Terms and Conditions of Use
This web site is intended as an educational resource for physicians, patients, and the community and provides only an overview of the services offered by Kitsap Cardiology Consultants, PLLC. It is not intended to serve as or replace an evaluation by a health care provider.
Kitsap Cardiology Consultants, PLLC, (“KCC”) makes this website, including all information, documents, photographs, graphics, and other materials available through this website and all services operated by KCC and third parties through this website, available to the general public for informational purposes only.
The KCC web site may contain links to sites on the Internet that are owned and operated by third parties (“External Sites”). You acknowledge that KCC is not responsible for the availability of, or the content located on or through, any External Sites. KCC is providing these links to you only as a convenience, and the inclusion of any link does not imply endorsement by KCC of the site.
You acknowledge that this web site contains information, documents, photographs, graphics, and other materials (collectively, “Content”) that are protected by copyright, trademark or other proprietary rights of KCC or third parties. All Content on the web site is copyrighted as a collective work of KCC pursuant to applicable copyright law. Users of the web site may use the Content only for their personal, noncommercial use.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who does this Notice apply to?
This notice has been published by KCC. It applies guidelines to be followed by everyone who works for KCC, including our physicians, employees, contractors, and volunteers regarding your health care information.
Why do we publish this Notice?
As medical professionals, we understand that information about you and your health is sensitive and personal. We are required by law to maintain the privacy of information we gather and use about our patients, and provide them with notices of our legal duties and privacy practices with respect to their information.
We are committed to the privacy of our patients’ information. In order to serve them we need to gather, keep and use records of this information. We may also need to share information with other parties. This Notice is intended to let you know how we use and disclose your information.
This Notice is to let you know about certain legal rights you have with respect to the information we hold about you. You have the right to review and obtain a copy our records of information about you. You may request that we amend these records, and may ask us to account for certain disclosures we may have made. (These types of disclosure require your signature before releasing your information.) We will not give nor sell your Protected Health Information for any reason, except for means for Treatment, Payment, and Health Care Operations.
Why do we have you sign a Sign a Consent Form?
We would like to give you the best care possible. We are required to obtain consent for us to treat you. Also, we would like for you to give us your consent to bill your insurance and certain necessary health care operation activities. We may not be able to provide you care if you refuse to sign the consent form.
We may use and disclose your health information in the following ways:
- We may use or disclose information about you for treatment purposes to doctors, nurses, technicians, medical students and/or other individuals who work in our practice and are involved in providing you with health care. We may also disclose information about you to organizations and individuals involved in your care who are outside our practice, such as; consulting physicians, laboratories, social workers, and so on.
- Example: We may provide records when we refer you to another physician, send you for surgery, etc.
- Example: We may request records from any doctors you have seen recently, to coordinate with the care that they provide you.
- These are only examples, and there may be many other ways in which we may use or disclose information about you to ensure proper treatment.
- We may use or disclose information about you for payment purposes to our clerks in the billing and claims payment department. We may also disclose such information to your health plan or other party financially responsible for your care. Also we may need to utilize a debt collection company to collect on any unpaid balances.
- Example: If you are covered by a health plan, we cannot get paid for the services we provide you unless we submit information in a claim. This might include detailed clinical information, depending on the kind of plan or claim.
- Example: If you need a procedure that may need a pre-authorization, we may call your insurance to see if it is a covered benefit. This may include giving them a diagnosis.
- These are only examples, and there may be many other ways in which we may use or disclose information about you in connection with payment for your care.
- Health Care Operations
- We may use or disclose information about you for operational functions in connection with our practice. These activities might include practice quality improvement, training of medical students, insurance underwriting, medical or legal review, and business planning or administration of our practice.
- Example: We may wish to review the quality of care you receive, in order to help us deliver the best care we can. We may audit our management practices in order to become more efficient.
- Release of information to family and friends
- We may, unless you object, using our best judgment, disclose information to a family member, other relatives, close personal friends and/or any other person you identify as having a relevant involvement in your care or payment related to your care.
- Appointment reminders
- We may, unless you object, contact you to provide you with appointment reminders by phone and/or mail. We may leave a message on an answering machine and/or with whomever answers the phone. We may mail or call you with information about treatment alternatives or other health related benefits and services that may be of interest to you.
Disclosures required by Law
Our practice will use and disclose your information when we are legally required to do so by Federal, State, or Local Law. The following do not need your consent to release your information:
Public Health Risks
- To prevent or control disease, injury or disability.
- To report births or deaths.
- To report child abuse or neglect.
- To report reactions to medications or problems with products
- To notify people of product recalls.
- 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.
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only disclose this if you agree or when required by law.
Under applicable Federal and State laws, we may disclose your protected health information if we believe that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose your protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military and Veterans
We may release protected health information about you as required by military command authorities for activities believed necessary to determine fitness for duty, eligibility for VA benefits, or to a foreign military authority if you are a member of that foreign military service.
We may disclose your protected health information to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or other officials including foreign heads of state, or to conduct special investigations.
We may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. These health oversight agencies might include government agencies that oversee the health care system; government benefits programs, other government regulatory programs and civil rights laws.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court order or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Inmates If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety; (3) for the safety and security of the correctional institution.
Coroner, Medical Examiners and Funeral Directors
We may release protected health information to a coroner or medical examiner, to identify a deceased person or determine the cause of death. If necessary, we may also release protected health information in order for funeral directors to carry out their duties.
Organ and Tissue Donation
If you are an organ donor, we may release your protected health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ banks, as necessary to facilitate organ or tissue donation and transplantation.
We may disclose your protected health information to researchers when authorized by law or for example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
What legal rights do you have in connection with your information?
By law your are entitled the:
Right to Request Further Restriction
You may request further restriction or limitation on the medical information we use or disclose about you for treatment, payment and health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as family members or 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.
How to request restrictions
Ask the receptionist for the “Further Restriction of Use and Disclosure” form.
Right to Request Alternate Communications
You may request that we communicate with you using alternative means or at an alternative location. Billing information will be sent to the address given on your profile. Other communications, phone calls, appointment reminders, results, etc. may be contacted in an alternative way.
How to request for alternate communications
Ask the receptionist for the “Alternate Communication Request” form.
Right to Record Inspection and Copies
You may inspect and obtain a copy of the protected health information that may be used to make decisions about you. This includes your medical and billing records, but does not include psychotherapy notes. Our practice may charge a fee for costs for copying, mailing, labor and supplies associated with your request.
How to request to inspect and/or obtain a copy of your records
Ask the receptionist for the “Authorization to Disclose Health Care Information” form. The form will ask you to make an appointment with medical records.
Right to Amendments
You may ask us to amend your health information if you believe it is incorrect or incomplete. We may deny your request for an amendment if it does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment, (2) is not part of the medical information kept by this practice, (3) is not part of the information, which you would be permitted to inspect and copy, and (4) is accurate and complete.
How to request and amendment
Ask the receptionist for the “Amendment Request” form.
Right to an Accounting of Disclosure
You may request an accounting of disclosures. This is a list of non-routine disclosures that we made about you regarding medical information. The request must state a time period, which may be no longer than six years, and may not included dates prior to 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. We will notify you of the costs involved with additional requests and you may withdraw your request before you incur any costs.
How to request an accounting of disclosures
Ask the receptionist for the “Request for an Accounting of Disclosure” form.
Right to Authorize Other Uses and Disclosures
Other uses and disclosures of medical information not covered by this Privacy Notice or the laws that apply to us will be made only with your written authorization/consent/permission. If you provide us with permission to use or disclose medical information about you, and subsequently desire to revoke that authorization you may do so at any time in writing to our practice. If you revoke the authorization, we will no longer use or disclose medical information about you for the reasons described in your written authorization. Our practice will not be able to take back any disclosures we have already made with your permission.
Right to a Paper Copy of this Privacy Notice
You may request to have a paper copy of this Privacy Notice from our practice at any time.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with the address below.
Contact AddressKitsap Cardiology Consultants, P.L.L.C.
2709 Hemlock Street
Bremerton, WA 98310
360-373-2547 Clinic Administrator, Mary Berglind
Compliance Officer, Brandi D.
You may also file a complaint with the Human Health Services Office for Civil Rights (OCR). The instructions on how to file are listed below.
- It must be in writing, either on paper or electronically
- It must name Kitsap Cardiology Consultants, and describe the acts or omissions that you believe violate the HIPAA privacy regulations
- It must be filed within 180 days of when you knew or should have known that the act or omission you’re complaining of occurred (unless you show good cause why the Secretary of HHS should waive the time limit and the Secretary does waive it).
Linda Yuu Connor, Regional Manager
2201 Sixth Ave., Suite 900
Seattle, WA 98121-1831
TEL. (206) 615-2287
FAX (206) 615-2297
TDD (206) 615-2296
— OR —OCR HEAHQUARTERS
Robinsue Frohboese, Acting Director
Office for Civil Rights
U.S. Dept. of Health and Human Services
200 Independence Ave SW
Rm. 509F, HHH Bldg.
Washington, DC 20201
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