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.

 

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by KIWI in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the Member, significant rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

 

As required by HIPAA, KIWI has prepared this explanation of how we are required to maintain the privacy of your health information and how the Practice may use and disclose your health information. KIWI may use and disclose your medical records only if subpoenaed by a court of law.  KIWI may create and distribute de-identified health information by removing all references to individually identifiable information. KIWI may contact you to provide appointment reminders or other health-related services that may be of interest to you. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and KIWI is required to honor and abide by that written request, except to the extent that the Practice has already taken actions relying on your prior authorization. You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Practice: 

 

1. The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. KIWI is not required to agree to a requested restriction. If we do agree to a restriction, the Practice will abide by it unless you agree in writing to remove it. 

 

2. The right to reasonable requests to receive confidential communications of protected health information from KIWI by alternative means or at alternative locations.

 

 3. The right to inspect and copy your protected health information.

 

4. The right to amend your protected health information. 

 

5. The right to receive an accounting of disclosures of protected health information. 

 

6. The right to obtain a paper copy of this notice from us upon request.

 

KIWI is required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. KIWI is required to abide by the terms of the Notice of Privacy Practices currently in effect. KIWI reserves the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that the Practice maintains. KIWI will post and you may request a written copy of a revised Notice of Privacy Practices. You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with the Practice, or with the Department of Health & Human Services, Office of Civil Rights about violations of the provisions of this notice or the policies and procedures of the Practice. KIWI will not retaliate against you for filing a complaint.

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                 Privacy Policy Consent Form for Address Sharing with Pharmacy for Delivery Services

KIWI is committed to protecting your personal information. By becoming a member, you authorize KIWI to share your address details with Hallandale Pharmacy for the sole purpose of facilitating doorstep delivery services of your prescription medications and related healthcare products and services.

 

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Last Updated: August 2024