is not part of the information that you would be permitted to inspect and copy; or • Is accurate and complete. If your request is denied, you wlll be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of health information about you, with certain exceptions specifically defined by law. To request this list or accounting of disclosures, you must complete a Request for Accounting of Disclosures of PHI form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Medical Information Services Coordinator at 838-2020 ext. 215. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must complete a Request for Restrictions on Certain Uses and Disclosures of PHI form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Medical Information Services Coordinator at 838-2020 ext. 215. Right to Request Alternative Methods of Communications. You have the right to request we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request an alternative method of communications, you must complete a Request for Alternative Means of Communicating PHI form providing information we need to process your request. Text Box: To obtain this form or to obtain more information concerning this process, please contact the Patient Accounts and Reception Supervisor at 838-2020 ext. 210. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.koc-pa.com. To obtain a paper copy of this notice, contact the Patient Services Coordinator at 838-2020 ext. 221. COMPLAINTS If you believe your rights with respect to health information about you have been violated by KOC, you may file a complaint with KOC or with the Secretary of the Department of Health and Human Services. To file a complaint with KOC, contact the Administrator at 838-2020 ext. 250. All complaints must be submitted in writing. You will not be penalized for filing a complaint. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU WITHOUT YOUR SPECIFIC AUTHORIZATION The following categories describe different ways we are permitted to use and disclose health information without a specific authorization from you. If you desire to restrict our use of your health information for any of these purposes, you need to submit a request for restrictions in the manner described above. For Treatment. We may use information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at KOC. For example, a physician treating you for a wound infection may need to know you have a compromised immune system which may make treating your infection more difficult and result in delayed healing. Your physician may need to inform a specialist concerning your compromised immune system to better treat your condition. Different departments of KOC also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose health information about you to people outside KOC who may be involved in your medical care after you leave KOC, such as family members, friends, or others we use to provide services that are part of your care. We will give you an opportunity, however, to restrict such communications. We may disclose health information about you to other health care providers who request such information for purposes of providing medical treatment to you. For Payment. We may use and disclose health information about you so the treatment and services you receive at KOC may be billed to and payment may be collected from you, an insurance company, or other third party. For example, we may need to give your health plan information about surgery you received so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.