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MIDWEST NEPHROLOGY CONSULTANTS, P.A.

NOTICE OF PRIVACY PRACTICES

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 ("Notice") describes how Midwest Nephrology Consultants, P.A. ("us," "we," or "our") may use or disclose your protected health information and how you can get access to such information. “Protected health information” is generally any information that identifies you and is created, received, maintained or transmitted by us in the course of providing health care items or services to you (referred to as "health information" in this Notice).

This Notice describes how we may use and disclose your 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 health information. Health information may include documentation of your symptoms, test results, treatment, diagnoses, claims for payment, billing information, and future care or treatment.

We are required by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and other applicable laws to maintain the privacy of your health information, to provide individuals with this Notice of our legal duties and privacy practices with respect to such information, and to abide by the terms of this Notice. We are also required by law to notify affected individuals following a breach of their unsecured health information. Please read this Notice carefully and feel free to ask us any questions about it.

USES AND DISCLOSURES OF INFORMATION

WITHOUT YOUR AUTHORIZATION

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 health 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 and Subcontractors: There are some services provided in our organization through contracts with business associates and their subcontractors. We may disclose your health information to our business associates so they can perform the job we’ve asked them to do and they may in turn provide this information to their subcontractors. However, business associates and their subcontractors are required by law to comply with the safety rules and most of the privacy rules applicable to your health information under HIPAA. We are also required under HIPAA to enter into agreements with business associates, and they are similarly required to enter into agreements with their subcontractors, to govern the proper use, security and protection of your health information.

5. Communication With Family: We may disclose to a family member, personal representative, support person, 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 with such persons. Detailed telephone messages may include information regarding appointments, lab results, medication changes, test results and physician responses/comments regarding your treatment plan. If you become deceased, we may disclose to your family members or to other persons who were involved in your care or payment for heath care prior to your death (such as your personal representative) health information relevant to their involvement in your care unless doing so is inconsistent with your preferences as expressed to us prior to your death.

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 Make

Without Your Authorization or Consent

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.

SPECIFIC USES AND DISCLOSURES OF

INFORMATION REQUIRING YOUR AUTHORIZATION

The following are some specific uses and disclosures we may not make of your health information without your authorization:

Psychotherapy notes. 

Although we do not anticipate creating or maintaining any psychotherapy notes that contain your health information, we must obtain your authorization prior to using or disclosing any such notes unless such use or disclosure is necessary to carry out certain treatment, payment or health care operations.

Marketing activities. 

We must obtain your authorization prior to using or disclosing any of your health information for marketing purposes unless such marketing communications take the form of face-to-face communications we may make with individuals or promotional gifts of nominal value that we may provide. If such marketing involves financial payment to us from a third party your authorization must also include consent to such payment.

Sale of health information. 

We do not currently sell or plan to sell your health information and we must seek your authorization prior to doing so.

YOUR RIGHTS TO PROVIDE AN AUTHORIZATION

FOR OTHER USES AND DISCLOSURES

• Other uses and disclosures of your health information that are not described in this Notice will be made only with your written authorization.

• You may give us written authorization permitting us to use your health information or to disclose it to anyone for any purpose.

• We will obtain your written authorization for uses and disclosures of your health information that are not identified in this Notice or are not otherwise permitted by applicable law.

• We must agree to your request to restrict disclosure of your health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and such information pertains solely to a health care item or service for which you have paid in full (or for which another person other than the health plan has paid in full on your behalf).

Any authorization you provide to us regarding the use and disclosure of your health information may be revoked by you in writing at any time. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in the authorization. However, we are generally unable to retract any disclosures that we may have already made with your authorization. We may also be required to disclose health information as necessary for purposes of payment for services received by you prior to the date you revoked your authorization.

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, we 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. We have 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,

o The information is not part of the health information kept by or for us,

o Is not part of the information you would be permitted to inspect or copy, or

o Is accurate and complete

• 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.

• If your request for access of your health information directs us to transmit a copy of the health information directly to another person the request must be made by you in writing and must clearly identify the designated recipient and where to send the copy of the health information.

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

2340 East Meyer Blvd, Building 2, Suite 480

Kansas City MO 64132

ATTN: Privacy Officer

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. Copies of this Notice are also available upon request at our reception area.

Notice Revised: September, 2013

Notice Revised: January, 2016

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