1.888.328.4827
Kidney Care Pharmacy Service
888-328-4827
866-667-1831
Specialty Pharmacy Services
888-817-8482
877-862-6987
Kidney Care Pharmacy Service
Specialty Pharmacy Services
888-328-4827 888-817-8482
866-667-1831 877-862-6987

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.


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Your health information is personal, and we are committed to protecting it.

For purposes of this notice, "DaVita" and the pronouns "we," "us" and "our" refer to all of the licensed dialysis facilities operated or managed by DaVita Inc. and/or its subsidiaries, DaVita Rx, LLC, DVA Laboratory Services Inc., Total Renal Laboratories, Inc., and HomeChoice Partners, Inc. These entities have been designated as a single affiliated covered entity for HIPAA Privacy Rule purposes.

DaVita uses and discloses health information about you for treatment, to obtain payment for treatment, for administrative purposes, to evaluate the quality of care that you receive, and for other purposes permitted by HIPAA. DaVita is required by law to maintain the privacy of your health information and provide you a notice of our legal duties and privacy practices with respect to that information. This notice applies to all records about your care that are created, and/or maintained by DaVita. Your health information is contained in a medical record that is the physical property of DaVita. DaVita is required to abide by the terms of this notice.

DaVita reserves the right to change its privacy practices and revise this notice, and to make the new provisions effective for all protected health information it maintains. Revised notices will be available in the clinic or upon your request.


How DaVita May Use or Disclose Your Health Information:

We may use or disclose your health information, in certain situations, without your consent or authorization. Below we describe examples of how we may use or disclose your health information as permitted under or required by federal law, including instances where we will obtain your consent or authorization. Such uses or disclosures may be in oral, paper or electronic format.

For Treatment.DaVita may use and disclose your health information to provide you with medical treatment or services or to assist in the coordination or continuation of your care. For example, a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for other health care providers to determine what treatment you should receive.

For Payment.DaVita may use and disclose your health information to others for purposes of obtaining payment for treatment and services that you receive. For example, a bill may be sent to you or to a third-party payer, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment.

For Health Care Operations.DaVita may use and disclose health information about you for operational purposes. For example, your health information may be used by DaVita or disclosed to others in order to:

  • Communicate with you about our clinic activities and locations;
  • Evaluate the performance of our staff;
  • Assess the quality of care and outcomes in your case and similar cases;
  • Learn how to improve our facilities and services; and
  • Determine how to continually improve the quality and effectiveness of the health care we provide.

Communications.

DaVita may use and disclose your information to provide appointment reminders, leave a message on your answering machine, or leave a message with an individual who answers the phone at your residence. We may, from time to time, contact you to provide information about treatment alternatives or other DaVita health-related benefits and services that may be of interest to you, including information on DaVitaRx (DaVita’s pharmacy), DVA Laboratory Services Inc., Total Renal Laboratories, Inc., or HomeChoice (DaVita’s home infusion company).

Required by Law.DaVita may use and disclose information about you as required by law. For example, DaVita may use and/or disclose information for the following purposes:

  • For judicial and administrative proceedings pursuant to legal authority;
  • To report information related to victims of abuse, neglect or domestic violence;
  • To assist law enforcement officials in their law enforcement duties;
  • In the rare instance of a security breach, to notify you, law enforcement and regulatory authorities of such a situation, and others as appropriate to help resolve the situation; and
  • To health oversight agencies responsible for monitoring the health care system and government programs.

Public Health.

Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or reporting information to the Food and Drug Administration for reporting and tracking adverse-event or regulated products.

Individuals involved in your care.

We may provide information to a family member, friend, or other person involved in your health care or in payment for your health care, if you do not object, or in an emergency. In addition, upon admission to our facitliy, we will ask you to complete a Permission to Discuss PHI with Other Individuals Form to help clarify for us which of your family members and/or friends are likely to be involved with your health care and/or payment for your health care. If we disclose information to a family member, relative or close personal friend, we will disclose only information that we believe is relevant to that person’s involvement with your health care or payment related to your health care.

Clinical Trials and Other Research Activities.

DaVita may use and disclose your health information for research purposes pursuant to a valid authorization from you or when an institutional review board or privacy board has waived the authorization requirement. Under certain circumstances, your information may be disclosed without your authorization to researchers preparing to conduct a research project or for research on decedents.

Health and Safety.

Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Notification and Disaster Relief.

We may use or disclose your health information to notify your family or personal representative of your location or condition. Unless you object, or there are emergency circumstances, we may also disclose your protected health information to persons performing disaster relief activities.

Correctional Institutions.

If you are an inmate or in the custody of law enforcement, we may disclose your health information to correctional institutions or law enforcement for such purposes as providing care and for the health and safety of others.

Decedents.

Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties. Because of the family environment in the clinic, if you have passed away, we may disclose to your fellow patients, who individually inquire, that you have passed away and direct that fellow patient to contact your family or personal representative for additional details.

Organ/Tissue Donation.

Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.

Government Functions.

We may disclose your health information for specialized government functions such as military and veterans activities or protection of public officials.

Workers' Compensation.

Your health information may be used or disclosed in order to comply with laws and regulations related to Workers' Compensation.


Consents and Authorizations for Other Uses

While we may use or disclosure your health information without your written authorization as explained above, there are other instances where we will obtain your written authorization. You may revoke an authorization at any time except to the extent DaVita has already relied on the authorization and taken action.

Examples of disclosures that require your authorization are:

Clinical Trials and Other Research Activities.While we may use or disclose your health information for certain research activities explained above, there are other activities which may require your authorization. When your specific treatment is part of a research study, we may disclose your health information to researchers only after you have signed a written informed consent to participate in the research study and a written authorization to use and disclose your health information for research purposes. You do not have to sign the authorization in order to receive traditional services from DaVita. However, if you do not provide written authorization for us to disclose your health information to the researchers, you may become ineligible for the research study itself.

Marketing.We will not share your health information with non-DaVita third-parties for their own marketing purposes without your written authorization. However, in order to better serve you, should you inquire about a particular product-specific good or service, we may provide you with informational materials. We may also, at times, send you informational materials about a particular product or service that may be helpful for your treatment.

Patient Recognition.DaVita strives to celebrate and honor the lives of our patients through a variety of patient recognition activities, such as celebrating birthdays, anniversaries, graduation, weddings and other personal achievements, recognizing dialysis milestones and other health achievements, publishing newsletters, holding patient contests, posting patient photos and fun facts on the facility bulletin board or "Wall of Fame", acknowledging when a patient is hospitalized, and memorializing patients who pass away ("Patient Recognition Activites"). We may use your information to send you or your family greeting cards as part of our Patient Recognition Activites.

Uses and Disclosures of Your Highly Confidential Information.Some federal and/or state laws require special privacy protections for certain highly confidential health information, relating to: (1) psychotherapy services; (2) mental health and developmental disabilities services; (3) alcohol and drug abuse prevention, treatment and referral; (4) HIV/AIDS testing, diagnosis or treatment; (5) venereal disease(s); (6) genetic testing; (7) child abuse and neglect; (8) domestic abuse of an adult with a disability; and/or (9) sexual assault. Unless an individual disclosure is permitted or required by law, we will obtain your written consent or authorization prior to disclosing your highly confidential health information to third parties.

Media.From time-to-time media events are hosted at our facilities. The purpose of these events is to raise awareness about chronic kidney disease and end-stage renal disease. At these events there may individuals from the media as well as DaVita's public relations and marketing teams. If your image, voice, or statement is captured on film, we will obtain your written authorization prior to running any news article, press statement, or other publication with your image, voice, or statement.

Your Health Information Rights

You have the following rights regarding your health information. To exercise any of the rights below, please contact your facility’s Facility Administrator to obtain the proper forms.

You have the right to:

  • Request a restriction on the uses and disclosures of your information for treatment, payment and health care operations purposes. All such requests must be in writing. The facility's DaVita representative can provide a form for you to use. Although we will consider your request carefully, we are not required under federal law to agree to your request. We will notify you of our decision in writing. If we agree to your request, we will comply with your request unless such information is needed to provide emergency treatment to you.
  • Obtain a paper copy of the notice of privacy practices upon request. You may obtain a paper copy of this Notice by contacting the Privacy Office at 855-472-9822. The Notice is also available in your facility.
  • Inspect and obtain a copy of your health and billing records. All requests to inspect or copy your health information must be in writing. The facility's DaVita representative can provide a form for you to use. In certain circumstances, we may deny your request, but if we do, we will notify you in writing of the reason(s) for the denial and explain your right to have the denial reviewed. If you ask for a copy of your health information, we may, charge you a fee for copying and mailing.
  • Request an amendment to your health information. You may request that your health record be amended if you believe that the health information we have about you is incomplete or incorrect. Requests to amend your health information must be in writing. The facility's DaVita representative can provide a form for you to use. We may deny your request and if we do, we will notify you in writing of the reason for the denial and your right to submit a statement disagreeing with the denial.
  • Request confidential communications. You have the right to ask DaVita to communicate health information to you using alternative means or at alternative locations. Such requests must be in writing. The facility’s DaVita representative can provide a form for you to use. We will accommodate reasonable requests and will notify you if we are unable to agree to your request.
  • Receive an accounting of disclosures of your health information. Requests to obtain a list of instances in which DaVita has disclosed your health information must be in writing. The facility's DaVita representative can provide a form for you to use. The list will not include disclosures made prior to April 14, 2003, those made for treatment, payment, health care operations purposes (except as described below), certain disclosures required by law, and disclosures made to, or authorized by you. After January 1, 2014 (or a later date as permitted by HIPAA), the list will include disclosures made for treatment, payment or health care operations using our electronic health record. The first disclosure list in a year is free, if you request additional lists in any year we may charge you a fee.


Complaints

You may complain to DaVita and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.


Contact Information

If you have any questions or complaints about this notice or our privacy practices, please contact:

If you DaVita Inc.
Privacy Office – 12th Floor
2000 16th St
Denver, CO 80202
Phone: (855) 472-9822