PRIVACY

This notice is intended to inform you about how we protect the privacy of our patients’ medical records. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this information related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect.

This notice will explain how we may use and disclose your medical information, our obligations related to the use and disclosure of your medical information and your rights related to any medical information that we have about you. If our patient is a minor child, references to “you” or “your” medical information in this notice means the child’s records. You are asked to sign an Acknowledgement of receipt of this Notice of Privacy Practices in your capacity as a parent or legal representative of the child. We are permitted to provide a minor’s Protected Health Information to either parent of the child, unless we are provided documents showing that only one parent has rights to such information. Further we may provide Protected Health Information to a legal representative (e.g., Durable Power of Attorney for Health Care or Guardian) of a child. This notice applies to the medical records that are generated in or by this practice.

With a few exceptions, we are required to obtain your authorization for the use or disclosure of information for reasons other than for treatment, payment or health care operations. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses or disclosures below. Not every use or disclosure is covered, but all of the ways that we are allowed to use and disclose information will fall into one of the categories.

If you have any questions about the content of this Notice of Privacy Practices, or if you need to contact someone at Panda Pediatrics about any of the information contained in this Notice of Privacy Practices, the contact person is:

Lucas D. Houk, Practice Administrator

1803 W. 6th St, Lawrence, KS 66044

785-842-4477

In addition to Panda Pediatrics employees, staff and other personnel, any health care professional who is authorized to enter information in your medical record must follow the practices set forth in this Notice.

March 21, 2016

Use and Disclosure of Medical Information for Treatment, Payment or Health Care Operations:

We can use or disclose medical information about you regarding your treatment, payment for services or for certain practice operations.

For Treatment: To provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, students or other Panda Pediatrics personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Other doctors may share this medical information about you to coordinate your care. For instance, the laboratory may request information to complete lab work. We may also disclose medical information about you to people who may be involved in your medical care after you leave the practice, such as home health agencies, your family and clergy members. We may also disclose information to other covered entities that are not affiliated with the practice for your treatment (e.g. pharmacists, emergency medical providers, and unaffiliated physicians).

For Payment: We may use and disclose your medical information for Panda Pediatrics to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to your insurance company about a service you received at the practice so that your insurance company can pay us or reimburse you for the service. We may also ask your insurance company for prior authorization for a service to determine whether the insurance company will cover it. We may also disclose your information so that other covered entities may obtain payment for treatment that they have provided (e.g. ambulance service providers).

For Health Care Operations: We can use and disclose medical information about you for Panda Pediatrics practice operations. These include uses and disclosures that are necessary to run the practice and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staff’s performance in caring for you. Medical information about you and other Panda Pediatrics patients may also be combined to allow us to evaluate whether the practice should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other practices to evaluate whether we can make improvements in the care and services that we offer.

Uses and Disclosures of Medical Information that do not Require Your Authorization:

We can use or disclose health information about you without your authorization when there is an emergency or when we are required by law to treat you, when we are required by law to use or disclose certain information, or when there are substantial communication barriers to obtaining consent from you.

Further, we may use or disclose your health information without your consent or authorization in any of the following circumstances:

  • When it is required by law

  • When it involves use and disclosure for public health activities, such as mandated disease reporting, etc.

  • When reporting information about victims of abuse, neglect or domestic violence as required by law.

  • When disclosing information for the purpose of health oversight activities, such as audits, investigations, licensure or disciplinary actions or legal proceedings or actions.

  • When disclosing information for judicial and administrative proceedings in accordance with state and/or federal law, for instance, in response to a court order, such as a court-ordered subpoena.

  • When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness or missing person or regarding a victim of a crime who can not give consent or authorization because of incapacity.

  • When disclosing information about deceased persons to medical examiners, coroners and funeral directors; When disclosing or using information for organ and tissue donation purposes.

  • When disclosing information related to a research project when a waiver of authorization has been approved by the Privacy Board.

  • When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public’s safety.

  • When disclosure is necessary for specialized government functions, such as military service, for the protection of the president or for national security and intelligence activities.

  • When required by military command authorities, if you are a member of the armed forces (or if foreign military personnel, to appropriate foreign military authorities).

  • In the case of a juvenile housed in a correctional facility such as a juvenile detention center or other such facility, information can be released to the facility in which he or she resides for the following purposes: (1) for the institution to provide the juvenile with health care; (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility.

  • When disclosure is necessary to comply with worker’s compensation laws or purposes.

Planned Uses or Disclosures to Which You May Object:

We will use or disclose your health information for any of the purposes described in this section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to:

Lucas D. Houk, Practice Administrator

1803 W. 6th St, Lawrence, KS 66044

785-842-4477

We may use or disclose your health information to contact you and remind that you have an appointment for treatment or medical care.

We may use or disclose your health information to provide you with information about or recommendations of possible treatment options or alternatives that may interest you.

We may use and disclose your health information to inform you about health benefits or services that may interest you.

We may release health information about you to a friend and/or family member who is involved in your care.

We can tell your family and/or friends of your condition and that you are in the Practice for treatment or services. We can also give this information to someone who will help or is helping to pay for your care.

We can disclose health information about you to a public or private entity that is authorized by law or its charter to assist in disaster relief efforts, i.e., the American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition.

Your Rights Regarding Electronic Health Information Technology

Panda Pediatrics participates in electronic health information technology 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.

Other Uses or Disclosures

Uses or disclosures not covered in this Notice of Privacy Practices will not be made without your written authorization. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization.

Complaints

If you believe that we have violated any of your privacy rights or have not adhered to the information contained in this Notice of Privacy Practices, you can file a complaint by putting it in writing and sending it to:

Lucas D. Houk, Practice Administrator

1803 W. 6th St, Lawrence, KS 66044

785-842-4477

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint with either Panda Pediatrics or the U.S. Department of Health and Human Services.

Changes to This Notice of Privacy Practices

We reserve the right to change or modify the information contained in this Notice of Privacy Practices. Any changes that we make can be effective for any health information that we have about you and any information that we might obtain. The most recent version of Privacy Practices will be posted in our building. Also, you can call or write our contact person, whose information is included on the first page of this Notice of Privacy Practices, to obtain the most recent version of our notice.