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.

In accordance with the Health Insurance Portability & Accountability Act of 1996 (“HIPAA”), Kentwood Family Physicians, P.C., will not release or disclose any protected health information about an individual except that which is required for the treatment of the individual, obtaining payment for treatment, or for the operation of our practice. Patients, their authorized representatives, or (if the patient is a minor) their parents or legal guardians, must sign a Consent to permit Kentwood Family Physicians, P.C., to use or disclose protected health information about the patient for these purposes. We will comply with HIPAA laws and regulations.

How We May Use or Disclose Protected Health Information

Following are examples of uses and disclosures of your protected health care information that we are permitted to make.
  1. Disclose identifiable health information about you without additional authorization (subject to certain requirements), for public health purposes, for auditing purposes, and in case of an emergency, or when required by law.
  2. Make daily telephone reminders about upcoming appointments, and may leave a message about the appointment, and/or send a reminder postcard about the need to schedule routine appointments.
  3. Only disclose the portion of the individual’s medical record that is minimally necessary to continue the individual’s treatment, obtain payment for treatment; or properly and efficiently operate our practice.
  4. Transmit information to be disclosed in accordance with this Notice by telephone, mail, facsimile, courier, electronic, or other means.
  5. Not use or disclose protected health information for any purpose without an express Authorization signed by the patient, their authorized representative, or (if the patient is a minor) their parent or legal guardian.
  6. Change these practices at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area and in each examination room.
  7. Appoint a HIPAA Compliance Officer to oversee the practice’s use and disclosure of protected health information, to resolve questions about these matters that arise in the operation of our practice, and to assist patients, their families, and this practice in dealing with applicable laws and applications.
  8. Leave a message on a patient’s answering machine or voice mail, possibly including but not limited to the following:  the fact that a specific item (written prescription, medication samples, completed form, etc.) is complete and ready to be picked up from our office, the fact that a prescription has been called to the patient’s pharmacy, and information regarding an appointment that has been scheduled on behalf of the patient (with a specialty physician, for example.)  The patient may request that we NOT leave this information on their answering machine or voice mail, if they prefer.  (This item was added on April 4, 2008)
  9. Notify you in writing when a breach in your protected information occurs.

Your Patient Rights

Following is a statement of your rights, under the Privacy Rule, in reference to your protected health information. Please feel free to discuss any questions with our staff.
  1. To inspect your medical records, or to receive a list of circumstances where we disclosed your health information (for purposes other than treatment, payment, or the operation of our practice) in accordance with our policy. This will be done by appointment only, and in the presence of a staff member of Kentwood Family Physicians, P.C.
  2. To request that Kentwood Family Physicians, P.C., be restricted from disclosing your protected health information in carrying out treatment, obtaining payment, or in the operation of our practice. However, we are not required to agree with your requested restrictions.
  3. To register a complaint if you feel that your protected health information has been improperly used or disclosed.
  4. To revoke your consent or authorization for use or disclosure of protected health information.
  5. To not authorize the release of Psychotherapy notes, highly sensitive information, alcohol/substance abuse treatment.
  6. To opt out of getting fundraising communications from our office, and marketing or a sale of protected information. Please note that our office does not sell protected information and we do zero fund raising.
  7. To restrict information sharing with an insurance company for service(s) paid in full and out of pocket unless disclosure authorized by the patient.


If you have questions or need assistance:
Please contact Renee Poland or Bruce M. Baker, D.O., our HIPAA Compliance Officers, at 616-281-9066.