NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed as well as how you can get access to this information. Please review this information carefully. If you have any questions, please do not hesitate to contact Southwest Kidney Institute (SKI).
Southwest Kidney Institute, PLC (the “Practice”) is dedicated to maintaining the privacy of your personal health information. Each time a patient visits an office of the Practice, a record is made that describes the treatments and services provided. Federal law outlines specific privacy protections and individual rights related to the information we maintain that identifies you as a patient. Protected health information includes demographic data and facts about your past, present and/or future physical or mental health. The Practice has put into place policies and procedures to help protect your health information. We are required to provide this notice outlining our legal duties and responsibilities related to the use and disclosure of patient identifiable health information (i.e. Privacy Practices), and examples of how your information may be used or disclosed. The Practice will abide by the terms of this notice and may revise this notice at any time. The new notice will be posted in the offices of the Practice in a prominent location. You may access a revised version on our website, by calling an office of the Practice and requesting a revised copy be mailed to you, or by requesting a copy in-person at an office of the Practice. Revisions to this notice will be effective for all health information the Practice maintains- past, present and/or future.
The Practice may use your individually identifiable health information for the following purposes without your authorization:
The Practice may disclose your health information without your authorization when permitted or required by law, including:
Unless you object, the Practice may also disclose your health information to family members and/or others involved in your care or payment for your care. The Practice may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person responsible for your care, general condition or death.
The Practice may leave messages for you at work or home about your visits. If you do not want the Practice to do so, please inform our Privacy Officer in writing. All other uses and/or disclosures of your health information to others will require a written, signed authorization from you. You have the right to revoke your authorization at any time, except to the extent the Practice has already acted on it. Should you require your records to be released, the Practice will provide you with an authorization form to complete and return to the address listed on it.
Your health record is the physical property of the Practice. The information contained in it belongs to you. Below is a list of your rights regarding individually identifiable health information.
All requests related to these items must be made in writing to the Practice’s Privacy Officer at the address listed below. The Practice will provide you with the appropriate forms to exercise these rights. The Practice will notify you in writing if your requests cannot be granted.
You may complain to the Practice at the address below or to the Secretary of Health and Human Services (Office for Civil Rights/ U.S. Department of Health and Human Services) online at HHS.gov, if you believe your privacy rights have been violated by the Practice. You may file a complaint with the Practice by notifying the Privacy Officer of your complaint. The Practice will not retaliate against you for filing a complaint.
You may contact SKI at (480) 610-6100 for more information about the complaint process. If you have any questions about this notice, please contact SKI as well.
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