Notice of Privacy Practice for Protected Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.   Please review carefully!

Lawrence Family Medicine & Obstetrics  is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment and health care operations.   Protected health information can be any information we create or obtain while providing services to you.   This includes all examinations, lab results, diagnosis, treatment, correspondence from other providers, billing documents, etc. 

Examples of uses of your health information for treatment purposes:

  • When the nurse or Dr. obtains treatment information & records it in your medical chart/EHR.
  • If the physician determines they need to consult with another physician,  he/she will share this information with the other Dr.  involved.

Examples of uses of your health information for payment purposes:

  • After we submit your insurance claim,    the insurance company may request additional information.     If this occurs we have permission to submit this requested information. 

Example of use of your information for health care operations:

  • We obtain services from our insurers or other business associates from time to time.   We may share your health information as necessary to obtain these services. 

Your Health Information Rights

The health and billing records we maintain are the physical property of Lawrence Family Medicine & Obstetrics.    The information in it,  however, belongs to you.   You have a right to:

  • Request a restriction on certain uses and disclosures of your health information by making a request to our office,  we are not required to grant the request, but will comply with any request granted.
  • Obtain a copy of this Notice of Privacy Practices for Protected Health Information(PHI).
  • Request that you be allowed to inspect and receive a copy of your health and billing record.   You may exercise this right by delivering the request to our office.
  • Appeal a denial of access to your PHI, except in certain circumstances.
  • Request that health care record be amended to correct incomplete or incorrect information, by delivering a request to our office.   We may deny your request if you ask us to amend information that:
    • Was not created by us;
    • Is not part of the PHI kept by or for this office;
    • Is not part of the information you would be permitted to inspect or copy;
    • Is accurate and complete.

If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.

  • Request that communication of your PHI be made by alternative means or alternative location by delivering the request in writing to LFM&O.
  • Obtain an accounting of disclosures of your PHI as required to be maintained by law by delivering a request to LFM&O.     These disclosures will not include uses covered by our signed authorization to release PHI.
  • Revoke authorization that you made previously,  except to the extent information has been disclosed or action has already been taken.    This request may be made in writing to LFM&O. 

If you desire to exercise any of the above rights, please contact the Administrator of LFM&O at 1220 Biltmore Dr.  Lawrence, KS.  66049  (785) 331-1700 in person or writing.   You will be informed of the steps needed to be taken to exercise your rights.

Our Responsibility

This office is required to:

  • Maintain the privacy of your PHI as required by law;
  • Provide you with a notice as to our duties and privacy practices in regard to the information we collect and maintain;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request;
  • Accommodate your reasonable requests regarding methods to communicate PHI.

We reserve the right to amend, change or eliminate provisions in our privacy practices.  If our information practices change, will may amend our Notice.   You are entitled to receive a revised copy of the Notice.

To Request Information or  File a Complaint

If you have questions, or would like to report a problem regarding the handling of your PHI,  you may contact the Office Manager of LFM&O.

If you believe your privacy rights may have been violated,  you may file a written complaint to the Administrator or Office Manager at LFM&O or by contacting the Secretary of Health and Human Services at 200 Independence Ave, SW., Washington, D.C. 20201 1-877-696-6775.

  • We cannot and will not require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from our office.
  • We cannot and will not retaliate against you for filing a complaint with the HHS.

Other Disclosures and Uses


  • Unless you object, we may use or disclose your PHI to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location and about your general condition or your death. 

Communication with Family

  • Using our best judgment, we may disclose to a family member, close personal friend or any other person you identify, PHI relevant to that person’s involvement in your care or in payment for such care, or in an emergency. 


  • We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocol to ensure the privacy of your PHI. 

Disaster Relief

  • We may use and disclose your PHI to assist in disaster relief efforts.

Organ Procurement Organizations

  • Consistent with applicable law, we may disclose your PHI to an organ procurement organization or other entities engaged in the procurement, banking  or transplantation of organs for the purpose of tissue donation and transplant

Food and Drug Administration (FDA)

  • We may disclose to the FDA your PHI relating to adverse events with respect to food, supplements, product defects or post marketing surveillance information to enable product recalls, repairs or replacements.

Workers Compensation

  • If you are seeking compensation through Workers Compensation, we may disclose your PHI to the extent necessary to comply with laws relating to Workers Comp. 

Public Health

  • As authorized by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability; to report reactions to medications or problems with products; to notify people of recalls, to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition. 

Abuse & Neglect

  • We may disclose your PHI to public authorities or other medical personnel as allowed by law to report abuse or neglect. 


  • Except in cases involving workers compensation, disclosures will be made only with a specific authorization from you.

Correctional Institutions

  • If you are an inmate of a correctional institution, we may disclose to the institution or its agents the PHI necessary for your health or the health & safety of other individuals.

Law Enforcement

  • We may disclose your PHI for law enforcement purposes as required by law,  ie; required by court order or in cases involving felony prosecution or to the extent an individual is in the custody of law enforcement. 

Health Oversight

  • Federal law allows LFM&O to release your PHI to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings

  • We may disclose your PHI in the course of any judicial or administrative proceeding as allowed or requested by law, with your authorization or as directed by a proper court order. 

Serious Threat

  • To  avert a serious threat to health or safety, we may disclose your PHI with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public. 

For Specialized Government Functions

  • We may disclose your PHI for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes or to public assistance program personnel. 

Coroners, Medical Examiners and Funeral Directors

  • We may release PHI to a coroner or medical examiner or Funeral Director

Other Uses

  • Other uses and disclosures, besides those identified in this Notice, will be made only as otherwise required by law or with your written authorization and you may revoke the authorization as previously provided in the Notice under “Your Health Information Rights.”


  • This notice is available on our website.

Effective Date:   January 1, 2014