Privacy Policy

Beloit Medical Center, P.A. ("BMC")
Notice of Privacy Practices - Effective February 1, 2013

This Notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. You have the right to a paper copy of this Notice. You may request a copy at any time.

HOW BMC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

BMC may use and disclose your health information for the following purposes without your express consent or authorization. We will obtain your express written authorization before using or disclosing your information for any other purpose. You may revoke such authorization, in writing, at any time to the extent BMC has not relied on it.

Treatment. We may use your health information to provide you with medical treatment. We may disclose information to doctors, nurses, technicians, medical students, or other personnel involved in your care. We also may disclose information to persons outside BMC involved in your treatment, such as other health care providers, family members, and friends.

We may use and disclose health information to discuss with you treatment options or health-related benefits or services or to provide you with promotional gifts of nominal value. We may use and disclose your health information to remind you of upcoming appointment. Unless you direct us otherwise, we may leave messages on your telephone answering machine or with the person who answers your telephone with the date and time of an upcoming appointment.

Payment. We may use and disclose your health information as necessary to collect payment for services we provide to you. We also may provide information to other health care providers to assist them in obtaining payment for services they provide to you.

Health Care Questions. We may use and disclose your health information for our internal operations. These uses and disclosures are necessary for our day-to-day operations and to make sure patients receive quality care. We may disclose health information about you to another health care provider or health plan with which you also have had a relationship for purposes of that provider's or plan's internal operations.

Business Associates. BMC provides some services through contracts or arrangements with business associates. We require our business associates to appropriately safeguard your information.

Creation of de-identified health information. We may use your health information to create de-identified health information. This means that all data items that would help identify you are removed or modified.

Uses and disclosures required by law. We will use and/or disclose your health information when required by law to do so.

Disclosures for public health activities. We may disclose your health information to a government agency authorized (a) to collect data for the purpose of preventing or controlling disease, injury, or disability; or (b) to receive reports of child abuse or neglect. We also may disclose such information to a person who may have been exposed to a communicable disease if permitted by law.

Disclosures about victims of abuse, neglect, or domestic violence. BMC may disclose your health information to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

Disclosures for judicial and administrative proceedings. Your protected health information may be disclosed in response to a court order or in response to a subpoena, discovery request, or other lawful process if certain legal requirements are satisfied.

Disclosures for law enforcement purposes. We may disclose your health information to a law enforcement official as required by law or in compliance with a court order, court-ordered warrant, a subpoena, or summons issued by a judicial officer; a grand jury subpoena; or an administrative request related to a legitimate law enforcement inquiry.

Disclosures regarding victims of a crime. In response to a law enforcement official's request, we may disclose information about you with your approval. We may also disclose information in an emergency situation or if you are incapacitated if it appears you were the victim of a crime.

Disclosures to avert a serious threat to health or safety. We may disclose information to prevent or lessen a serious threat to the health and safety of a person or the public or as necessary for law enforcement authorities to identify or apprehend an individual.

Disclosures for specialized government functions. We may disclose your protected health information as required to comply with governmental requirements for national security reasons or for protection of certain government personnel or foreign dignitaries.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

Right to inspect and copy. You have the right to inspect and copy health information maintained by BMC. To do so, you must complete a specific form providing information needed to process your request. If you request copies, we may charge a reasonable fee. We may deny you access in certain limited circumstances. If we deny access, you may request review of that decision by a third party, and we will comply with the outcome of the review.

Right to request amendment. If you believe your records contain inaccurate or incomplete information, you may ask us to amend the information. To request an amendment. you must complete a specific form providing information we need to process your request, including the reason that supports your request.

Right to an announcing of disclosures. You have the right to request a list of disclosures of your health information we have made, with certain exceptions defined by law. To request this list, you must complete a specific form providing information we need to process your request.

Right to request restrictions. You have the right to request a restriction on our uses and disclosures of your health information for treatment, payment, or health care operations. you must complete a specific form providing information we need to process our request. BMC's Privacy Officer is the only person who has the authority to approve such a request.

Right to request alternative methods of communication. You have the right to request that we communicate with you in a certain way or at a certain location. You must complete a specific form providing information needed to process your request. BMC's Privacy Officer is the only person who has the authority to act on such a request. We will not ask you the reason for your request, as we will accommodate all reasonable requests.

YOUR RIGHTS REGARDING ELECTRONIC HEALTH INFORMATION EXCHANGE

Beloit Medical Center, P.A. participates in electronic health information exchange, or HIE. New technology allows a provider or a health plan to make a single request through a health information organization, or HIO, to obtain electronic records for a specific patient from other HIE participants for purposes of treatment, payment, or health care operations. HIOs are required to use appropriate safeguards to prevent unauthorized uses and disclosures.

You have two options with respect to HIE. First, you may permit authorized individuals to access your electronic health information through an HIO. If you choose this options, you do not have to do anything.

Second, you may restrict access to all of your information through an HIO (except access by properly authorized individuals as needed to report specific information as required by law). If you wish to restrict access, you must complete and submit a specific form available at http://www.khie.org. You cannot restrict access to certain information only; your choose is to permit or restrict access to all of your information.

If you have questions regarding HIE or HIOs, please visit http://www.khie.org for additional information.

Even if you restrict access through an HIO, providers and health plans may share your information directly through other means (e.g., facsimile or secure e-mail) without your specific written authorization.

If you receive health care services in a state other than Kansas, different rules may apply regarding restrictions on access to your electronic health information. Please communicate directly with your out-of-state health care provider regarding those rules.

COMPLAINTS

If you believe your rights with respect to health information have been violated, you may file a complaint with BMC, P.A. or with the Secretary of the Department of Health and Human Services. To file a complaint with BMC, P.A., please contact Privacy Officer, Beloit Medical Center, P.A., 1005 North Lincoln Avenue, Beloit, Kansas 67420. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

BMC reserves the right to change the terms of this Notice and to make the revised Notice effective with respect to all protected health information regardless of when the information was created.