To our clients: This notice describes how health information about you, as a client of this clinic, may be used and disclosed, and how you can get access to your health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Our commitment to your privacy
Our clinic is dedicated to maintaining the privacy of your health information. Liberty Women’s Clinic strives to provide the very best care to our clients, and due to that fact, we have made a commitment to be HIPAA compliant. Liberty Women’s Clinic realizes that these regulations are complicated, but we must provide you with the following important information:
Use and disclosure of your health information in certain special circumstances:
The following circumstances may require us to use or disclose your health information:
Treatment: to provide, coordinate or manage your health care and related services. Liberty Women’s Clinic may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. Liberty Women’s Clinic may use or disclose protected health information about your treatment activities of another health provider.
Payment: Currently, Liberty Women’s Clinic provides all of its services at no cost. However, should Liberty Women’s Clinic begin providing other services that are fee based, we will adhere to the following regulations; Liberty Women’s Clinic may use or disclose protected health information so that Liberty Women’s Clinic can bill and collect payment for the treatment and services provided to you. Before providing treatment or services, Liberty Women’s Clinic may share details with your health plan concerning the services you are scheduled to receive for payment approval.
Health Care Operations: Liberty Women’s Clinic may use or disclose protected health information to allow us to improve the quality of care Liberty Women’s Clinic provides and to reduce health care costs, which may include training programs for our staff.
Cooperating with outside legal entities:
- To public health authorities and health oversight agencies that are authorized by law to collect information.
- Lawsuits and similar proceedings in response to a court of administrative order.
- If required to do so by a law enforcement official.
- When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
- Liberty Women’s Clinic will only make disclosures to a person or organization able to prevent the threat.
- If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
- To federal officials for intelligence and national security activities authorized by law.
- To correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.
- For workers compensation and similar programs.
Your rights regarding your health information:
Communications: You can request that Liberty Women’s Clinic communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that Liberty Women’s Clinic contact you at home, rather than work. Liberty Women’s Clinic will accommodate reasonable requests.
You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that Liberty Women’s Clinic restrict our disclosure of your health information to only certain individuals involved in your care of the payment for your care, such as family members and friends. Liberty Women’s Clinic is 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.
You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to our Privacy Official.
You may ask us to amend your health information if you believe it is incorrect or incomplete, and as long as the information is kept by/for our clinic. To request an amendment, your request must be made in writing and submitted to our Privacy Official. You must provide us with a reason that supports your request for the amendment.
Right to a copy of this notice: You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this notice, contact our Privacy Official.
Right to file a complaint: If you believe your privacy rights have been violated, you may file a complaint with our clinic or with the Secretary of the Department of Health and Human Services. To file a complaint with our clinic, contact our Privacy Official. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right to provide an authorization for other uses and disclosures: Our clinic will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.
In accordance with the standards of implementation specifications of 45 C.F.R. 164.524, Liberty Women’s Clinic may grant an individual access to inspect and obtain a copy of protected health information about the individual in a designated record set.
Liberty Women’s Clinic’s policy:
- The designated record set that is subject to access by an individual is as follows:
- Medical records
- Billing records
- The titles of the persons or offices responsible for receiving and processing requests for access by individuals are as follows:
Privacy Official: Holly Williams
Liberty Women’s Clinic also uses protected health information for the following reasons: (you may opt out of this authorization). Special initial authorization is required and attached.
Marketing, internal referral board, testimonials, pictures for special events, sending newsletters or information unrelated to healthcare and other marketing materials.
If you have any questions regarding this notice or our health information privacy policies, please contact: Holly Williams
If Holly Williams is not available, you may speak with the Clinic Director.
You can reach the Privacy Official at: Liberty Women’s Clinic, 1532 NE 96th Street, Suite B , Liberty, MO 64068, (816) 415.9415
Hours Available: Monday-Wednesday, 10am-4pm, Thursday 12:30pm-6pm
A message may be left for our privacy official any time the clinic is open and your call will be returned within 7 business days.