New Birth Company - Overland Park
9209 West 110th Street
Overland Park, Kansas 66210
New Birth Company - Kansas City, KS
721 North 31st Street, #100
Kansas City, KS 66102
This notice describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for the purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Your protected health information may be used and disclosed by your health care provider, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of our office, and any other use required by law.
Treatment- we will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. Our records are kept by means of electronic medical record (EMR). Transmission of PHI may be done by electronic means such as email. This includes the coordination or management of your health care with a third party. For example, your PHI may be provided to a physician or other provider to whom you have been referred to ensure that the provider has the necessary information to diagnose or treat you.
Payment – Your PHI will be used, as needed, to obtain payment for your health care services. Our clinic is fee-for-service, meaning cash, check, or credit card payment is expected at time of service. We will only file claims on your behalf with your insurance plan if we are included in their network.
Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our office. These activities include, but are not limited to, quality assurance activities, employee review activities, training of medical and/or nursing students, licensing, and conducting or arranging for other business activities. For example, we may disclose your PHI to medical or nursing students that assist in your care in our office. We may also call you by name in the waiting room when the provider is ready to see you.
Research-New Birth Company participates in the American Association of Birth Centers Perinatal Data Registry. The purpose is to a)help improve and maintain quality of care of childbearing families; provide for ongoing and systematic collection of data on normal birth; and facilitate research on maternity care practices that support normal birth. No identifying information is used. More information about the project can be found on the attached information sheet.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: International Travel: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures – These will be made only with your consent, authorization or opportunity to object unless required by law.
Authorization- You may revoke this authorization, at any time, in writing, except to the extent that your provider or provider’s office has taken an action in reliance on the use or disclosure indicated in the authorization.
Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of or use in a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want this restriction to apply.
Your provider is not required to a restriction that you may request. If the provider believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another healthcare professional.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e. electronically.
You may have the right to have your provider amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this notice and will inform you of any changes made. You then have the right to object or withdraw as provided in this notice.
Complaints – You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint by notifying our clinic director of your complaint. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with the clinic director in person or by phone at (913) 735-4888.
Your signature below is your acknowledgment that you have been provided and reviewed our Notice of Privacy Practices. Your signature will be kept on file.
I understand that during the transfer of care for any purpose (request records/ travel copies/change of provider/ future care) my prenatal records may include personal information on diagnostic results such as HIV or other sexually transmitted diseases. I consent to these records being transferred. I understand that during transfer of care for any purpose( request records/ travel copies/ change of provider/ future care) my prenatal records may include personal information on mental health concerns such as substance abuse, depression and anxiety.
AABC Perinatal Data Registry consent statement: I have read or had read to me the preceding information describing the project. All of my questions have been answered to my satisfaction. I am 18 years of age or older, or am considered an “emancipated minor” because I am pregnant. I freely consent to participate, and also give permission for data about my newborn to be used. I understand that I am free to withdraw from the project at any time without penalty. I understand that my care during pregnancy will not be affected in any way by whether or not I participate in this project. I have received a copy of this consent form.
Many of our patients allow family members such as their spouse or partner to reschedule appointments and review financial information on their behalf. Under HIPAA we are not allowed to give this information to anyone without your consent. You are giving NBC permission to leave a detailed message with the following person regarding health treatment, scheduling appointments or financial information.
New Birth Company offers secure viewing as a service to patients who wish to view parts of their health records electronically. Health information can only be read by someone who knows the right password or pass-phrase to log in to the portal site. This method of viewing prevents unauthorized parties from being able to access your information. Only you can make sure these two factors are present. We need you to make sure we have your correct email address and are informed if it ever changes. You also need to keep track of who has access to your email account so that only you, or someone you authorize, can see the messages you receive from us. You may receive a copy of your health records via email if you consent to the use of email.
I acknowledge that I have read and fully understand the consent to access the New Birth Company patient portal and the policies and procedures regarding the Patient Portal that appears at log in. I understand the risks associated with viewing information on the internet and consent to the conditions outlined herein. In addition, I agree to follow the instructions set forth herein and including the policies and procedures as set forth in the patient portal log in screen. I agree New Birth Company may send a copy of my health records to my email address on file if I request an electronic copy of my records, All of my questions have been answered and I understand and concur with the information provided in the answers.