Privacy Policy
NORTHWEST FAMILY PHYSICIANS NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
Effective Date of This Notice: April 14, 2003
If you have questions about any part of this Notice or if you want more information about our privacy practices please contact:
Northwest Family Physicians, LLC
Heather Steinert – Privacy Officer
3730 N Ridge Rd. Suite 100 – Wichita, KS 67205
Tel: 316-
We are committed to protecting the confidentiality of health information about you. We collect health information from you and store it in a chart and on the computer creating a record of the care and services you receive in our facility. We need this record to provide you with quality care and to comply with certain legal requirements. We may obtain this information directly from you, such as information provided to us on your general exam, family history from or patient information form. Information may also be collected from third parties, such as your insurance carrier, your employer (especially for workman’s compensation) and from any and all doctors, individuals, hospitals, labs or pharmacies for which you give permission, either in writing or verbally. This also includes billing documents for those services. This Notice informs you of the ways in which we may use and disclose this health information about you.
We are required by law to maintain the privacy of your health information. We give you this Notice of our privacy practices and make a good faith effort to obtain your acknowledgement of receipt of this Notice. We must also follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
Treatment. We may use your health information to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or other office personnel who are involved in taking care of you. Different departments in our office may share your health information in order to coordinate different treatments you may need such as prescriptions, lab and X-
We may use or disclose your health information in an emergency treatment situation. If this happens, your phy7sician will try to obtain your consent as soon as reasonably practical, after the deliver of treatment. If you physician or other provider is unable to obtain your consent, he or she may still use or disclose your health information to treat you.
Payment. We may use and disclose your health information so the treatment and services you receive may be billed to and payment may be collected from you, your insurance company or other third party. We submit requests for payment to your health insurance company. The health insurance company will require information from us regarding medical care given. We will provide information to them about you and the care given. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
Health Care Operations. We may disclose, as needed, your protected health information in order to support the business activities of our practice. The activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing activities and conduction or arranging for other business activities.
OTHER POSSIBLE USES AND DISCLOSURES
Appointment Reminders/Messages. We may use and disclose protected health information to contact you, as a reminder that you have an appointment for treatment or medical care. Unless you request otherwise, we may leave a message on an answering machine or with another person, who may answer the phone, identifying our office and asking you to return the call.
Health Related Benefits and Services. We may use and disclose health information to tell you about health-
Individuals Involved in Your Care or Payment for You Care. We may release your health information to a friend or family member who is involved in your medical care or who helps pay for your care. We may also disclose your health information to an organization assisting in disaster relief efforts so that your family can be notified about your condition, status, and location. If you ae able and available to agree or object, we will give you the opportunity prior to making notification. If you ae unable or unavailable to agree or object, our health professionals will use their best judgement in communication with your family and other.
Business Associates. Some services in our organization may involve contracts or arrangements with business associate. When these services are contracted, we may disclose your health information to our business associate, so they can perform the job we have asked them to do. To protect your health information, we require our business associates to appropriately safeguard your information.
Public Health Risks. As authorized by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reaction to medications or problems with products; to notify people of recalls; to report births and deaths; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse and Neglect. We may disclose your protected health information to public authorities, as allowed by law to report child abuse or neglect or domestic violence.
Public Safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety to you, another person or the general public. Any disclosure would only be to a person able to help prevent the threat.
Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections licensure and other proceedings.
Food and Drug Administration. We may disclose your health information to a person or company required by the FDA to report adverse events, problems with products and reactions to medications, product defects or problems, biologic product deviations, to track products, to enable product recalls, to make repairs or replacements or to conduct post marketing surveillance, as necessary.
Lawsuits and Disputes. We may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a court order.
Inmates. If you are an inmate of a correctional facility or under the custody of a law enforcement official, we may disclose the health information necessary for your health and the health and safety of others.
Serious Threat. Consistent with the applicable federal and state laws, we may disclose your health information if we believe the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Deceased Person Information. We may disclose your health information to coroners or medical examiners for identification purposes, determining the cause of death or for the coroner or medial examiner to perform other duties authorized by law. We may also disclose your health information to funeral directors, as authorized by law, in order to permit the funeral directors to carry out their duties.
Organ and Tissue Donation. If you are an organ donor, we may use or disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues, as necessary, to facilitate organ or tissue donation and transplantation.
Specialized Government Functions. We may disclose health information for specialized government functions, as authorized by law, such as, to Armed Forces personnel for national security purposes or to public assistance program personnel.
Workers Compensation. We may release health information about you, as necessary, if you are seeking compensation through workers compensation or similar programs, to comply with laws relating to workers compensation.
Research. We may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recover of all patients who received one medication to those who received another for the same condition. We may use or disclose your information for research purposes, without your written authorization, on three circumstances: (a) if, as the result of a special review process, it has been determined by an Industrial Review Board or Privacy Board that the research study protocol incorporates sufficient privacy protections so that the authorization requirement may be waived; (b) such use or disclosure is preparatory to research and no information will be removed from our facility and; (c) certain limited review of information relating to deceased individuals. A member of our workforce may discuss with you the opportunity to participate in a research project, but will not ask any researcher to contact you without your expressed written authorization.
Surveys. We may use and disclose health information about you to contact and to assess your satisfaction with our services.
Fundraising Activities. We may use your health information to contact you to participate in fundraising activities for our organization. We may disclose your health information to a foundation related to our office, so they may contact you for raising money for our office. We will only release information such as your name, address, phone number and dates you received treatment or services, at our office. If you do not want our office contacting you for fundraising efforts you must notify our office.
OTHER USES OF HEALTH INFORMATION
We will disclose your health information, when required to do so, by federal, state or local law. Other uses and disclosures of health information not covered by this Notice will be made only with your written authorization. If you provide us an authorization to use or disclose your health information you may revoke that authorization, on writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. We ae unable to take back any disclosures previously made with your permission.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. Typically, this includes medical and billing records, but does not include psychotherapy notes, information compiled in reasonable anticipation of or use in, a civil, criminal or administrative action or proceeding.
To inspect and copy your health information, you must submit your request, in writing, to our office. If you request a copy of this information, we may charge a fee for the cost of copying, mailing or other supplies and services associated with your request.
Right to Amend. If you believe the health information we have about you in incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as our office has your information.
To request an amendment, you must submit your request in writing to our office. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, 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 health information kept by our office;
Is not part of the information you would be permitted to inspect and copy; or
Accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement, to be maintained with your records.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of all the disclosures of your health information we have made. It excludes disclosures made to you, to family members or friends involved in your care, or for notification purposes.
You must submit your request for accounting of disclosures in writing to our office. Your request must state the time period, which may not be longer than six years and may not include dates prior to April 14, 2003. The first list you request in a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment for your care.
To request restriction, you must make your request in writing to our office. In you request, you must tell us 1)what information you want to limit 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply, for example, your spouse.
We are not required to agree to your request. If your physician believes it is in your best interest to permit use and disclosure of your health information, it will not be restricted. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Alternative Methods of Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to our office. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy.
If we maintain a website that provides information about our entity, this Notice will be available on the website.
CHANGES TO THIS NOTICE
We reserve the right to amend, change or eliminate provisions of this Notice, at any time. We reserve the right to make the revised Notice effective for health information we already have about you, as well as, any information we receive in the future. We will post a copy of the current Notice in our office. In addition, we will offer you a copy of the current Notice each time you register at our office for treatment or health care services.
COMPLAINTS
If you believe our office has violated your rights with respect to your health information, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office please contact Heather Steinert, Privacy Officer, 3730 N. Ridge Rd, Suite 100, Wichita, KS 67205, 316-
We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from our office. You will not be penalized for filing a complaint.
ACKNOWLEDGEMENT
You will be asked to provide a written acknowledgement of your receipt of this Notice of Privacy Practices. We are required by law to make a good faith effort to provide you with our Notice and to obtain such acknowledgement from you. However, your receipt of care and treatment from our office is not conditioned upon your providing a written acknowledgement.
Copyright © All rights reserved.
3730 N Ridge Rd
Suite 100,
Wichita KS 67205
Web: https://www.NWFPWichita.com
Phone: 316.462.6200
Fax: 316.462.6201
Northwest Family Physicians
Office Hours
Monday -
8:00 -
Please call for Holiday Hours