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.
This Notice of Privacy Practices describes how we may use and disclose your protective health information (PHI) to carry out treatments, 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 about you including demographic information that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your medical information is used and shared for several purposes, which are detailed below:
FOR TREATMENT
We may use medical information about you to provide, coordinate or manage your health care and related services by both us and other health care providers. We may disclose medical information about you to staff members, doctors, nurses, hospitals, healthcare providers, and other health facilities who become involved in your care. We may consult with other health care providers concerning you, and as part of the consultation share your medical information with them. Similarly, we may refer you to another healthcare provider, and as part of the referral share medical information about you with that provider.
FOR PAYMENT
We may use or disclose your health information to obtain payment for services we provide to you and to participate in quality assurance, disease management, training, licensing, and certification programs. This may include billing you, your insurance company, or a third-party payer.
FOR HEALTHCARE OPERATIONS
We may use or disclose, as needed, your protected health information in order to support the business activities of our organization. These activities include but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as a part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, to contact you to check the status of your equipment.
HOW WE WILL CONTACT YOU
Unless you tell us otherwise in writing, we may contact you by telephone, text, email, or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail.
APPOINTMENT REMINDERS
We may use and disclose medical information about you to contact you to remind you of an appointment such as voicemail, text message, or email.
TREATMENT ALTERNATIVES
We may use and disclose medical information about you to contact you about treatment alternatives or services that may be of interest to you.
MARKETING/FUNDRAISING
We may use and share medical information about you to communicate with you about a product or service.
This may be:
for your treatment.
for care coordination for you; or
to direct or recommend alternative treatments, therapies, health care providers, or settings.
Kidworks may use, unless you tell us otherwise, pictures or other information for website development, and other such applications if obtained at an event open to the public or as part of any other organization's event.
We will not use your health information for marketing or fundraising purposes without your written consent. You can opt out of receiving information about our marketing or fundraisers. We will not sell your health information without your explicit authorization.
INDIVIDUALS INVOLVED IN YOUR CARE
At your request we may disclose your health information to a family member or other person if necessary to assist with your treatment and or payment for services. Based on our judgment and as per 164.522(a) of HIPAA we may disclose your information to these persons in the event of an emergency situation.
REQUIRED BY LAW
We may use or disclose medical information about you when we are required to do so by law.
PUBLIC HEALTH ACTIVITIES
We may disclose medical information about you for public health activities and purposes. For example, your protected health information may be disclosed to prevent or control disease, injury or disability; report child abuse or neglect; notify a person regarding potential exposure to a communicable disease; notify an appropriate government agency about the abuse or neglect of an adult individual (including domestic violence); or to the Federal Food and Drug Administration (FDA) to report adverse events with medications, track regulated products, report product recalls, defects or replacements.
ABUSE, NEGLECT OR DOMESTIC VIOLENCE
If we reasonably believe you are a victim of abuse, neglect, or domestic violence, to the extent the law requires, protected health information about you may be disclosed to an agency authorized by law to receive such reports.
HEALTH OVERSIGHT ACTIVITIES
We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions.
JUDICIAL AND ADMINISTRATIVE PROCEEDINGS
We may disclose your protected health information in the course of any judicial or administrative proceeding. For example, we may disclose your protected health information in response to a court or administrative order, or in response to a discovery request, subpoena or other lawful process only if efforts have been made to tell you about the request, or to obtain an order protecting the information to be disclosed.
DISCLOSURES FOR LAW ENFORCEMENT PURPOSES
We may disclose medical information about you to a law enforcement official for law enforcement purposes:
as required by law;
in response to a court, grand jury or administrative order, warrant or subpoena;
to identify or locate a suspect, fugitive, material witness or missing person;
about an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain
that person’s agreement, in limited circumstances, the information may still be disclosed;
to alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct;
about crimes that occur at our facility; or
to report a crime in emergency circumstances.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose medical information to an organization to facilitate the duties of coroners, medical examiners and funeral directors.
RESEARCH
We may use or disclose medical information to researchers when an institution’s review board or special privacy board has reviewed the proposed study and established protocols to ensure the privacy of the health information used in their research and determined that the researcher does not need to obtain your authorization prior to using your medical information for research purposes.
TO AVERT SERIOUS THREAT TO HEALTH OR SAFETY
We may use or disclose protected health information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
MILITARY
Your protected health information may be disclosed to an appropriate military command authority to ensure the proper execution of a military mission if you are a member of the armed forces.
NATIONAL SECURITY AND INTELLIGENCE
When required we may disclose medical information about you to authorized federal officials for the conduct of intelligence, counter-intelligence, and other national security activities authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT
We may disclose medical information about you to authorized federal officials, so they can provide protection to the President of the United States, certain other federal officials, or foreign heads of state.
SECURITY CLEARANCES
We may use medical information about you to make medical suitability determinations and may disclose the results to officials in the United States Department of State for purposes of a required security clearance or service abroad.
INMATES; PERSONS IN CUSTODY
We may disclose medical information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary:
to provide health care to you;
for the health and safety of others; or
for the safety, security and good order of the correctional institution.
WORKERS COMPENSATION
We may release medical information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illness without regard to fault.
YOUR RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU
You have the following rights with respect to medical information that we maintain about you:
RIGHT TO REQUEST RESTRICTIONS
You have the right to request that we restrict the uses or disclosures of medical information about you to carry out treatment, payment, or health care operations. You also have the right to request that we restrict the uses or disclosures we make to a family member, other relative, a close friend or any other person identified by you; or, for to public or private entities for disaster relief efforts.
RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS
You have the right to request that we communicate medical information about you to you in a certain way or at a certain location. Your request must state how or where you can be contacted. We will accommodate your request. However, we may, when appropriate, require information from you concerning how payment will be handled. We may also require an alternate address or another method to contact you.
You have the right to decline the use of insurance. If you choose to elect private payment and bypass your insurance benefit, it is your obligation to inform Kidworks in writing.
RIGHT TO INSPECT AND COPY
You have the right to inspect and obtain a copy of medical information about you. To inspect or copy medical information about you, you must submit your request in writing to Kidworks.
Your request should state what medical information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of
mailing. We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies. We may deny your request to inspect and copy medical information if the medical information involved is a civil, criminal or administrative action or proceeding. If we deny your request, we will inform you of the basis for the denial and how you may have our denial reviewed.
RIGHT TO AMEND
You have the right to ask us to amend medical information about you. You have this right for so long as the medical information is maintained by us. To request an amendment, you must submit your request in writing to Kidworks. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within sixty (60) calendar days after we receive your request. We may deny your request if the information or record you want amended was not created by us; not part of the medical information kept by us; is not part of the information which you would be permitted to inspect or copy; or if the information is accurate and complete.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
RIGHT TO COPY OF THIS NOTICE
You are entitled to receive a paper copy of this notice at any time by contacting Kidworks.
OUR RIGHT TO CHANGE NOTICE OF PRIVACY PRACTICES
We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice.
COMPLAINTS
You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. To file a complaint with us, contact Kidworks. All complaints should be submitted in writing. To file a complaint with the United States Secretary of Health and Human Services, send your complaint to: the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201. You will not be retaliated against for filing a complaint.
QUESTIONS AND INFORMATION
If you have any questions or want more information concerning this Notice of Privacy Practices, please call Kidworks.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our organization, 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, to pay your health care bills, to support the operation of the organization, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for equipment or supplies coverage may require that your relevant protected health information be disclosed to the health plan to obtain approval for coverage.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, to contact you to check the status of your equipment.
Your Rights: Following is a statement of your rights with respect to your protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to
obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, e.g., electronically.
Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact with your complaint. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.
We welcome your comments. Please feel free to call us if you have any questions about how we protect your privacy. Our goal is always to provide you with the highest quality services.
