HIPAA Disclosure

Notice of Privacy Practices

Last Updated: July 13th, 2026

Midwest Surgery Center of Kansas City (hereinafter “The Provider”) uses this Notice of Privacy Practice (“Notice”) to comply with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). HIPAA was enacted by Congress to establish standards for protecting the confidentiality and security of your health information.

Purpose

The Provider, including its professional staff, employees, and credentialed Medical and Dental staff, is committed to protecting the privacy of your health information and follows the privacy practices described in this Notice. The Provider complies with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) as well as the applicable privacy laws of the state in which the facility is located.

This Notice explains how your protected health information (“PHI”) may be used and disclosed to provide medical and dental treatment, obtain payment for the services you receive, and support The Provider’s health care operations. It also describes your rights regarding your PHI and The Provider’s legal responsibilities to safeguard your information.

Under HIPAA, PHI is individually identifiable health information stored in your medical, dental, or billing records that relate to your past, present, or future physical or mental health, the health care services you receive, or payment for those services. During the course of treatment, payment, and health care operations, PHI may be created, received, maintained, or shared by health care providers, health plans, insurance companies, and, where permitted by law, your employer.

Your Health Information Rights

You as a patient have certain rights regarding your PHI. To exercise any of the rights described below, you must submit a written request. To obtain the appropriate request forms or for assistance, please contact The Provider at

care@midwestsurgerykc.com.

You have the right to:

• Receive a Paper Copy of This Notice
• Inspect and Obtain a Copy of Your PHI, subject to law
• Request an Amendment of Inaccurate or Incomplete PHI
• Request Restrictions on Use and Disclosure of PHI
• Request Confidential Communications
• Receive an Accounting of Disclosures

The Provider Responsibilities

The Provider is required by federal and applicable state law to protect the privacy and security of your PHI and to provide you with this Notice describing its legal duties and privacy practices regarding your PHI. The Provider is required to comply with the terms of this Notice currently in effect. The Provider reserves the right to revise this Notice at any time, and any revisions will apply to all PHI maintained by The Provider, to the extent permitted by law. The revised Notice will remain in effect until it is replaced by a subsequent notice.

Use and Disclosure of Your Protected Health Information

The following describes the circumstances in which The Provider may use or disclose your PHI without your written authorization, as permitted or required by applicable federal and state law. While every possible use or disclosure is not listed, all permitted uses and disclosures will fall within one of the categories below:

• Treatment
• Payment
• Health Care Operations
• Appointment Reminders and Health Care Communications
• Business Associates
• Coroners, Medical Examiners, and Funeral Directors
• Correctional Institutions and Law Enforcement Custody
• Group Health Plans
• Health Oversight Activities
• Health-Related Benefits and Services
• Individuals Involved in Your Care or Payment
• Lawsuits and Legal Proceedings
• Public Health Activities
• Research
• Serious Threat to Health or Safety
• Workers' Compensation

Written Authorization

Except as described in this Notice or as otherwise permitted or required by applicable law, The Provider will not use or disclose your PHI without your written authorization. If you provide written authorization for a use or disclosure of your PHI, you may revoke that authorization at any time by submitting a written revocation to The Provider. A revocation will not apply to any use or disclosure that was made in reliance on your prior authorization before The Provider received your written revocation.

Changes to this Notice

The Provider reserves the right to revise this Notice and to make the revised Notice effective for all PHI maintained by The Provider, including PHI created or received before the effective date of the revised Notice, as permitted by applicable law.

The Provider will make the current version of this Notice, or a summary of the current Notice, available at The Provider's facilities and on its website at www.midwestsurgerycenter.com/hipaa-disclosure. The effective date of the current Notice will be identified on the first page of the Notice or summary.

Each time you register with or receive treatment or health care services from The Provider, you may request a copy of the current Notice in effect.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with The Provider by contacting

care@midwestsurgerykc.com or by submitting a complaint to the Secretary of the United States Department of Health and Human Services. The Provider will not retaliate against you or take any action to penalize you for filing a complaint.

Complaints may be submitted to:

U.S. Department of Health and Human Services

Office for Civil Rights

Telephone: 1-800-368-1019

TDD: 1-800-537-7697

Website: https://www.hhs.gov/hipaa

Contact

If you have any questions about this Notice or wish to obtain a form to exercise your privacy rights as described above, you may contact The Provider at ______________.

Forms Available to Request

• Notice of Privacy Practices
• Patient Request to Restrict Use or Disclosure of Protected Health Information
• Authorization for Use and Disclosure of Medical Info
• Patient Request to Amend Protected Health Information
• Patient Request for Access to Protected Health Information
• Revocation of Authorization to Release Personal Health Information