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> AKSM Code of Conduct

(Effective April 1, 2003)

American Kidney Stone Management, Ltd.

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.

We understand that your health information and the use of that information is very important to you.  AKSM believes that your health information is personal, and we are committed to protecting it.  We also are required by law to respect your confidentiality.  In order to provide you with quality care and to comply with legal requirements, on occasion we do use and give out (“disclose”) your information.  We also keep records of the care and services that you receive at our facilities. 

This notice will describe for you how and when we use your information.  We are legally required to give you this Notice and to follow the terms of this Notice that are currently in effect.  This Notice only applies to the privacy practices of AKSM.  Each of your physicians may have different confidentiality and disclosure policies for his/her office and may also give you other privacy notices that describe their office practices.  If you are eighteen (18) years of age, your parents must sign for you and handle your privacy rights for you.

AKSM WILL NOT USE OR DISCLOSE YOUR HEALTH INFORMATION FOR THE FOLLOWING:

1. Fundraising Activities: We will not use or give out your protected health information for fundraising activities.
   
   
2. Marketing Activities: We will not use or give out your health information for marketing activities without your express written authorization.

HOW AKSM MAY USE OR GIVE OUT YOUR HEALTH INFORMATION.

When you become a patient of AKSM, we may use or give out your health information for the reasons described in this Notice.  The following categories describe some of the ways that we will use and give out your health information.

1. For Treatment: We may use medical information about you to provide you with treatment and services.  We may disclose your health information to doctors, nurses, technicians, medical students, or other persons who need that information to take care of you.  All of our staff have signed confidentiality statements.  We may also disclose medical information about you to people outside our facility who may be involved with your medical care, such as treating doctors, home care providers, pharmacies, and family members.  For example, requesting laboratory results from the place where your testing was done.
   
   
2. Payment / Insurance: We may use and disclose health information about you so that the treatment and services you receive at our facility may be billed and paid for by you, your insurance company or another third party payor.  For example, we may give information about the procedure you had here to your health plan so it will pay us or reimburse you for the procedure.  We may also tell your health plan about a treatment you are going to receive so we can get prior payment approval or learn if your plan will pay for the
   treatment.
   
   
3. For Health Care Operations: We may use and give out health information about you for our operations.  These uses and disclosures are necessary to ensure that all of our patients receive quality care.  For example, we may use your health information to review the care you received and to evaluate the performances of our staff in caring for you.  We will enter your treatment information into a secure, computerized database.  This information will be utilized by our Quality Assurance Committee.  We also may combine health information about many patients to identify new services to offer, what services are not needed, and whether certain therapies are effective.  In addition, we may give out information to doctors, nurses, technicians, medical students, and other persons for learning and quality improvement purposes.  We may remove information that identifies you so that people outside AKSM may study your health data without knowing who you are. 
   
   
4. Appointment Reminders:  We may use and disclose information to schedule appointments for you, to contact you either by mail or telephone for a reminder of your treatment or to obtain a history from you.

5. Legal Matters:  We will give out health information about you when required to          to do so by federal, state, or local law, or by the court process.  We may disclose health information about you for public health reasons, like reporting deaths, reactions to medications or problems with medical products.  We may release health information to control the spread of disease or to notify a person whose health and safety may be threatened.  We may give out health information to a health oversight agency authorized by law, such as for audits, investigations, inspections, and licensure.

6. To Avert a Serious Threat to Your Well-Being:  We may use and disclose health information to transfer you to another healthcare facility should your physician decide that is necessary.

7. Medical Research:  We do not perform medical research here.

AUTHORIZATIONS FOR OTHER USES AND DISCLOSURES

As described above, we will use and give out your health information for treatment, payment, healthcare operations and when required by law.  We will not use or disclose your health information for other reasons without your written authorization.  For example, you may want us to release health information to your attorney.  This kind of use and disclosure of your health information will be made only with your written authorization.  You may cancel the authorization, in writing, at any time, but we cannot take back any uses or disclosures of your health information already made with your authorization.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

1.       Right to Inspect and Copy:  You have the right to inspect and obtain a copy

of your completed health records unless your doctor believes that giving you that information could harm you.  You may not see or get a copy of information gathered for legal proceeding.  Your request to inspect or obtain a copy of these records must be submitted in writing, signed, and dated to AKSM Medical Records, 797 Thomas Lane, Columbus, Ohio 43214.  We may charge a fee for processing your request.  If AKSM denies your request to inspect or obtain a copy of the records, you may appeal the denial with AKSM.

2.       Right to Amend:  If you feel that health information we have about you is              

incorrect or incomplete, you may ask us to amend this information.  Your request to amend your health information must be made in writing, signed, and dated, and submitted to us.  In addition you must specify the information you wish to change and give the reason for your request.  Your request must be submitted to Privacy Officer, AKSM, 797 Thomas Lane, Columbus, Ohio  43214.  We will respond to you within 60 days.  We may deny your request for amendment.  If we do, we will tell you why and explain your options.

3.       Right to an Accounting of Disclosures:  You may request an “accounting of disclosures”.  This is a listing of the entities or persons (other than yourself) to whom AKSM has given out your health information without your written authorization.  The accounting would not include disclosures for treatment, payment, healthcare operations, and certain other disclosures allowed by law.  Your request for an “accounting of disclosures” must be in writing, signed, and dated.  It must identify the time period of the disclosures for which you want the accounting.  We will not list disclosures made before April 14, 2003, or those made earlier than 6 years before your request.  Your request should indicate the form in which you want the list (for example, on paper or electronically).  You must submit your written request to Privacy Officer, AKSM, 797 Thomas Lane, Columbus, Ohio 43214.  We will respond to you within 60 days.  We will give you the first listing within any 12-month period free, but we will charge you for all other accountings requested within the same 12 months.

4.       Right of Request Restrictions:  You have the right to ask us to restrict the                                     uses or disclosures we make of your health information for treatment, payment, or healthcare operations, but we do not have to agree.  You also may ask us to limit the health information that we use or disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  Again, we do not have to agree.  A request for restriction must be in writing, signed, and dated.  The request should describe the information you want restricted, say whether you want to limit the use or disclosure of the information or both, and tell us who should not receive the restricted information.  You must submit your request to Privacy Officer, AKSM, 797 Thomas Lane, Columbus, Ohio 43214.  We will tell you if we agree with your request or not.  If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

5.       Right to Request Confidential Communications:  You have the right to request that we communicate with you about your health in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.  Your request for confidential communications must be in writing, signed, and dated.  It must specify how and/or where you wish to be contacted.  You need not tell us the reason for your request, and we will not ask.  You must send your written request to Privacy Officer, AKSM, 797 Thomas Lane, Columbus, Ohio 43214.  We will agree to all reasonable requests.             

6.       Right to a Paper Copy of This Notice:  You have the right to a paper copy of this Notice.  You may ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.  You may obtain a paper copy of this Notice at AKSM Medical Records, 797 Thomas Lane, Columbus, Ohio 43214 or by calling AKSM’s Privacy Officer at (614) 447-0281.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with AKSM or with the Secretary of the U.S. Department of Health and Human Services.  To file a complaint with AKSM, you must submit your complaint in writing to Privacy Officer, AKSM, 797 Thomas Lane, Columbus, Ohio 43214.  You will not be penalized for filing a complaint. 

CHANGES TO THIS NOTICE

AKSM may change this Notice at any time.  Any change in the Notice could apply to health information we already have about you, as well as any information we receive in the future.  We will post a copy of the current Notice at AKSM and on our web site, www.aksm.com.  The effective date of the Notice is on the first page.