SEK PRIMARY CARE ASSOCIATES, LLC
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
Effective Date: January 9, 2006
This Notice describes how information about you may be
used and disclosed and how you can gain access to this information. Please review it carefully.
SEK Primary Care Associates, LLC, is committed to protecting
the confidentiality and security of our records containing information about
you. Typically, this record may contain
your symptoms, examination and test results, diagnoses, treatment, a plan for
your future care or treatment, and/or prescription-filling and billing-related
information. Such records are necessary
for the healthcare provider to provide you with quality care and to comply with
certain legal requirements. This notice
applies to all records of your care created or received by SEK Primary Care
1. SEK Primary
Care Associates, LLC may use and disclose protected health information for
treatment, payment and healthcare operations.
Treatment examples include, but are not limited to, requested preschool,
life insurance or sports physicals; referral to nursing homes or foster care
homes; information obtained by a pharmacist to dispense your prescriptions;
home health agencies; and /or referral to other providers for treatment. Payment examples include, but are not limited
to, collection agencies and insurance companies for claims including
coordination of benefits with other insurers, and for prescription benefits. Healthcare operations examples include, but
are not limited to, internal quality control and assurance, including auditing
of clinic and pharmacy records, and government and licensure audits.
2. SEK Primary
Care Associates, LLC, are permitted or required to use or disclose protected
health information without the individual’s written authorization in certain
circumstances. These examples include,
but are not limited to, public health requirements, Food and Drug
Administration (FDA), medical examiners, coroners, funeral directors, and/or
SEK Primary Care
Associates, LLC, provide services through business associates
contracts, for which we may
disclose protected health information about you so that they may perform the
job that we have asked them to do, and bill you or your third-party payer for
the services rendered. We require the
business associate to appropriately safeguard your protected health information
through a Business Associate Agreement with SEK Primary Care Associates,
LLC. Examples include clearinghouses for
billing, software vendors, some insurers, and drug wholesalers.
4. SEK Primary
Care Associates, LLC may release protected health information about you for
worker’s compensation or similar programs.
SEK Primary Care Associates, LLC may release health
information about you to
a correctional institution or a law enforcement official if
you are an inmate of a correctional institution or under the custody of a 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.
6. SEK Primary
Care Associates, LLC may at times contact the patient to provide appointment
and pharmacy refill reminders, information regarding treatment alternatives,
and/or other health-related benefits and services that may be of interest to
the individual patient.
7. SEK Primary
Care Associates, LLC may release protected health information about you to a
friend or family member to the extent necessary to help with your healthcare or
with payment for your healthcare.
Individuals requesting financial information on patient accounts other
than their own will be required to provide authorization from the patient in
advance in order for SEK Primary Care Associates, LLC, to release the financial
information. You may request a form to
list specific people who we may speak to regarding your medical or pharmacy
information. In addition, we may
disclose protected health information about you to an entity assisting in a
disaster relief effort so that your family can be notified about your
condition, status and location.
8. SEK Primary
Care Associates, LLC will not make any other use or disclosure of a patient’s
protected health information without the individual’s written
authorization. Such authorization may be
revoked at any time. Revocation must be
9. SEK Primary
Care Associates, LLC will abide by the terms of this notice or the notice
currently in effect at the time of the disclosure.
10. SEK Primary
Care Associates, LLC reserve the right to change the terms of this notice and
to make the revised or changed notice effective for health information we
already have about you as well as any information we receive in the
future. SEK Primary Care Associates,
LLC, will make available a copy of any revisions to the Notice of Privacy
11. Any person/patient
may file a complaint to SEK Primary Care Associate, LLC or to the Department of
Health and Human Services, Office of Civil Rights, if they believe their
privacy rights have been violated. To
file a complaint with SEK Primary Care Associates, LLC please contact the
Privacy Officer at the following address:
SEK Primary Care Associates, LLC, 205 Mill, P.O. Box 345, Neodesha, KS 66757. A complaint may also be filed by calling
620-325-2500. All complaints will be
addressed and the results will be reported to the patient and the appropriate
SEK Primary Care Associates, LLC personnel.
12. It is the
policy of SEK Primary Care Associates, LLC that no retaliatory action will be
made against any individual who submits or conveys a complaint of suspected or
actual non-compliance of the privacy standards.
13. For further
information about his notice you may contact SEK Primary Care Associates, LLC
Privacy Officer at 620-325-2500.
14. The Effective
date of this notice is January 9, 2006.
Patients have been granted individual rights under the HIPPA
These include the following:
1. You have the right to inspect and/or request a copy of your
protected health information that may be used to make decisions about your
care. To inspect and/or request a copy
of your protected health information, you must submit your request in writing
to SEK Primary Care Associates, LLC Privacy Officer. If you request a copy of the information, we
may charge a fee for the costs of copying (including labor), mailing or other
supplies associated with your request.
We may deny your request to inspect and/or copy in certain very limited
circumstances. If you are denied access
to protected health information, you may request that the denial be reviewed.
2. If you feel that protected health information we have about
you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment
for as long as the information is maintained by SEK Primary Care Associates,
LLC. To request an amendment, your
request must be made in writing and submitted to the SEK Primary Care
Associates, LLC Privacy Officer. You
must provide a reason that supports your request and 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 protected health
information kept by or for our practice, is not part of the information that
you would be permitted to inspect or copy, or is accurate and complete.3. You have the right to request an “accounting of
disclosures.” This is a list of the
disclosures we made of protected health information about you that were not
made for treatment, payment, and/or health care operations. There are certain exceptions to this
right. To request this list or accounting
of disclosures, you must submit your request in writing to SEK Primary Care
Associates, LLC Privacy Officer. Your
request must state a time period, which may not be longer than six years and
may not include dates before August 16, 2006.
You may request that we provide copies in a format other than
photocopies. We will use the format you
request unless we cannot practicably do so.
The first list you request within a 12-month period will be free. For additional list, 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. The accounting must be provided at you no
later than 60 days after the receipts of your request, unless we utilize a
30-day extension period.
4. You have the right to request a restriction or limitation on
the protected health information we use or disclose about you for treatment,
payment or health care operations, as well as the protected health information
we disclose about you to someone who is involved in your care or the payment
for your care, like a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your
request unless the information is needed to provide you emergency
treatment. To request restrictions, you
must make you request in writing to SEK Primary Care Associates, LLC Privacy
Officer. In your 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, disclosure to your spouse.
Either you or we may terminate the restriction upon notification of the
5. You have the right to request that we communicate with you
about medical matters in certain way or at a certain location. For example, you can ask that we only contact
you at work or by mail. To request
confidential communications, you must make your request in writing to SEK
Primary Care Associates, LLC Privacy Officer.
We will not ask you the reason for your request. We will accommodate all requests we deem
reasonable. Your request must specify
how or where you wish to be contacted.
6. You have the right to a paper copy of the current Notice of
Privacy Practices. You may ask us to
give you a copy of this notice at any time.
7. You will be asked to sign an acknowledgement of receipt of
this Notice of Privacy Practices. If you
have any questions regarding this Notice of Privacy Practices, please do not
hesitate to Contact SEK Primary Care Associates, LLC Privacy Officer for more
information or clarification.