Notice of Privacy Practices


Privacy and Security

Patient Privacy

Kansas City Bone & Joint Clinic

A Division of Signature Medical Group of K.C., P.A.

 

Notice of Privacy 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.

 

If you have any questions about this Notice please contact our Privacy Contact who is: Jeanne Cantalin.

 

We require that each patient or their legal representative read and sign an acknowledgement of our HIPAA privacy policy.

 

Confidentiality

Your medical record is confidential.  It will not be given to anyone without your written consent.  We will ask you to complete our PHI (Personal Health Information) release form on your first visit. Please include anyone you will authorize to obtain medical information written or verbally. For example, spouse, parent, disability provider, etc. If this is not completed we will not be able to communicate with anyone but you. Please be specific with names and contact information. Having this in your file will authorize our physicians and staff members to disclose your personal health information to the people you designate.

 

You may restrict access to your personal health information. You will need to complete the “Request to Restrict Personal Health Information” form to submit to our office. If you have previously signed a release of information for an outside entity and now want to rescind that release or restrict your information, you may also use this form for that purpose.

 

You may have your medical records sent elsewhere with a written request. Copies of records to another physician for continuity of your care will be provided at no charge. We utilize DataFile Technologies to handle our medical record requests. You may be contacted by them if there is any question on your request or to discuss any fees associated.

 

If you feel the documentation from your visit needs to be amended, we ask you to fill out a request form and submit it to our office for review by your provider.

 

X-ray images taken in our office are the property of Kansas City Bone & Joint Clinic, PA. These are part of your permanent medical record and to provide quality care for you, the patient, medical records must be kept. If you must transfer X-rays to another physician, we will make copies and provide them to you on a compact disc. The current charge is $6.50. We have made every effort to keep these costs as low as possible.

Disability and FMLA forms 

We know being off of work due to an injury or surgery is difficult. We are happy to complete disability, FMLA or other forms needed. Please make arrangements to bring these forms to our clinic or have them sent to us prior to your procedure when possible. Sorry, but forms cannot be accepted at the hospitals or surgery centers. While we make every effort to complete these quickly, we ask you to allow 5-7 business days for completion. There is a $20.00 fee per form which needs to be paid when dropping these forms off.

  • Notice of Privacy Practices