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Notice of Information 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.

During the course of your treatment here, various types of information about you will be collected and maintained in your clinical record. Generally, such information is closely protected by state and federal laws guarding the privacy and confidentiality of that information. The use and disclosure of that information, (with exceptions noted below), will be made only with the client’s written authorization and the client may revoke that authorization at any time in writing.

The exceptions would include: 1. Treatment, payment, and healthcare operations: access to your record will be granted to Center staff on a “need to know basis,” that is, all Center staff assisting you in your treatment will be granted access as will appropriate members of the business office who may need to access certain information for billing purposes. Additionally, certain, select staff members will also have access as needed to carry out such functions as quality assurance, (e.g., peer review, risk management, corporate compliance, etc.), and provided as required by the client’s insurance/funding source. In these cases the client has the right to request restrictions on use and disclosure of such information. However, The Center may not be able to grant a particular request and would, therefore, be under no legal obligation to do so. 2. State statutes require that suspected cases of abuse or neglect of children and dependent adults be reported to the appropriate agency. 3. Threats of imminent harm to oneself or others may necessitate the exchange of sufficient information with appropriate parties as to prevent harm from occurring. 4. Client information may also be released without authorization when ordered by a court or administrative tribunal.

Additionally, The Center may have need to contact the client by such means as letter, telephone, or e-mail to provide appointment information. The client may request limitations to such contact, (in writing).

The client has the right to inspect, copy, and request corrections to the record. Such rights are exercised via written format and the client may do so by contracting his/her provider of services here. The Center may limit that right if it believes access to the record could be detrimental to the welfare of the client or others. Any denial of the above right will be made in writing to the client and the client may appeal that denial to The Center’s executive director. Additionally, the client may complain regarding any denials or concerns about breaches in privacy or confidentiality to the United States Department of Health and Human Services. The Center will not act punitively toward any client who wishes to make such a complaint.

The Center is required by law to abide by the terms of this notice. Should the terms change at any point in the future, The Center will provide revised notice to the client. Should you wish further information related to these terms, please contact either The Center’s executive director or its quality assurance coordinator at (620) 792-2544.

To file complaints with the U.S. Secretary of Health and Human Services, contact the office of Civil Rights at:

Office for Civil Rights US Dept. of Health & Human Services 601 E. 12th St., Room #248 Kansas City, MO 67106 1-816-726-7278

Date of statement’s implementation: March 13, 2003