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Your Medical Records and Privacy
This notice describes how medical
information about you may be used and disclosed and how
you can
get access to
this
information. We ask that you review it carefully.We are
committed to protecting the confidentiality of medical
information
about you. We create a medical record of the care and
services you receive to provide you with quality care
and to comply
with certain legal requirements. This notice is to tell
you about the ways in which we may use and disclose medical
information
about you. We also describe your rights and certain obligations
we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical
information that identifies you is kept private;
- Give you this notice of our legal
duties and privacy practices with respect to medical
information about you, and make a good faith effort to
obtain your
acknowledgement of receipt of this notice; and
- Follow the terms of the notice
that is currently in effect.
If you have any questions about this notice or our
policies please contact:
Sharon White or Debbie Klingler
Lawrence Plastic Surgery
1112 W 6th St Suite 210
Lawrence, Kansas 66044
Phone: 785-843-7677
Fax: 785-843-1637
Toll Free: 866-298-2986
Effective January 2003
Your Rights Regarding
Your Medical Information
Right to inspect and copy:
You have the
right to inspect and copy medical information that may
be used to make
decisions about your care. Usually this includes medical
and billing records notes. Please feel free to ask our staff if you will need
this information. We can typically comply with your wishes for limited portions
of your chart to be copied and given to you right away (i.e. a test report,
x-ray
report, etc.). Requests for more extensive information may take longer to process
and such requests should be submitted in writing to our office staff. We may
charge a fee for the costs of copying, mailing, or other supplies and services
associated with your request.
We may deny your request to inspect and
copy in certain very limited circumstances. If you are
denied access
to medical information you may request that the denial
be reviewed. Another licensed health care professional chosen by this office
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 Amend:
If you believe that medical
information we have about you is incorrect or incomplete
you may ask us
to amend the information. You
have the
right to request an amendment at any time. We ask that requests to amend
medical information be in writing and that you provide a reason that
supports your
request.
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
medical information kept by or for this medical office;
or
- Is accurate and complete.
Right to Request Restrictions:
You have
the right to request a restriction or limitation on the
medical
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 medical 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. 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
with emergency care.
Please note the following:
- Many patients are cared for by a spouse,
relative, or friend at home immediately following an
operation or procedure. In fact,
we insist on this after procedures involving a general anesthetic. In
order to assist
these
caregivers
and insure your safety postoperatively it will be
necessary to communicate with them information involving
the procedures you have had
performed. We will
not
discuss your information with others not directly
involved with
your care unless we have your permission to do so.
- You have the right
to request that medical information be communicated
to you in a certain way
or a certain location. For example,
you may ask that we only contact you at work or by mail. Please let
us know how you
would
prefer
to be contacted if we need to reach you regarding
lab results, scheduling, appointment changes, or for
other
medical matters.
- We will not give out medical information
about you to others, whether by phone, in person,
or in writing, unless we have your
permission to do so except as described in the following section.
How We May Use and Disclose Medical Information
About You
The following categories describe different
ways that we
are permitted to use and disclose medical information
without a specific authorization from you.
For Treatment:
We may use medical information
about you to provide you with medical treatment services.
We
may
disclose medical information about you to other medical
personnel who are involved in taking care of you.
For example, we will need to provide medical information
when ordering
x-rays, mammograms, or lab work.
We also may disclose
medical information about you to people outside the
office who may be involved
in your
care after you leave the office such as family
members, friends, or other medical providers we use to
provide services that are
part of your care.
For Payment:
We may use and disclose
medical information about you so that the treatment and
services you
receive may be billed to and payment may
be collected
from you, an insurance company, or a third party. For example, we may
need to give your health insurance company medical
information about you to
support our
claim for reimbursement. We may also tell your health plan about treatment
you are going to receive to obtain prior authorization for your procedure.
We may
also provide information about you to other health care providers to
assist them in obtaining payment for treatment
and services provided to you.
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
your medical
information that was sent to requesting entity. Information on this
prior to 2003 may be
incomplete, as this represents a new change in our policies.
Appointment
Reminders:
We may use and disclose medical information
to contact you as a reminder that you have an appointment
for treatment
or medical
care at this office.
Research. Under certain circumstances, we may use and disclose
medical information about you for research purposes. For example,
a research
project may involve
comparing the health and recovery of all patients who received
one treatment to those who received another for the same condition.
All
research projects,
however, are subject to a special approval process. Your name,
address and other information that would reveal who you are will
only be
given with your
authorization.
As Required By Law:
We will disclose
medical information about you when required to do so
by federal, state or local law.
To Avert A Serious Threat to
Health or Safety:.
We may use and disclose medical information
about you when necessary to prevent
a serious
threat to your
health and safety or the health and safety of the public or
another person. Any disclosure,
however, would only be to someone able to help prevent the
threat.
Organ and Tissue Donation:
If you are
an organ donor, we may use or disclose medical information
to organizations
that handle
organ
procurement
or
organ tissue transplantation as necessary to facilitate organ
or tissue donations.
Military and Veterans:
If you are a member
of the armed forces, we may release medical information
about you as required
by the military
command
authorities.
Employers:
We may disclose medical information
about you to your employer if we provide healthcare for
work related
illness
or
evaluations at
the request of your employer.
Worker’s
Compensation:
We may release medical information about you for workers’ compensation
or similar programs. These programs provide benefits
for work related injuries or illness.
Public Health
Requirements:
We may disclose medical information
about you for public health activities.
These activities
generally include
the following:
control of disease, births and deaths, child abuse,
reactions to medications, to notify
patients of product recalls, to notify persons who
may have been exposed to
disease or to notify appropriate government authority
if there is belief that the patient
has been a victim of neglect, abuse or domestic violence.
We will only make this disclosure if required by
law.
Health Oversight Activities:
We may disclose
medical information to a health oversight agency for activities
required by
law. Examples include
audits,
credentialing, medical review, investigations,
inspections
or licensure. These activities
are necessary for the government and other entities
to monitor health care systems.
Lawsuits and Disputes:
If you are involved in a lawsuit or a dispute we may
disclose medical information
in response to a
court order.
Examples might include a subpoena, warrant, summons,
or other
lawful process
by someone else involved in the dispute.
We may use information in emergency circumstances
to report a crime, the
location of the crime, or the identity, description
or location of the person who committed
the crime.
Inmates:
If you are an inmate of a
correctional institution or under the custody of
a law enforcement
official
we may release medical
information about you
to the correctional institution or law enforcement
official. This release would be necessary for
the institution to
provide you with
health care,
to protect
your health and safety, and for the safety
and security of the
correctional institution.
Other Uses of Medical
Information:
Other uses and disclosures of medical
information not
covered by this notice or
the laws that
apply to us
will be made only with
your written authorization. If you provide
us authorization
to use or disclose medical information about
you, you may revoke that authorization,
in writing,
at any time. If you revoke your authorization
we will no longer use or
disclose
medical information about you for the reasons
covered by your written authorization. Of
course, we are
unable to
take back
any disclosures
we have already made
with your permission and we are required
to retain our records of the care that we
provided to you.
Changes To This Notice:
We
reserve the right to make revisions or changes in
these policies
effective
for medical information
we already
have
about you
as well as any information we receive in
the future. You may ask for a copy of the
current notice in effect at any time.
Acknowledgement:
You will be asked to
provide a written acknowledgement of your receipt
of this
notice of
our privacy practices.
We are required by
law to provide
you with this notice and obtain acknowledgement
from you. However, your receipt of care
and treatment from this office
is not
conditioned upon
your providing
the written acknowledgement.
Right to
a Paper Copy of this Notice:
You have the right to
a paper copy of
this
notice. To
obtain a
paper copy
please ask
our staff
and one will
be provided
to you.
Complaints
If you believe your rights
with respect to medical information about you have been
violated you can file a complaint
in writing to Debbie Klingler, Patient Billing Coordinator.
You will not be penalized for filing a complaint.
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