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THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. IF YOU HAVE A MEDICAL EMERGENCY, PLEASE CALL 9-1-1. MIDWEST NEPHROLOGY CONSULTANTS, P.A. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully! This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” is information we create and obtain in providing our services to you. Such information may include documenting your symptoms, test results, treatment, diagnoses, and future care or treatment. We are required to abide by the terms of this Notice of Privacy Practices. If for any reason we revise our notice, we will provide you with a copy of such notice. We will not use or disclose your health information without your authorization, except in the following situations: 1. Treatment: We will use and disclose your health information while providing, coordinating or managing your health care. For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will put in your record his or her expectations of the members of your health-care team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We may also provide other healthcare providers with your information to assist him or her in treating you. 2. Payment: We will use and disclose your medical information to obtain or provide compensation or reimbursement for providing your health care. For example, we may send a bill to you or your health plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. As another example, we may disclose information about you to your health plan so that the health plan may determine your eligibility for payment for certain benefits. 3. Health Care Operations: We will use and disclose your health information to deal with certain administrative aspects of your health care, and to manage our business more efficiently. For example, members of our medical staff may use information in your health record to assess the quality of care and outcomes in your case and others like it. This information will then be used in an effort to improve the quality and effectiveness of the health-care and services we provide. 4. Business Associates: There are some services provided in our organization through contracts with business associates. We may disclose your health information to our business associate so they can perform the job we’ve asked them to do. However, we require the business associate to take precautions to protect your health information. 5. Communication With Family: We may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care. We will have your prior authorization to leave a detailed telephone message. Detailed telephone message may include information regarding appointments, lab results, medication changes, test results, physician responses/comments regarding your treatment plan. 6. Research: Consistent with applicable law we may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. Other Disclosures and Uses We may use or disclose your protected health information in the following situations without your consent: • Workers’ Compensation – We may disclose your health information in order to comply with workers’ compensation laws. • Law Enforcement – We may disclose your health information for law enforcement purposes. • Coroners, Funeral Directors – We may disclose your health information to a coroner or medical examiner for identification purposes. • Abuse and Neglect – We may disclose your health information to authorities as allowed by law to report abuse or neglect. • Legal Proceedings – We may disclose your health information in the course of any judicial proceedings as allowed by law. • Food and Drug Administration – We may disclose your health information relating to adverse events with regards to food, products and recalls. • Public Health – As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse and neglect. • Organ Procurement Organizations – Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant. • Inmates – If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. • Specialized Government Functions – Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits. • Other uses and disclosures besides those identified in this notice will be made only as otherwise authorized by law or with your written authorization. Prohibition on Other Uses or Disclosures We may not make any other use or disclosure of your personal health information without your written authorization. Once given, you may revoke the authorization by writing to the attention of the Privacy Officer of Midwest Nephrology Consultants (details to follow at the end of this notice). Understandably, we are unable to take back any disclosure we have already made with your permission. INDIVIDUAL RIGHTS You have many rights concerning the confidentiality of your health information. You have the right: • To request restrictions on the health information we may use and disclose for treatment, payment and health care operations. We are not required to agree to these requests. To request restrictions, please send a written request to the address below. • In order to receive confidential communications of health information about you in any manner other than described in the authorization request form, you must make that request in writing to the address below. However, MNC will reserve the right to determine if we will be able to continue your treatment under such restrictive authorizations. • To inspect or copy your health information. You must submit your request in writing to the address below. If you request a copy of your health information we may charge you a fee for the cost of copying, mailing or other supplies. In certain circumstances we may deny your request to inspect or copy your health information. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional will then 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. MNC has 30 to 60 days to comply with any request for health information. • To amend health information. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must write to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your health information if it is not in writing or does not provide a reason to support your request. We may also deny your request if: o The information was not created by us, unless the person that created the information is no longer available to make the amendment, • To receive an accounting of disclosures of your health information. You must submit a request in writing to the address below. Not all health information is subject to this request. Your request must state a time period, no longer than 6 years and may not include dates before April 14, 2003. Your request must state how you would like to receive the report (paper, electronically). The first accounting you request within a 12 month period is free. For additional accountings, we may charge you the cost of providing the accounting. We will notify you of this cost and you may choose to withdraw or modify your request before charges are incurred. All requests to restrict the use of your health information for treatment, payment and health care operations, to inspect and copy health information, to amend your health information, or to receive an accounting of disclosures of health information must be made in writing to the contact person listed below. Complaints: If you believe that your privacy rights have been violated, a complaint may be made to our privacy officer at 816-276-1700 or the address listed below. You may also submit a complaint to the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint. Contact Person: Our contact person for all questions, requests or for further information related to the privacy of your health information is: Midwest Nephrology Consultants Changes to This Notice: We reserve the right to change our privacy practices and to apply the revised practices to health information about you that we already have. Any revision to our privacy practices will be described in a revised Notice that will be posted prominently in our facility. Notice Effective Date: April 14, 2003 Consult a doctor or physician before you altering, starting or stopping any medications. This site not provide medical advice, diagnosis or treatment! Never disregard, avoid or delay obtaining assistance from your doctor or other qualified health care provider because of something you have read on this website! If you may be experiencing an emergency in your family, please do not take the time to examine this website; call 911 right away! Termination: We may cancel or terminate your right to use this website or any part of the site at any time without notice. In the event of cancellation or termination, you are no longer authorized to access the part of the site affected by such cancellation or termination. The restrictions imposed on you with respect to material downloaded from the Site, and the disclaimers and limitations of liabilities set forth in these Terms of Service, shall survive.
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