Anesthesia Associates of
Pain Management Associates
KC Pain Centers
Notice of Privacy Practices
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.
The Effective Date of this Notice is
A federal regulation, known as the “HIPAA Privacy Rule,” requires that we
provide detailed notice in writing of our privacy practices. The HIPAA Privacy
Rule requires us to address many specific things in this Notice.
I. OUR COMMITMENT TO PROTECTING HEALTH INFORMATION ABOUT
YOU
In this Notice, we describe the ways that we may use and disclose health
information about our patients. We will protect the privacy of health
information that identifies you, or where there is a reasonable basis to believe
the information can be used to identify you. This information is called
“protected health information” or “PHI.”
This Notice describes your rights as our patient and our obligations regarding
the use and disclosure of PHI. We are required by law to:
We reserve the right to make changes to this Notice and to make such changes
effective for all PHI we may already have about you. If and when this Notice is
changed, we will post a copy in our office in a prominent location. We will also
post a copy of the current Policy on our web sites at
www.AAKC.com and www.KCPain.com.
We will also provide you with a copy of
the revised Notice upon your request made to our Privacy Official.
II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
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USES AND DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH CARE
OPERATIONS:
The following categories describe the different ways we may use and disclose PHI
for treatment, payment, or health care operations. The examples included in each
category do not list every type of use or disclosure that may fall within that
category.
Treatment:
We may use and disclose PHI about you to provide, coordinate or manage your
health care and related services. We may consult with other health care
providers regarding your treatment and coordinate and manage your health care
with others. For example, we may use and disclose PHI when you need a
prescription, lab work, an X-ray, or other health care services.
In addition, we may use and disclose PHI about you when referring you to another
health care provider. For example, if you are referred to another physician, we
may disclose PHI to your new physician regarding whether you are allergic to any
medications. We may also disclose PHI about you for the treatment activities of
another health care provider. For example, we may send a report about you to a
physician that we refer you to so that the other physician may treat you.
Payment:
We may use and disclose PHI so that we can bill and collect payment for the
treatment and services provided to you. Before providing treatment or services,
we may share details with your health plan concerning the services you are
scheduled to receive. For example, we may ask for payment approval from your
health plan before we provide care or services. We may use and disclose PHI to
find out if your health plan will cover the cost of care and services we
provide. We may use and disclose PHI for billing, claims management, and
collection activities.
Health Care Operations:
We may use and disclose PHI in performing business activities that are called
health care operations. Health care operations include doing things that allow
us to improve the quality of care we provide and to reduce health care costs. We
may use and disclose PHI about you in the following health care operations:
If another health care provider, company, or health plan that is required to
comply with the HIPAA Privacy Rule also has or once had a relationship with you,
we may disclose PHI about you for certain health care operations of that health
care provider or company. For example, such health care operations may include:
reviewing and improving the quality, efficiency, and cost of care provided to
you; reviewing and evaluating the skills, qualifications, and performance of
health care providers; providing training programs for students, trainees,
health care providers, or non-health care professionals; cooperating with
outside organizations that evaluate, certify, or license health care providers
or staff in a particular field or specialty; and assisting with legal compliance
activities of that health care provider or company. We may also disclose PHI for
the health care operations of any “organized health care arrangement” in which
we participate. An example of an organized health care arrangement is the joint
care provided by a hospital and the physicians who see patients at the hospital.
Communication from Our Office:
We may contact you to remind you of appointments and to provide you with
information about treatment alternatives or other health related benefits and
services that may be of interest to you.
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OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN
AUTHORIZATION FOR WHICH YOU HAVE THE
OBJECT:
Individuals Involved in Your Care or Payment for Your Care.
We may use and disclose PHI about you in some situations where you have the
opportunity to agree or object to certain uses and disclosures of PHI about you.
If you do not object, we may make these types of uses and disclosures of PHI.
Ø
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR
We may use and disclose PHI about you in the following circumstances without
your authorization or opportunity to agree or object, provided that we comply
with certain conditions that may apply.
Required by Law.
We may use and disclose PHI as required by federal, state, or local law to the
extent that the use or disclosure complies with the law and is limited to the
requirements of the law.
Public Health Activities.
We may use or disclose PHI to public health authorities or other authorized
persons to carry out certain activities related to public health, including the
following activities:
Abuse, Neglect, or Domestic Violence.
We may disclose PHI in certain cases to proper government authorities if we
reasonably believe that a patient has been a victim of domestic violence, abuse,
or neglect.
Health Oversight Activities.
We may disclose PHI to a health oversight agency for oversight activities
including, for example, audits, investigations, inspections, licensure and
disciplinary activities, and other activities conducted by health oversight
agencies to monitor the health care system, government health care programs, and
compliance with certain laws.
Lawsuits and Other Legal Proceedings.
We may use or disclose PHI when required by a court or administrative tribunal
order. We may also disclose PHI in response to subpoenas, discovery requests, or
other required legal processes, with some limitations.
Law Enforcement.
Under certain conditions, we may disclose PHI to law enforcement officials for
the following purposes where the disclosure is:
Coroners, Medical Examiners, Funeral Directors.
We may disclose PHI to a coroner or medical examiner to identify a deceased
person and determine the cause of death. In addition, we may disclose PHI to
funeral directors, as authorized by law, so that they may carry out their jobs.
Organ and Tissue Donation.
If you are an organ donor, we may use or disclose PHI to organizations that help
procure, locate, and transplant organs in order to facilitate an organ, eye, or
tissue donation and transplantation.
Research.
We may use and disclose PHI about you for research purposes under certain
limited circumstances. We must obtain a written authorization to use and
disclose PHI about you for research purposes, except in situations where a
research project meets specific, detailed criteria established by the HIPAA
Privacy Rule to ensure the privacy of PHI.
To Avert a Serious Threat to Health or Safety.
We may use or disclose PHI about you in limited circumstances when necessary to
prevent a threat to the health or safety of a person or to the public. This
disclosure can only be made to a person who is able to help prevent the threat.
Specialized Government Functions.
Under certain conditions, we may disclose PHI:
Workers’ Compensation.
We may disclose PHI as authorized by workers’ compensation laws or other similar
programs that provide benefits for work-related injuries or illness.
Disclosures Required by HIPAA Privacy Rule.
We are required to disclose PHI to the Secretary of the United States Department
of Health and Human Services when requested by the Secretary to review our
compliance with the HIPAA Privacy Rule. We are also required in certain cases to
disclose PHI to you upon your request to access PHI or for an accounting of
certain disclosures of PHI about you (these requests are described in Section
III of this Notice).
Incidental Disclosures.
We may use or disclose PHI incident to a use or disclosure permitted by the
HIPAA Privacy Rule so long as we have reasonably safeguarded against such
incidental uses and disclosures and have limited them to the minimum necessary
information.
Limited Data Set Disclosures.
We may use or disclose a limited data set (PHI that has certain identifying
information removed) for the purposes of research, public health, or health care
operations. This information may only be disclosed for research, public health,
and health care operations purposes. The person receiving the information must
sign an agreement to protect the information.
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OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
REQUIRE YOUR AUTHORIZATION:
All other uses and disclosures of PHI about you will only be made with your
written authorization. If you have authorized us to use or disclose PHI about
you, you may later revoke your authorization at any time, except to the extent
we have taken action based on the authorization.
III. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Under federal law, you have the following rights regarding PHI about you:
Right to Request Restrictions:
You have the right to request additional restrictions on the PHI that we may use
or disclose for treatment, payment and health care operations. You may also
request additional restrictions on our disclosure of PHI to certain individuals
involved in your care that otherwise are permitted by the Privacy Rule.
We are not required to agree to your request.
If we do agree to your request, we are required to comply with our agreement
except in certain cases, including where the information is needed to treat you
in the case of an emergency.
To request restrictions, you must make your request in writing to our Privacy
Contact Person. In your request, please include:
(1) the information that you want to restrict;
(2) how you want to restrict the information (for example, restricting use to
this office, only restricting disclosure to persons outside this office, or
restricting both); and
(3) to whom you want those restrictions to apply.
Right to Receive Confidential Communications:
You have the right to request that you receive communications regarding PHI in a
certain manner or at a certain location. For example, you may request that we
contact you at home, rather than at work. You must make your request in writing.
You must specify how you would like to be contacted (for example, by regular
mail to your post office box and not your home). We are required to accommodate
only
reasonable
requests.
Right to Inspect and Copy:
You have the right to request the opportunity to inspect and receive a copy of
PHI about you in certain records that we maintain. This includes your medical
and billing records but does not include psychotherapy notes or information
gathered or prepared for a civil, criminal, or administrative proceeding. We may
deny your request to inspect and copy PHI only in limited circumstances. To
inspect and copy PHI, please contact our Privacy Contact Person. If you request
a copy of PHI about you, we may charge you a reasonable fee for the copying,
postage, labor and supplies used in meeting your request.
Right to Amend:
You have the right to request that we amend PHI about you as long as such
information is kept by or for our office. To make this type of request, you must
submit your request in writing to our Privacy Contact Person. You must also give
us a reason for your request. We may deny your request in certain cases,
including if it is not in writing or if you do not give us a reason for the
request.
Right to Receive an Accounting of Disclosures:
You have the right to request an “accounting” of certain disclosures that we
have made of PHI about you. This is a list of disclosures made by us during a
specified period of up to 6 years,
other than
disclosures made: for treatment, payment, and health care operations; to family
members or friends involved in your care; to you directly; pursuant to an
authorization of you or your personal representative; for certain notification
purposes (including national security, intelligence, correctional, and law
enforcement purposes); certain incidental disclosures that occur as a result of
otherwise permitted disclosures as part of a limited data set of information
that does not directly identify you and disclosures made before April 14, 2003.
If you wish to make such a request, please contact our Privacy Contact Person
identified on the last page of this Notice. The first list that you request in a
12-month period will be free, but we may charge you for our reasonable costs of
providing additional lists in the same 12-month period. We will tell you about
these costs, and you may choose to cancel your request at any time before costs
are incurred.
Right to a Paper Copy of this Notice:
You have a right to receive a paper copy of this Notice at any time. You are
entitled to a paper copy of this Notice even if you have previously agreed to
receive this Notice electronically. To obtain a paper copy of this Notice,
please contact our Privacy Contact Person listed at the end of this Notice.
IV. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint
with us or the Secretary of the United States Department of Health and Human
Services. To file a complaint with our office, please contact our Privacy
Contact Person at the address and number listed below. We will not retaliate or
take action against you for filing a complaint.
V. QUESTIONS/CONTACT INFORMATION:
If you have any questions about this Notice, please contact our Privacy Contact
Person at the following address and telephone number:
816/965-8537
This notice was published and first became effective on
APRIL 14, 2003,
and was last revised on OCTOBER 28, 2009.