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.
If you have any questions about this Notice please contact the Privacy Officer.
Effective Date: August 2010 Revised:
September 18th, 2013
We are committed to protect the privacy of your
personal health information (PHI).
This Notice of Privacy Practices (Notice) describes how we may use within our
practice or network and disclose (share outside of our practice or network) your PHI to carry out treatment, payment or health
care operations. We may also share your information for other purposes that are permitted or required by law.
This Notice also describes your rights to access and control your PHI.
We are required by law to maintain the privacy of your PHI. We will follow the terms outlined
in this Notice.
We may change our Notice, at any time. Any changes will apply to all PHI. Upon your request, we
will provide you with any revised Notice by:
- Posting the new Notice in our office.
- If requested, making copies of the new Notice available in our office or by mail.
Posting the revised Notice on our website www.plazapcg.com
Uses and Disclosures
of Protected Health Information
We may use or disclose (share) your PHI to provide health care treatment for
Your PHI may be used and disclosed by your physician, our office staff and others
outside of our office that are involved in your care and treatment
for the purpose of providing health care services to you.
Your PHI may be provided to a physician to whom you have been referred for evaluation to ensure that the physician has the
necessary information to diagnose or treat you. We may also share your PHI from time-to-time to another physician or health
care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
We may also share your PHI with people outside of our practice that may provide medical care for
you such as home health agencies.
We may use
and disclose your PHI to obtain payment for services. We may provide your PHI to others in order to bill or collect payment
for services. There may be services for which we share information with your health plan to determine if the service will
be paid for.
PHI may be shared with the following:
- Billing companies
- Insurance companies, health plans
Government agencies in order to assist with qualification of benefits
EXAMPLE: You are seen at our practice for a procedure.
We will need to provide a listing of services such as x-rays to
your insurance company so that we can get paid for the procedure. We may at times contact your health care plan to receive
approval PRIOR to performing certain procedures to ensure the services
will be paid for. This will require sharing of your PHI.
We may use or disclose, as-needed, your PHI in order to support the business activities of this practice which are
called health care operations.
- Training students, other health care providers, or ancillary
staff such as billing personnel to help them learn or improve their skills.
- Quality improvement processes which look at delivery of health care and for improvement in processes which will provide
safer, more effective care for you.
- Use of information
to assist in resolving problems or complaints within the practice.
We may use and disclosure your PHI in other situations without your permission:
- If required by law: The use or disclosure will be made in compliance with the law and will be limited to the relevant
requirements of the law. For example, we may be required to report gunshot wounds or suspected abuse or neglect.
Public health activities: The disclosure will be made for the purpose of controlling disease, injury or disability and only to public health
authorities permitted by law to collect or receive information. We may also notify individuals who may have been exposed to
a disease or may be at risk of contracting or spreading a disease or condition.
- Health oversight agencies: We may
disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations,
and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system,
government benefit programs, other government regulatory programs and civil rights laws.
- Legal proceedings: To assist in
any legal proceeding or in response to a court order, in certain conditions in response to a subpoena, or other lawful process.
Police or other law enforcement purposes: The release of PHI will meet all applicable legal requirements for release.
Coroners, funeral directors: We may disclose protected health information to a coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical examiner to perform other duties authorized by law
Medical research: We may disclose your protected health 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 protected health
- Special government purposes: Information may be shared for national security purposes, or if you are a member
of the military, to the military under limited circumstances.
institutions: Information may be shared if you are an inmate
or under custody of law which is necessary for your health or the health and safety of other individuals.
Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’
compensation laws and other similar legally-established programs.
Other uses and
disclosures of your health information.
Business Associates: Some services are provided through the use of contracted entities called “business associates”. We will always release only the minimum amount of PHI necessary so that the business
associate can perform the identified services. We require the business associate(s) to appropriately safeguard your information. Examples of business associates include billing companies
or transcription services.
Health Information Exchange: We may make your health information available electronically to other healthcare
providers outside of our facility who are involved in your care.
Appointment reminders: We may contact you
as a reminder about upcoming appointments or treatment.
We may use or disclose your PHI in the following
situations UNLESS you object.
- We may share
your information with friends or family members, or other persons directly identified by you at the level they are involved
in your care or payment of services. If you are not present or able to agree/object, the healthcare provider using professional
judgment will determine if it is in your best interest to share the information. For example, we may discuss post procedure
instructions with the person who drove you to the facility unless you tell us specifically not to share the information.
- We may use or disclose protected health information to notify or assist in notifying
a family member, personal representative or any other person that is responsible for your care of your location, general condition
- We may use or disclose your protected health
information to an authorized public or private entity to assist in disaster relief efforts.
All other uses and disclosures not recorded in this Notice will require a written authorization
from you or your personal representative.
Written authorization simply explains how you want your information used and disclosed. Your written
authorization may be revoked at any time, in writing. Except to the extent that your doctor or this practice has used or released information based on the direction provided in the authorization, no further
use or disclosure will occur.
Your Privacy Rights
You have certain rights
related to your protected health information. All requests to exercise your rights must be made in writing. Send a letter stating the information you would like to obtain to: The
Privacy Officer: 4440 Broadway, Kansas City, MO 64111.
You have the right to see and obtain a copy of your protected health information.
Additional Privacy Rights
- You have the right to obtain a paper copy of this notice from us, upon request. We will provide you a copy of this Notice the first day we treat you at our facility. In an emergency
situation we will give you this Notice as soon as possible.
have a right to receive notification of any breach of your protected health information.
you think we have violated your rights or you have a complaint about our privacy practices you can contact:
Privacy Officer; 4440 Broadway, Kansas City, MO 64111 Phn
You may also complain
to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us.
If you file a complaint we will not retaliate against you for filing a complaint.
This notice was published and becomes effective on September 19, 2013