Notice of Privacy Practices

As required by the Privacy Regulations created as a result of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)

Effective Date April 14, 2003

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 our HIPAA Privacy Officer
at Phone (620) 669-6690 Fax (620) 669-6665

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IV. YOUR RIGHTS REGARDING YOUR PHI.
The health and billing records we maintain are the physical property of the Medical Center. The information in it, however, belongs to you. You have the:

Right To Amend.
If you believe that medical information we have about you is incorrect or incomplete, you may request us to amend the information for as long as the information is kept by or for the Medical Center. You must make your request by completing our request form, include a reason that supports your request and deliver the request to our office at 1100 North Main. We will respond to your request in writing. We may deny your request under certain conditions. If we deny your request, we will include the reason for the denial. You may then file a statement of disagreement which will become part of your health record.

Right to Accounting Of Disclosures.
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of your PHI, with certain exceptions specifically defined by law. You must make your request in writing by completing our request form and delivering it to our office at 1100 North Main. Your request must state a time period which may not be longer than six (6) years from the date of the disclosure and may not include dates before April 14, 2003. The first list you request within 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 before any costs are incurred.

Right To Request Restrictions.
You have the right to request a restriction or limitation on the medical 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 medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. You must make your request in writing by completing our request form and delivering it to our office at 1100 North Main.

Right to Request Confidential Communications.
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 can ask that we only contact you at home or by mail. You must make your request in writing by completing our request form and delivering it to our office at 1100 North Main. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice.
You have the right to a paper copy of this Notice. You may ask for a copy of this Notice at any time. To obtain a paper copy, contact us at the address and phone number at the top of this Notice.

To Request Information or File a Complaint. If you have questions, need additional information or want to report a problem regarding the use and disclosure of your PHI, you may contact us at the address and phone number at the top of this Notice. Additionally, if you believe your rights to the privacy of your PHI have been violated by our office, you may file a complaint in writing by delivering it to our office at 1100 North Main or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

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