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 provider, Kalin Johnson, will use and distribute this Notice as a Notice of Privacy Practices and follow the information practices described in this Notice when using or disclosing records and information. She will share your health information with other providers with your signed consent, as necessary, to carry out treatment, payment, or health care operations as described in this Notice.
Understanding Your Health Information
Each time you have a session appointment with Kalin Johnson, a record of your visit is made. Typically, this health record contains your medical history, symptoms, examination and test results, diagnosis, treatment, care plan, billing, and employment information. This health information, often referred to as your health record, serves as a basis for planning your care and treatment and is a vital means of communication among the many health professionals who contribute to your health care.
Kalin’s Responsibility
Kalin is required by law to:
Maintain the privacy of your health information during your lifetime and for 50 years following your death.
Provide you with an additional current copy of our Notice upon request.
Abide by the terms of the current Notice.
Notify you following a breach of unsecured protected health information in the event you are affected.
We (we is defined as Kalin Johnson, your provider, throughout this notice) will not use or disclose your health information without your written authorization, except as described in this Notice.
Uses And Disclosures Without Your Written Authorization
We may use and disclose your health information without your written authorization for Treatment, Payment and Health Care Operations
Kalin will use and disclose your health information for treatment purposes
For example: Information obtained by a nurse, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment. Health care team members will communicate with one another personally and through the health record to coordinate care provided. Kalin will also provide your physician or subsequent health care provider with copies of various reports that should assist him or her in treating you in the future.
Kalin will use and disclose your health information for payment purposes
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may disclose health information about you to other qualified parties for their payment purposes.
Kalin will use and disclose your health information for health care operations
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of health care Kalin provides.
Health Information Exchange
We may make your protected health information available electronically through an information exchange service to other health care providers, health plans and health care clearinghouses that request your information. Participation in information exchange services also lets us see their information about you.
Teaching
Kalin values guiding future healthcare professionals and may have students shadowing appointments. As a teaching site, the student may be assisting with your care under the supervision of Kalin and other licensed health care providers as a part of their professional health care training program. Kalin will give you notice if a student will be present at an appointment. You may decline to have the student there and can do so verbally or in writing to Kalin.
Other Uses and Disclosures of your health information without your written authorization
Notification
Kalin may use or disclose health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care of your location and general condition.
Communication With Family and Others
Kalin may disclose relevant health information to a family member, friend, or other person involved in your care. Kalin will only disclose this information if you agree, are given the opportunity to object and do not, or if in our professional judgment, it would be in your best interest to allow the person to receive the information or act on your behalf.
Business Associates
There are some services provided in our organization through contracts with business associates and electronic health record software. When these services are contracted, we may disclose your health information to our business associates so that they can perform such services. However, we require the business associate to appropriately safeguard your information.
Appointment Reminders
We may contact you as a reminder that you have an appointment for treatment or medical care.
Treatment Alternatives
We may contact you about treatment alternatives or other health-related benefits and services that may be of interest to you.
Research
Research is conducted under strict Institutional Review Board (IRB) guidelines designed to protect the subjects of research. For actual research studies we will obtain your specific authorization, if information that directly identifies you is disclosed. The only exception would be circumstances when the IRB grants a waiver of authorization as permitted under federal guidelines.
Public Health
We may disclose health information about you for public health activities. These activities may include disclosures:
To a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability;
To appropriate authorities authorized to receive reports of abuse and neglect;
To FDA-regulated entities for purposes of monitoring or reporting the quality, safety or effectiveness of FDA-regulated products; or
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Workers’ Compensation
We may disclose health information to the extent authorized and necessary to comply with laws relating to workers’ compensation or other similar programs established by law.
Correctional Institutions
If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose to the correctional institution, its agents or the law enforcement official your health information necessary for your health or the health and safety of other individuals.
Law Enforcement
We may disclose your health information for law enforcement purposes:
At the request of a law enforcement official and in response to a subpoena, court order, investigative demand or other lawful process;
If we believe it is evidence of criminal conduct occurring during our sessions;
If you are a victim of crime and we obtain your agreement, or under certain circumstances, if we are unable to obtain your agreement;
To identify or locate a suspect, fugitive, material witness or missing person;
To alert authorities that a death may be the result of criminal conduct;
To report a crime, the location of the crime or victim, or the identity, description or location of the person who committed the crime.
Health Oversight Activities
We may disclose health information for health oversight activities authorized by law. For example, oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Threats to Health or Safety
Under certain circumstances, we may use or disclose your health information if we believe it is necessary to avert or lessen a serious threat to health and safety and is to a person reasonably able to prevent or lessen the threat or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.
Specialized Government Functions
We may disclose your information for national security and intelligence activities authorized by law, for protective services of the president; or if you are a military member, to the military under limited circumstances.
As Required by Law
We will use or disclose your health information as required by federal, State or local law.
Lawsuits and Administrative Proceedings
We may release your health information in response to a court or administrative order. We may also provide your information in response to a subpoena or other discovery request, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Incidental Uses and Disclosures
There are certain incidental uses or disclosures of your health information that occur while we are providing services to you or conducting our business. Kalin will make reasonable efforts to limit these incidental uses and disclosures.
Uses And Disclosures That Require Your Written Authorization
The following uses and disclosures will only be made with your written authorization:
Uses and disclosures not listed above as permitted without your written authorization;
most uses and disclosures of psychotherapy notes; and
uses and disclosures for marketing purposes.
Your authorization may be revoked in writing at any time except with respect to any actions we have taken in reliance on it.
Your Health Information Rights
You have the following rights regarding your health information:
Right to Inspect and Copy
You may request to look at your medical and billing records and obtain a copy. You must submit your medical records request in writing to Kalin Johnson. If you ask for a copy of your records, we may charge you a copying fee plus postage. If we maintain an electronic health record about you, you have the right to request your copy in electronic format.
Right to Request Amendment
You may request that your health information be amended if you feel that the information is not correct. Your request must be in writing and provide rationale for the amendment. Please send your request to Kalin Johnson. We may deny your request, and will notify you of our decision in writing.
Right to an Accounting of Disclosures
You may request an accounting of certain disclosures of your health information showing with whom your health information has been shared (does not apply to disclosures to you, with your authorization, for treatment, payment or health care operations, and in certain other cases).
To request an accounting of disclosures, you must send a written request to Kalin Johnson. Your request must state a time period that may not be longer than six years.
Right to Request Restrictions
You may request restrictions on how your health information is used for treatment, payment or health care operations or disclosed to certain family members or others who are involved in your care. If we agree to a voluntary restriction, the restriction may be lifted if use of the information is necessary to provide emergency treatment.
To request a restriction, you must send a written request to Kalin Johnson, specifying what information you wish to restrict and to whom the restriction applies. You will receive a written response to your request.
Right to Request Private Communications
Communications with Kalin Johnson will take place on a privacy protected telehealth platform, professional email, and privacy protected electronic health record messaging. You may request that we communicate with you in a certain way in a certain location. You must make your request in writing to Kalin Johnson and explain how or where you wish to be contacted.
Right to a Paper Copy of this Notice
You may request an additional paper copy of this Notice at any time from Kalin Johnson.
You may contact Kalin Johnson at:
KalinPharmD@gmail.com
Phone: (785)633-4059
Hours: Mon-Thurs 9:30 a.m. - 4:00 p.m. CST
Changes to this Notice
Kalin Johnson reserves the right to change this Notice as the privacy practices change and to make the new provisions effective for all health information we maintain. We will send you the updated Notice via email or electronic health record.
For More Information or Questions, You May Contact Kalin Johnson.