SASTUN CENTER OF INTEGRATIVE HEALTH CARE

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT/CLIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

                                  PLEASE REVIEW THIS CAREFULLY.

A.    OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

ï How we may use and disclose your IIHI

ï Your privacy rights in your IIHI

ï Our obligations concerning the use and disclosure of your IIHI

The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

Effective Date of this Notice: April 14, 2003

B.    IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

CONNIE KERSTETTER, OFFICE MANAGER, SASTUN CENTER OF INTEGRATIVE HEALTH CARE, 5509 FOXRIDGE DRIVE, MISSION, KANSAS, 913-384-2284 X 101.

C.    WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your IIHI:

1. Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have a laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice, including, but not limited to, our doctors and nurses, may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.
2. Health Care Operations. Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.
3. Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.
4. Release of Information to Family/Friends. Our practice may release your IIHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter bring their child to the office for treatment of a cold. In this example, the babysitter may have access to this child's medical information.
5. Disclosures Required By Law. Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.

D.    USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public Health Risks. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:

ï Maintaining vital records, such as births and deaths

ï Reporting child abuse or neglect

ï Preventing or controlling diseases, injury or disability

ï Notifying a person regarding potential exposure to a communicable disease

ï Notifying a person regarding a potential risk for spreading or contracting a disease or condition

ï Reporting reactions to drugs or problems with products or devise

ï Notifying individuals if a product or device they may be using has been recalled

ï Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient/client (including domestic violence); however, we will only disclose this information if the patient/client agrees or we are required or authorized by law to disclose this information

ï Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3.Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:

ï Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement

ï Concerning a death we believe has resulted from criminal conduct

ï Regarding criminal conduct at our offices

ï n response to a warrant, summons, court order, subpoena or similar legal process

ï To identify/locate a suspect, material witness, fugitive or missing persons

ï In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients/Clients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

6. Organ and Tissue Donation. Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation bans, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

7. Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

8. Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

9. National Security. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

10. Inmates. Our practice may disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

11. Workers' Compensation. Our practice may release your IIHI for workers' compensation and similar programs.

E.     YOUR RIGHTS REGARDING YOUR IIHI

You have the following rights regarding the IIHI that we maintain about you:

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn: Office Manager, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in writing to the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn: Office Manager. Your request must describe in a clear and concise fashion:

(a)    the information you wish restricted;

(b)   whether you are requesting to limit our practice's use, disclosure or both; and

(c)    to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient/client medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn: Office Manager. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn: Office Manager. You must provide us with a reason that supports your request for amendment. Our practice will deny you request if you fail to submit your request, and the reason supporting your request, in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not available to amend the information.

5. Accounting of Disclosures. All of our patients/clients have the right to request an �accounting of disclosures.¦ An �accounting of disclosures¦ is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment or operations purposes. Use of your IIHI as part of the routine patient/client care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file you insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn: Office Manager. All request for an �account of disclosures¦ must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Sastun Center, 5509 Foxridge Drive, Mission, KS 66202, attn. Office Manager.

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the office manager at the Sastun Center at 913-384-2284. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Right to Provide and Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact the Office Manager at the Sastun Center at 913-384-2284 for further information.

SASTUN CENTER OF INTEGRATIVE HEALTH CARE

PRIVACY POLICIES

It is the policy of our practice that all health care practitioners and staff preserve the integrity and the confidentiality of protected health information (PHI) pertaining to our patients/clients. The purpose of this policy is to ensure that our practice and its health care practitioners and staff have the necessary medical and PHI to provide the highest quality medical care possible while protecting the confidentiality of the PHI of our patients/clients to the highest degree possible. Patients/clients should not be afraid to provide information to our practice and its health care practitioners and staff for purposes of treatment, payment and healthcare operations (TPO). To that end, our practice and its health care practitioners and staff will:

•  Adhere to the standards set forth in the Notice of Privacy Practices.

•  Collect, use and disclose PHI only in conformance with state and federal laws and current patient/clients covenants and/or authorizations, as appropriate. Our practice and its health care practitioners and staff will not use or disclose PHI for uses outside of practice's TPO, such as marketing, employment, life insurance applications, etc. without an authorization from the patient/client.

•  Use and disclose PHI to remind patients/clients of their appointments only within their consent.

•  Recognize that PHI collected about patients/clients must be accurate, timely, complete, and available when needed. Our practice and its health care practitioners and staff will:

Implement reasonable measures to protect the integrity of all PHI maintained about patients/clients.

•  Recognize that patients/clients have a right to privacy. Our practice and its health care practitioners and staff respect the patient's/client's individual dignity at all times. Our practice and its health care practitioners and staff will respect patient's/client's privacy to the extent consistent with providing the highest quality medical care possible and with the efficient administration of the facility.

•  Act as responsible information stewards and treat all PHI as sensitive and confidential. Consequently, our practice and its health care practitioners and staff will:

•  Treat all PHI data as confidential in accordance with professional ethics, accreditation standards, and legal requirements.

•  Not disclose PHI data unless the patients/clients (or his or her authorized representative) has properly consented to or authorized the release or the release is otherwise authorized by law.

•  Recognize that, although our practice �owns¦ the medical record, the patient/client has a right to inspect and obtain a copy of his/her PHI. In addition, patients/clients have a right to request an amendment to his/her medical record if he/she believes his/her information is inaccurate or incomplete. Our practice and its health care practitioners and staff will:

•  Permit patients/clients access to their medical records when their written requests are approved by our practice. If we deny their request, then we must inform the patients/clients that they may request a review of our denial. In such cases, we will have an on-site healthcare professional review the patients'/clients' appeals.

•  Provide patients/clients an opportunity to request the correction of inaccurate or incomplete PHI in their medical records in accordance with the law and professional standards.

•  All health care practitioners and staff of our practice will maintain a list of all disclosures of PHI for purposes other than TPO for each patient/client. We will provide this list to patients/clients upon request, so long as their requests are in writing.

•  All health care practitioners and staff of our practice will adhere to any restrictions concerning the use or disclosure of PHI that patients/clients have requested and have been approved by our practice.

•  All health care practitioners and staff of our practice must adhere to this policy. Our practice will not tolerate violations of this policy. Violation of this policy is grounds for disciplinary action, up to and including termination of employment and criminal or professional sanctions in accordance with our practice's personnel rules and regulations.

•  Our practice may change this privacy policy in the future. Any changes will be effective upon the release of a revised privacy policy and will be made available to patients/clients upon request.

PRIVACY PROCEDURE

Privacy Policy:   Our practice recognizes and respects the fact that the patient/client has a right to inspect and obtain a copy of his/her Protected Health Information (PHI).

Privacy Procedures to accomplish this Privacy Policy

•  The Privacy Officer will provide the front office staff with an original form for patients/clients to complete when the patient/client desires to inspect and copy his/her PHI.

•  The front office staff will photocopy and make available to patients/clients the form to Inspect and Copy PHI.

•  The front office staff will respond to patients'/clients' requests and questions concerning inspecting and copying their PHI. In addition, the front office staff will distribute the form to the patients/clients upon their request.

•  Once the patient/client completes the form, the front office staff should forward the form to the Privacy Officer for review.

•  Once the patient/client has submitted his/her request in writing (using the practice's form is optional), the front office staff must verify that the patient's/client's signature matches his/her signature on file.

•  The Privacy Officer must review the patient's/client's request and respond to the patient/client within 30 days from the date of the request. The Privacy Officer can request an addition 30-day extension as long as the request is made to the patient/client in writing with the reason for the delay clearly explained.

•  The Privacy Officer should agree to all reasonable requests. If access is denied, the Privacy Officer must provide the patient/client with an explanation for the denial as well as a description of the patient's/client's review appeal.

•  When the patient/client has requested to inspect their PHI and his/her request has been accepted, the Privacy Officer or other authorized practice representative should accompany the patient/client to a private area to inspect his/her records. After the patient/client inspects the record, the Privacy Officer will note in the record the date and time of the inspection, and whether the patient/client made any requests for amendments or changes to the record.

              When the patient's/client's request to copy his/her PHI has been accepted, the front office staff should copy his/her record within 10 business days at a charge of $15.00 plus $ 0.10 per page.