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!

The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination, and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

*A comprehensive copy of this information is available at all of our locations.

Other Disclosures and Uses

• Notification
• Communication with Family*
• Research*
• Disaster Relief*
• Organ Procurement Organizations*
• Food and Drug Administration (FDA)
• Public Health*
• Abuse & Neglect*
• Employers*
• Correctional Institutions*
• Law Enforcement*
• Health Oversight*
• Judicial/Administrative Proceedings*
• Serious Threat
• For Specialized Governmental Functions
• Coroners, Medical Examiners, and Funeral Directors

Note: (*) If an item has an asterisk, we will consult state law to avoid conflicts.

The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have a right to:

1. Request a restriction on certain uses and disclosures of your health information by delivering the request to our office.
2. Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.
3. Request that you be allowed to inspect and copy your health record and billing record.
4. Appeal a denial of access to you protected health information, except in certain circumstances.
5. Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office.
6. Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office
7. Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to our office.
8. Revoke authorizations that you made previously to use or disclose information.

If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.

To Request Information or File a Complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Beth Bartell at 866-623-0633.

Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the office receptionist. That employee will then forward your written complaint to the HIPAA officer. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services.

Please Note:

1. We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.
2. We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

The office is required to:

1. Maintain the privacy of your health information as required by law.
2. Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you.
3. Abide by the terms of this Notice.
4. Notify you if we cannot accommodate a requested restriction or request.
5. Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.

Central Care, P.A.
Administration, Billing, & Insurance
2121 Crawford Place
P.O. Box 256
Salina , KS 67402-0256

(866) 623-0633

www.cccancer.com