Notice of Privacy Practices

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.

We respect the confidentiality of your health information and will protect it in a responsible and professional manner. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to protect the privacy of Protected Health Information (Your Information) and to make this notice available to you.

This notice describes how we may use and share Your Information to carry out payment and health care operations. And, it describes how we may use and share Your Information for other purposes that are permitted or required by law. In the event uses or disclosures of Your Information described in this notice are prohibited or materially limited by other applicable law in your state we will comply with that more stringent law.

We abide by the terms of this notice. If we materially change the terms of this notice we will mail you a copy of the revised notice if you are still an active patient of our medical practice. Copies of our current notice may be obtained by contacting us at the telephone number, address below.

It is not necessary for you to take any action as a result of this notice unless you wish to exercise one or more of your rights as explained under the Rights That You Have section.


How we use or share your information

The following are different ways that we use and share Your Information:

Your Authorization
Except as described below, we will not use or share Your Information unless you have signed a form telling us we can. You may revoke your authorization, in writing, but not for any information that we have already relied on. Nor may you revoke your authorization if signing it was a condition of obtaining insurance and we have the right, under other law, to contest a claim under the policy.

Use and Share for Payment
We may request, use, and share your protected health information (PHI) as necessary to file medical claims to your insurance company and other third-parties for the purpose of obtaining reimbursement for services rendered. As one example, we may use information regarding your medical procedures, diagnoses, and treatments in the submission of insurance claims.

Use and Share for Health Care Operation
We may use and share your protected health information (PHI) with others who help us conduct our business operations. Examples of business operations might be the transfer of PHI to contracted vendors such as clinical diagnostic laboratories, internet service provider, and database repository providers. We will not share Your Information with outside groups unless they agree to keep it protected.

Family and Friends Involved in Your Care
We may share your protected health information (PHI) with your family, friends, and others who are involved in your care or payment of a claim unless you can and do object. If we determine that a limited disclosure is in your best interest, we may share your PHI with such individuals, even if you are incapacitated or not available. For example, we may use our professional judgment to disclose information to your spouse concerning your medical care. If you do not wish us to share your PHI with your spouse or others, you may exercise your right to request a restriction on our disclosures of Your Information (see below).

Plan Sponsor
We may share Your Information with an employee benefit plan through which you receive health benefits. We will not share detailed health information with your benefit plan unless they promise us to keep it protected.

Other Products and Services

We may contact you to provide information about other health-related products and services that may be of interest to you. For example, we may contact you about other medical services, programs, and products that are offered through our medical practice such as fitness and weight loss programs, health assessments, and other health-related products and services.

Other Uses and Disclosures
Unless otherwise prohibited by law, we may, under certain circumstances, as described below make other uses and disclosures of your protected health information (PHI) without your authorization.

  • We may use or disclose your PHI for any purpose required by law. For example, to respond to a court order.
  • We may disclose your PHI for public health activities, such as reporting of disease, injury, birth and death, and for public health investigations.
  • We may disclose your PHI to the proper authorities if we suspect child abuse or neglect; we may also disclose your PHI if we believe you to be a victim of abuse, neglect, or domestic violence.
  • We may disclose your PHI if authorized by law to a government oversight agency (e.g., a state insurance department) conducting investigations, or civil or criminal proceedings.
  • We may disclose your PHI in the course of a judicial or administrative proceeding (e.g., to respond to a subpoena or discovery request).
  • We may disclose your PHI to the proper authorities for law enforcement purposes.
  • We may disclose your PHI to coroners, medical examiners, and/or funeral directors consistent with law.
  • We may use or disclose your PHI for cadaveric organ, eye or tissue donation.
  • We may use or disclose your PHI for research purposes, but only as permitted by law.
  • We may use or disclose your PHI to avert a serious threat to health or safety.
  • We may use or disclose your PHI if you are a member of the military as required by armed forces services, and we may also disclose Your Information for other specialized government functions such as national security or intelligence activities.
  • We may disclose your PHI to workers' compensation agencies for your workers' compensation benefit determination.
  • We will, if required by law, release your PHI to the Secretary of the Department of Health and Human Services for enforcement of HIPAA.


Rights That You Have

Access to Your Information
You have the right to inspect and obtain a copy of certain information that we maintain about you in your medical records. Your request must be in writing and signed by you. We may charge you a fee for copying and postage. You may request access request forms from us at the address below.

Amendments to Your Information
You have the right to request that your protected health information (PHI) be amended or corrected. We will give each request careful consideration but we are not required to amend your PHI. Your amendment request must be in writing, must be signed by you, and must state the reasons for the request. You may ask for amendment request forms from us at the address below.

Accounting for Disclosures of Your Information
You have the right to receive an accounting of certain disclosures of your protected health information (PHI) made by us during the six years prior to your request. Please note that we are not required to provide you with an accounting of the following information:

  • Any information collected prior to April 14, 2003;
  • Information disclosed or used for treatment, payment, and health care operations purposes;
  • Information disclosed to you or pursuant to your authorization;
  • Information that is incident to a use or disclosure otherwise permitted;
  • Information disclosed for a facility's directory or to persons involved in your care or other notification purposes;
  • Information disclosed for national security or intelligence purposes;
  • Information disclosed to correctional institutions, law enforcement officials or health oversight agencies;
  • Information that was disclosed or used as part of a limited data set for research, public health, or health care operations purposes.

To be considered, your requests must be in writing and signed by you.

Restrictions on Use and Disclosure of Your Information
You have the right to ask us to restrict how we use or disclose your protected health information (PHI) for insurance payment or health care operations purposes, or to family members and others who are involved in your health care or payment for your health care. We are not required to agree to your request but will attempt to honor reasonable requests.

We retain the right to terminate an agreed-to restriction if we believe it is appropriate. If we terminate the restriction we will notify you of such termination. You also have the right to terminate, in writing, any agreed-to restriction. You may request a restriction (or termination of an existing restriction) by contacting us at the address below.

Request for Confidential Communications
You have the right to ask to receive confidential communications regarding your protected health information (PHI). For example, if you think that you would be harmed if we left you a message on voice mail or sent information to a particular address, you can ask us to send the information by alternate means such as by fax or to an alternate address. Requests for confidential communications must be in writing, signed by you, and sent to us at the address below.

Right to a Paper Copy of the Notice
You have the right to a paper copy of this notice upon request by contacting us at the telephone or address below.

If you believe your privacy rights have been violated, you can file a complaint with us in writing at the address below. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C., within 180 days of a violation of your rights. Filing a complaint will not negatively impact your status as an insured or the services you receive from us.

Personal Representative
We will treat your personal representative as you, except where prohibited by law.



Protected Health Information (PHI) means information about you that we have collected and maintain and that identifies you, or reasonably could identify you, and that relates to:

  • your past, present, or future physical or mental health or condition;
  • the provision of health care to you; or
  • the past, present, or future payment for the provision of health care to you.

Protected Health Information includes that of persons living or dead.


For Further Information

If you have questions or need further assistance regarding this Notice, you may contact our Privacy Officer by writing to:

ProPartners Healthcare, P.A.
Attn: Privacy Officer
4501 College Boulevard, #300
Overland Park, KS  66211
(913) 451-4776


Effective Date

This Notice is effective April 14, 2003.