Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES

Post Rock Family Medicine
Effective Date of this Notice: 4/14/2003

(Post Rock Family Medicine is an Organized Health Care Arrangement permitted to represent itself as such under the federal Health Insurance Portability and Accountability Act of 1996 [HIPAA] and is comprised of Daniel J. Sanchez, M.D., P.A.; Prairie Star Family Practice, P.A.; LifeLine Family Medicine, P.A.; Solomon Valley Family Medicine, P.A.; RCHC Clinic; and Doctors Without Delay.   This OHCA relates to clinic locations at 1210 N. Washington, Plainville, KS  67663; 107 S. Spruce, Stockton, KS  67669; and 505 Main, Palco, KS  67657.  These named corporations are not to be construed as one for any other purpose other than for HIPAA Privacy Rules.)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS THIS. PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide to you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.  By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following information:

  • How we may use and disclose your PHI
  • Your privacy rights in your PHI
  • Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B.   IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:   Privacy Officer, 1210 N. Washington, Plainville, KS  67663   or call  (785) 434-2622


C.  WE MAY USE & DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS:

1. TREATMENT.  Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – such as, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment.  Additionally we may disclose your PHI to other who may assist in your care; such as your spouse, children, or parents.  Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2. PAYMENT. Our practice may use or disclose your PHI in order to bill or collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provider your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.

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.  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.  Our practice may use and disclose your PHI to contact you and reminder you of an appointment.

5. TREATMENT OPTIONS.  Our practice may use and disclose your PHI to inform you of potential treatment options and alternatives.

6.  HEALTH-RELATED BENEFITS & SERVICES.  Our practice may use and disclose your PHI to inform you of health-related benefits and services that may be of interest to you.

7.  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.

8.  AS REQUIRED BY LAW.  We will disclose health information about you when required to do so by federal, state, or local law. This may include reporting of communicable diseases, wounds, abuse, disease/trauma registries, health oversight matters or other public policy requirements. We may be required to report this information without your permission.

9. 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.

10. 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.

11. 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.

D.  USE & DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES:  The following categories describe unique situations in which we may use or disclose your PHI without your permission.

1.  PUBLIC HEALTH RISKS, ABUSE, NEGLECT, OR DOMESTIC VIOLENCE.  Our practice may disclose your PHI to public health or government authorities that are authorized by law to collect or receive information for the purpose of:maintaining vital records, such as births and deaths

  • notifying a person regarding potential exposure to a communicable disease
  • notifying individuals if a product/device they may be using has been recalled
  • notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
  • notifying appropriate government authorities regarding the abuse, neglect, or domestic violence of a patient; however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
  • reporting child abuse or neglect
  • preventing or controlling disease, injury, or disability
  • notifying a person regarding potential risk for spreading or contracting disease/condition
  • reporting reactions to drugs or problems with products/devices.

2.  HEALTH OVERSIGHT ACTIVITIES.  Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, (censure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the healthcare system in general.

3.  LAWSUITS AND SIMILAR PROCEEDINGS.  Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party (someone other than yourself) involved in dispute, but only if we have made an effort to inform you of the request or to have obtained satisfactory assurances to include an order protecting the information the party has requested.

4. LAW ENFORCEMENT.  We may release PHI if asked to do so by a law enforcement official:  Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement; concerning a death we believe has resulted from criminal conduct; regarding criminal conduct at our offices; in response to a warrant, summons, court order, subpoena, or similar legal process; to identify/locate a suspect, material witness, fugitive or missing person; in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

5.  CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS:  We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release health information about patients of the hospital to funeral directors as necessary under the law to carry out their duties.

6.  ORGANS AND TISSUE DONATION.  Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to help with the organ or tissue donation and transplantation if you are an organ donor.

7.  SERIOUS THREATS TO HEALTH OR SAFETY.  Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

8.  MILITARY.  Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

9.  NATIONAL SECURITY.  Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law.  We may also disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

10. INMATES.  Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary:   (a) for the institution to provide healthcare services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

11. WORKERS’ COMPENSATION.  Our practice may release your PHI for workers’ compensation and similar programs as permitted by law.

E.  YOUR RIGHTS REGARDING YOUR PHI.  You have the following rights regarding the PHI that we maintain about you:

1.  CONFIDENTIAL COMMUNICATIONS.  You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to the Privacy Officer at 1210 N. Washington, Plainville, KS  67663 specifying the requested method of contact, or the location where you wish to be contacted.  Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2.  REQUESTING RESTRICTIONS.  You have the right to request a restriction in our use or disclose of your PHI for treatment, payment, or other health care operations.  Additionally, you have the right to request; that we restrict our disclosure of PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound by  our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Privacy Office at 1210 N. Washington, Plainville, KS  67663. Your request must describe in clear and concise fashion:  (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure, or both; and (c) to whom you want the limits to apply.  If we agree to a restriction we may end any restriction if you agree to end it or if we inform you that we are going to end our agreement to the restriction.  You may also end any restriction.

3.  INSPECTION AND COPIES.  You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to Privacy Officer at 1210 N. Washington, Plainville, KS  67663, in order to inspect and/or obtain a copy of your PHI.  Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.  Another licensed health care professional chosen by us will conduct reviews.

4.  AMENDMENT.  You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Office at 1210 N. Washington, Plainville, KS  67663. You must provide us with a reason that supports your request for amendment.  Our practice will deny your request if you fail to submit your request (and the reason for supporting your request) in writing.  Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for our practice; (c) not part of the PHI which you would be permitted to inspect or copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5.  ACCOUNTING OF DISCLOSURES.  All of our patients have the right to request an “accounting of disclosures”.  An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment, non-payment, or non-operations purposes.  Use of your PHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing to Privacy Office at 1210 N. Washington, Plainville, KS  67663.  All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of the disclosure and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period.  Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6.  RIGHT TO A PAPER OR ELECTRONIC COPY OF THIS NOTICE.  You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, contact the Privacy Officer at 1210 N. Washington, Plainville, KS  67663 or (785) 434-2622.  These privacy practices are also available electronically on our website: www.postrock.us

7.  RIGHT TO FILE A COMPLAINT.  Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer at 1210 N. Washington, Plainville, KS  67663.  If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint by paper mail, fax, or email.  Information on how to file a complaint can be found at http://www.hhs.gov/ocr/privacy/hipaa/complaints/  You will not be penalized in any way for filing a complaint.

8.  ELECTRONIC HEALTH INFORMATION EXCHANGE.  Post Rock Family Medicine participates in electronic health information exchange, or HIT.   This technology allows a provider or a health plan to make a single request through a health information organization or HIO to obtain electronic records for a specific patient from other HIT participants for purposes of treatment, payment, or health care operations. HIOs are required to use appropriate safeguards to prevent unauthorized uses and disclosures.

You have two options with respect to HIT.  First, you may permit authorized individuals to access your electronic health information through an HIO.  If you choose this option, you do not have to do anything. Second, you may restrict access to all of your information through an HIO (except as required by law).  If you wish to restrict access, you must submit the required information either online at http://www.KanHIT.org or by completing and mailing a form.  This form is available at http://www.KanHIT.org.  You cannot restrict access to certain information only; your choice is to permit or restrict access to all of your information.

If you have questions regarding HIT or HIOs, please visit http://www.KanHIT.org for additional information.  If you receive health care services in a state other than Kansas, different rules may apply regarding restrictions on access to your electronic health information. Please communicate directly with your out-of-state health care provider regarding those rules.

9.  BREACH NOTIFICATION.  In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have registered with a Patient Portal account, we may use that 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 (specifically via registered mail).

10.  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 on the day of your visit, 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.

OTHER USES AND DISCLOSURES – REVOKING PREVIOUS PERMISSION TO USE OR DISCLOSE YOUR HEALTH INFORMATION:   Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.  For certain disclosures of your information you must complete an “authorization” form and submit it to us.  If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.  To revoke any permission already given to us or permission given to us in the future you must revoke that permission in writing by sending it to the Contact Person.  If you revoke your permission, we will no longer use of disclose health information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

IF CHANGES ARE MADE TO THIS NOTICE:  We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for the health information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice in the clinic.  You will find the date the notice became effective at the top of the page below the title.  In addition, each time you register at the clinic for treatment or healthcare services, a copy of the current notice in effect will be given to you if you request it.

Again, if you have any questions regarding this notice or our Health Information Privacy Policies, please contact our Privacy Officer at 1210 N. Washington, Plainville, KS  67663 or (785) 434-2622.  Policies are also available on our website: www.postrock.us