privacy_policy
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.
Your health information is private, and no one without a legitimate need to know may have
access to it. Vivo Integrative Medicine of Kansas City, LLC (“Practice”) is required by law to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. In the unlikely event that your health information becomes unsecured, Practice will provide you with prompt notification.
Practice will not use or disclose your health information except as described in this Notice of Privacy Practices (“Notice”). This Notice applies to all of the medical records generated
during your treatment at Practice.
EXAMPLES OF DISCLOSURE FOR TREATMENT, PAYMENT AND HEALTH
OPERATIONS
The following categories describe the ways that Practice may use and disclose your health
information:
Treatment: Practice will use your health information in the provision and coordination of
your healthcare. We may disclose all or any portion of your medical record information to
your physician, consulting physician(s), nurses and other healthcare providers who have a
legitimate need for such information in the care and continued treatment of the patient. For
example, a healthcare provider treating you for an injury can ask another healthcare provider about your overall health condition.
Payment: Practice may release medical information about you for the purposes of
determining coverage, billing, claims management, medical data processing and
reimbursement. The information may be released to an insurance company, third-party payor
or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your medical record that are necessary for payment of your account. For example, to the extent Practice bills for services it provides to you, a bill sent to a third-party payor may include information that identifies you, your diagnosis, the procedures and supplies used.
Routine Healthcare Operations: Practice may use and disclose your medical information
during routine health care operations to run our practice, improve your care, and contact you when necessary. For example, we can use your health information to manage your treatment
and services.
Business Associates: Practice may use and disclose certain health information about you to its business associates. A business associate is an individual or entity under contract with Practice to perform or assist Practice in a function or activity that necessitates the use or disclosure of medical information. Examples of business associates include but are not limited to, a copy service used by the Clinic to copy medical records, consultants, independent contractors, accountants, lawyers, medical transcriptionists and third-party billing companies. Practice requires the business associate to protect the confidentiality of your medical information. In addition, Practice requires any subcontractor of Practice’s
business associate to protect the confidentiality of your medical information.
Regulatory Agencies: Practice may disclose your medical information to public health or
legal authorities charged with preventing or controlling disease, injury or disability. For
example, billing practices may be audited by the State Auditor and records are subject to
review by the Secretary of Health and Human Services and his/her authorized
representatives.
Workers’ Compensation: Practice may release medical information about you for workers’
compensation or similar programs that provide benefits for work-related injuries or illnesses.
Military Veterans: Practice may disclose your medical information as required by military
command authorities if you are a member of the armed forces.
Inmates: If you are an inmate of a correctional institution or under the custody of a law
enforcement officer, Practice may release your medical information to the correctional
institution or law enforcement official.
Organ and Tissue Donation Requests: Medical information can be shared with organ
procurement organizations.
Medical Examiner or Funeral Director: Medical information can be shared with a coroner,
medical examiner, or funeral director when an individual dies.
Required by Law: Practice will disclose medical information about you when required to do
so by law, for example, responding to lawsuits and legal actions.
Other Uses: Any other uses and disclosures will be made only with your written
authorization.
PATIENT INFORMATION RIGHTS
Although all records concerning your treatment obtained at Practice are the property of Practice, you have the following rights concerning your medical information:
Right to Confidential Communications: You have the right to receive confidential
communications of your medical information by alternative means or at alternative locations.
For example, you may request that Practice contact you only at work or by mail.
Right to Inspect and Copy: You have the right to inspect and copy your medical
information.
Right to Amend: You have the right to amend your medical information. Any request for
amendment should be submitted to Practice in writing, stating a reason in support of the
amendment.
Right to an Accounting: You have the right to obtain an accounting of the disclosures of
your medical information made during the preceding six (6) year period.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your medical information. Practice is not required to honor your request
except where: (i) the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law, and (ii) the medical information pertains
solely to a healthcare item or service for which you, or person other than the health plan on
your behalf, has paid Practice in full.
Right to Receive a Paper Copy: You have the right to receive a paper copy of this Notice.
Right to Receive Electronic Copies: You have the right to receive electronic copies of
your medical information.
Right to Choose Someone to Act For You: If you have given someone medical power of
attorney or if someone is your legal guardian, that person can exercise your rights and
make choices about your health information.
Right to Revoke Authorization: You have the right to revoke your authorization to use or
disclose your medical information, except to the extent that action has already been taken
in reliance on your authorization. A request to exercise any of these rights must be
submitted, in writing, to Practice at 6801 East 187 th Street, Belton, MO, 64012, or by
contacting Practice at (816) 237-0414.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact our office at
816-237-0414. If you believe your privacy rights have been violated, you may file a complaint
with us by calling 816-237-0414 and with the U.S. Department of Health and Human Services
Office for Civil Rights by calling 1-800-368-1019, visiting
https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf, emailing OCRComplaint@hhs.gov, or
sending a letter to:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
We will not retaliate against you for filing a complaint.
CHANGES TO THIS NOTICE
Practice will abide by the terms of the Notice currently in effect. Practice reserves the right to
change the terms of its Notice and to make the new Notice provisions effective for all health
information that it maintains. An updated version of the Notice may be obtained at Practice.
I certify that I have received a copy of Vivo Integrative Medicine of Kansas City, LLC’s
(“Practice”) Notice of Privacy Practices. The Notice of Privacy Practices describes the types of
uses and disclosures of my protected health information that might occur in my treatment,
payment of my bills or in the performance of Practice’s health care operations. The Notice of
Privacy Practices also describes my rights and Practice’s duties with respect to my protected
health information. The Notice of Privacy Practices is also posted in the Front Desk area and on
Practice’s website at https://vivointegrativekc.com/
Vivo Integrative Medicine of Kansas City, LLC, reserves the right to change the privacy
practices that are described in the Notice of Privacy Practices. I may obtain a revised Notice of
Privacy Practices by calling the office and requesting a revised copy be sent in the mail, asking
for one at the time of my next appointment, or accessing Practice’s website.
