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Privacy Act

Please Read Below with Awareness.


Notices of Privacy Practices 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 with awareness




Four Winds Family Recovery Center, LLC





 Four Winds Family Recovery Center, LLC © 2003


 2930 SW  Wanamaker Dr., Ste. 6

Topeka, Kansas 66614


Phone: 785-845-5416

Fax: 785-271-5416



Federal Laws and Regulations protect the confidentiality of client records maintained by J.M. Lees, an independent provider doing business as Four Winds Family Recovery Center, LLC.  Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment and applying for future care or treatment.  It also includes billing documents for those services.  Our office may not disclose any protected health information regarding a client unless the client consents in writing.


Under certain circumstances, J.M. Lees may be required by law to release information without signed consent:

The disclosure is allowed by a court order;

The disclosure is made to medical personnel in a medical emergency;

The disclosure is made regarding clients who represent a danger to themselves or others;

The disclosure is made to qualified personnel for research, audit, or program evaluation;

The disclosure is made when a crime is committed by a client on program premises or against program personnel or about any threat to commit such a crime;

The disclosure is reported under Kansas law to appropriate State or local authorities in cases of suspected child abuse or neglect.


Examples of uses of your health information for treatment purposes are:


A provider obtains treatment information about you and records it in a health record.

During the course of your treatment or assessment, the provider determines he/she will need to consult with another specialist in the area.  He/she will share the information with such specialist and obtain his/her input.


An example of use of your health information for payment purposes:


We submit a request for payment to your health insurance company.  The health insurance company requests information from us regarding medical care given.  We will provide information to them about you and the care given.


An example of use or your health information for health care operations:


The state licensing authority wants to review records to assure that we have acted consistent with state law regarding your care.  In doing so, it wants to take a sampling, which includes review of your chart.  At the licensing authority’s request, we will provide it with a copy of your record.



The health record we maintain and billing records are the physical property of Four Winds Family Recovey Center, LLC.  The information in it, however, belongs to you. You have a right to: 

Request a restriction on certain uses and discloses of your health information by delivering the request in writing to our office – we are not required to grant the request, but will comply with any request granted;

Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”) by  making a request at our office;

Request that you be allowed to inspect and copy your health record and billing record – you may exercise this right by delivering a written request to our office using the form request;

File a statement of disagreement if your amendment is denied and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;

Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request, an accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request; or disclosures made to family members or friends in the course of providing care;

Request that communication of your health information be made by alternative location by delivering the request in writing to our office using the form we give you upon request; and, Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.

You have a right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

If you want to exercise any of the above rights, please contact J.M. Lees, in person or in writing, during normal business hours.  He will provide you with assistance on the steps to take to exercise your rights.




Our site is required to:

Maintain the privacy of your health information as required by law;

Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;

Abide by the terms of this Notice Notify you if we cannot accommodate a requested restriction or request, and, Accommodate your reasonable requests regarding methods to communicate health information to you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain.  If our information practices change, we will amend our Notice.  You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our Notice or by visiting our office and picking up a copy.




We are committed to the confidentiality and security of your protected health information.  We restrict access to the protected information to those employees or agents who need to know that information to provide you with our services or otherwise conduct business.  We maintain physical, electronic and procedural safeguards that comply with the federal and state regulations to safeguard all of your protected information.  In addition, we also provide training and education for our personnel regarding our privacy and security policies and procedures, and oversee the implementation and enforcement of these policies and procedures. 




If you have any questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact J.M. Lees.


Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to J.M. Lees.  You may also file a complaint by mailing or e-mailing to the Secretary of Health and Human Services.


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 Secretary of Health and Human Services.

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