HIPAA Privacy Statement

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Kid Talk
PO Box 34
Victoria, MN 55386

FAX: 952-443-9804
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Your case history and any other requested information must be received no later than one week before your scheduled appointment.

  • Notice of Privacy Practices

  • This notice describes how protected medical information about you may be used and disclosed and how you can gain access to this information.

  • PLEASE REVIEW IT CAREFULLY

  • The privacy of your health information is important to us. Kid Talk is required by law to maintain the security and confidentiality of your medical information as well as other identifiable information such as your name, address and telephone number. We are required to extend certain protections to your “Protected Health Information” (PHI) which includes any identifiable information about your past, present, or future health care services or payment of your health care. We are required by law to provide you with this notice regarding our legal duties and our privacy practices. We are required to abide by the terms of the notice currently in effect. We reserve the right to change our Privacy Practices and the terms of this notice at any time. For example, if privacy laws change, we will change our practices to comply with the law. Kid Talk will provide you, at your request, a copy of any revised Notice of Privacy Practices at the time of your appointment, in the mail, or you may view the revised Notice of Privacy Practices, which will be posted on our web site (www.kid-talk.com) and in our office.

  • USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

  • Kid Talk, is permitted to make uses and disclosures of your protected health information. For some of these purposes, we are required to obtain your consent. For others we may be required to obtain your individual authorization. In a limited number of circumstances we will be authorized by law to disclose your protected health information without your consent or authorization.

  • Following is a description of these uses and disclosures:

  • a. For treatment- We may use or disclose your protected health information to provide and coordinate your care and treatment and any other related services. For example, we will disclose your protected health information as necessary to a health care provider or agency that provides care to you. We may also provide your protected health information to a specialist that is involved in your care by providing assistance with diagnosis or treatment.

    b. For payment- We may disclose your health information to coordinate claims processing and payment from third party payors. This may include activities such as needed for your health plan to determine eligibility and, benefits and utilization review activities. Information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures and supplies used.

    c. For health care operations- We may disclose your health information to support the business activities of Kid Talk. These activities include but are not limited to, quality assessment activities, employee and health care professional review activities, staff training, and other business activities. For example, we may disclose you protected health information by calling you by name in clinic areas. We may also disclose your PHI to Kid Talk business associated that perform activities and conduct health care operations on behalf of Kid Talk.

  • MINNESOTA PATIENT CONSENT FOR DISCLOSURES

  • For some disclosures described above we are required by Minnesota law to obtain written consent from you.

  • OTHER USES AND DISCLOSURES

  • Kid Talk is permitted or required, under specific circumstances, to use or disclose protected health information without your written authorization. These disclosures include those required by law such as:

    a. for public health issues such as for reporting of certain communicable diseases or to the state immunization registry.

    b. for reporting of abuse or neglect

    c. to government agencies authorized to conduct audits or investigations such as to the Food and Drug Administration for reporting adverse events, or recalls of products.

    d. for legal proceedings in response to a court order, and in certain circumstances in response to a subpoena, discovery request or other lawful process

    e. to law enforcement officials in response to a warrant, for the purpose of identifying or locating a suspect, witness or missing person or to provide information concerning victims of crimes

    f. to researchers if certain measures are taken to protect your health information

    g. to the extent necessary to avoid a serious health threat to your health or safety or to the health or safety of others

    h. to armed forces personnel under certain circumstances ad to authorized federal official for national security and intelligence

    i. to your correctional facility to help provide your health care or to provide safety to your or others, if you are an inmate at a correctional facility

    j. as required by workers compensation laws

    k. to the Secretary of the Department of Health and Human Services to investigate or determine compliance with the federal requirements for PHI.

    Other uses and disclosures will be made only with your written authorization, unless otherwise permitted by law and you may revoke such authorization in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect.

  • Kid Talk may engage in the following activity:

  • a. Kid Talk may contact you by telephone or mail to provide test results, appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

  • YOUR INDIVIDUAL RIGHTS

  • a. The right to request restrictions on certain uses and disclosures of PHI. This means you may ask us not to use or disclose any part of your PHI. Your request must be in writing and specific in describing the restriction request and to whom the restriction applies. Kid Talk is not required to agree to a requested restriction, however , if your provider believes it is not in your best interest to restrict the information, your PHI will not be restricted and you will be notified of this in writing. If your provider does agree to the restriction you will be notified of this in writing and Kid Talk will not use or disclose your PHI in violation of that restriction unless it is to provide emergency medical treatment.

    b. Periodically, we may contact you by phone, or other means to the location identified in our records. You have the right to receive confidential communications of PHI form use by alternative means or at an alternative location. We will make every effort to accommodate reasonable requests to communicate with you. We will not request an explanation from you related to the basis for the request, however, for our records, we will need your request in writing. It is important that you understand that any payment or payment information may be sent to the original address in our records unless you discuss alternative payment options with our business office.

    c. The right to inspect and copy PHI, as provided in the Privacy Regulation. You may receive a copy of the PHI contained in your “designated record set” by requesting it in writing. A designated record set includes medical and billing record and any other records that Kid Talk uses to make health care decisions about you, with some specific exceptions. For example, if your provider determines that your records are sensitive, we may not give you access to these records. If your request is denied, we will respond to you in writing explaining why we cannot grant your request and describing your right to request a review of our denial.

    d. The right to ask Kid Talk to amend protected health information that is contained in your “designated record set” as provided in the Privacy Regulation. For our records, the request must be in writing and we ask that it explain, in as much detail as possible, your reason(s) for the amendment and include any supporting documentation if appropriate. In certain circumstances Kid Talk may deny your request for amendment. These include:

    * Kid Talk does not have the records you want amended

    * Kid Talk did not create the records that you want amended.

    * Kid Talk determines that the records are accurate and complete

    * The records have been compiled in anticipation of a civil, criminal or administrative action or proceeding

    If Kid Talk denies your request for amendment we will notify you of this in writing. You have the right to file a written statement of disagreement with us and we have the right to rubut that statement.

    e. The right to receive an accounting of disclosures of PHI. You may request, in writing, information about the times we have disclosed your PHI for any purpose other that the following exceptions:

    * Treatment, payment or health care operations as described previously

    * Disclosures that you or your person representative have authorized.

    * Certain other disclosures such as disclosures for national security purposes. The requirement that we provide you with information about the times we have disclosed your PHI applies for six years from the date of the disclosure. This applies to disclosures made on or after April 14, 2003.

    f. The right to obtain a paper copy of the Notice from Kid Talk, upon request. This right extends to an individual who has agreed to receive the Notice electronically.

    Individuals may complain to Kid Talk and/or to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:

    If you feel we may have violated your privacy rights, or you disagree with the decision we made about access to your protected health information, you may either:

    Contact Kid Talk’s Privacy Officer at:
    Kid Talk
    Attn: Privacy Officer
    952-443-9888
    1772 Steiger Lake Lane
    PO Box 34
    Victoria, MN 55386
    OR

    Secretary of Health and Human Services Telephone: 1-
    800-368-1019
    Medical Privacy Complaint Division
    Office of Civil Rights
    U.S. Dept of Health and Human Services
    200 Independence Ave SW
    Room 509F, HHH Building
    Washington, DC 20201
    THIS NOTICE IS FIRST IN EFFECT ON APRIL 14, 2003

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