Stroke HealthRisk Assessment

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Medically Reviewed By: Expert-24 Medical Review Board on March 27, 2014 | References | Terms of Use & Privacy

HEALTHTOOLS™ (HEALTHRISK™ AND HEALTHAGE™) DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Expert Review Panel – Expert-24 Ltd

Terms of reference

The aim of the Expert Review Panel is to ensure that all Expert-24 clinical and epidemiological content is robust, independent and up to date.

Qualifications

Medical Director and Editor

Dr. Timothy Dudley

Chairman of the Expert Review Panel

Dr. Robin Christie

Current authors and reviewers for the Health Risk Assessment

Dr. Martin Dawes

Dr. Jonathan Mant

Emeritus authors and reviewers for the Health Risk Assessment

The following individuals were deeply involved in the creation of the health risk assessment at its inception, but are no longer active reviewers on the panel:

Dr. John Fletcher

Dr. Emma Boulton

Professor Larry Ramsay

Professor Klim McPherson



Patient-centered health risk using an Evidence Based Medicine approach

Who created it and how often is it reviewed and updated?

This health risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is: 


Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of two diseases, say bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer. 

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are: 

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remains transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it. 

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.


How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given. 

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk. 
However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by up to 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment. 

The risk for developing heart disease in tobacco users has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). 

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is largely unknown. Therefore, the amount of risk reduction that can be expected from optimizing these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.


How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohorts, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question. 
What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgment tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. 

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgment. The judgments have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta-analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting. 

References for the Stroke Assessment

Most recently reviewed:
  • Rautiainen S et al. Total Antioxidant Capacity of Diet and Risk of Stroke: A population-based prospective cohort of women. Stroke 2012; 43: published online ahead of print. 
  • Del Rio D et al. Total antioxidant Capacity of the Diet is Associated with Lower Risk of Stroke in a Large Italian Cohort. J Nutr Jan. 1, 2011; 145(1): 118-123 
  • Bibbins-Domingo K et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM 362; 7:590-9. Feb. 18, 2010. 
  • Howard BV et al. Low-Fat Dietary Pattern and Risk of Cardiovacular Disease. The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA Feb. 8, 2006. 295(6):655-666.

Guidelines reviewed annually:
  • Goldstein, L B et al. Primary Prevention of Stroke. AHA/ASA Guideline in Stroke 2006;37:1583-1633

References from previous updates:
  • Amarenco P and Labreuche J.”Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention”. Lancet Neurology, Vol. 8 Issue 5, 453-463 May 2009 doi:10.1016/S1474-4422(09)70058-4 
  • Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-1860. 
  • Connolly SJ, Ezekowitz MD, Yusuf S, et al, for the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361(12):1139-1151. 
  • Almgren T, et al. "Stroke and coronary heart disease in treated hypertension -- a prospective cohort study over three decades." J Intern Med June 2005, 257(6):496-502 
  • Bath PM, Gray LJ "Association between hormone replacement therapy and subsequent stroke: a meta-analysis." BMJ 12/02/05 330(7487):342 
  • Ni Mhurchu C, et al. "Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants." Int J Epidemiol Aug 2004, 33(4):751-8 
  • Iso H, et al. "Alcohol consumption and risk of stroke among middle-aged men: the JPHC Study Cohort I." Stroke May 2004 35(5):1124-9 
  • Etminan M, et al. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies" BMJ. 2005 Jan 8, 330(7482):63 
  • Panagiotakos DB, et al. "Risk factors of stroke mortality: a 40-year follow-up of the Corfu cohort from the Seven-Countries Study" Neuroepidemiology, 11/12/2003, 22(6):332-8 
  • Bath, P.M. and Gray, L.J. (2005) Association between hormone replacement therapy and subsequent stroke: a meta-analysis. British Medical Journal 330(7487), 342. 
  • National Collaborating Centre for Chronic Conditions (2006) Hypertension. Management of hypertension in adults in primary care: pharmacological update (full NICE guideline). Clinical guideline 18 (update). Royal College of Physicians and British Hypertension Society. www.nice.org.uk 
  • Stroke prevention. Lipid management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 25-7. 
  • Stroke prevention. Blood pressure management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 22-4. 
  • Stroke prevention. Life style and risk factor management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 17-21. 
  • EUSI Executive Committee and EUSI Writing Committee, "Ischaemic Stroke Prophylaxis and Treatment", European Stroke Initiative Recommendations 2003 
  • Casiglia, E., "Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll." J Hum Hypertens, 01 Jan 2002; 16(1): 21-31. 
  • Lernfelt, B., "Cerebral atherosclerosis as predictor of stroke and mortality in representative elderly population.", Stroke, 01 Jan 2002; 33(1): 224-9. 
  • Weverling-Rijnsburger, A.W., "High-Density vs Low-Density Lipoprotein Cholesterol as the Risk Factor for Coronary Artery Disease and Stroke in Old Age.", Arch Intern Med 14 Jul 2003; 163(13): 1549-54. 
  • Whisnant, J.P., "Effect of time since onset of risk factors on the occurrence of ischemic stroke." Neurology 12 Mar 2002; 58(5): 787-94. 
  • Kernan, W.N., "Insulin resistance and risk for stroke." Neurology 24 Sep 2002; 59(6): 809-15. 
  • Vermeer, S.E., "Homocysteine, silent brain infarcts, and white matter lesions: The Rotterdam Scan Study." Ann Neurol 01 Mar 2002; 51(3): 285-9. 
  • Wong, T.Y., "Cerebral white matter lesions, retinopathy, and incident clinical stroke." JAMA 3 Jul 2002; 288(1): 67-74. 
  • Dey, D.K., "Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds." J Am Geriatr Soc 01 Sep 2002; 50(9): 1510-8. 
  • Wilson, P.W., "Overweight and obesity as determinants of cardiovascular risk: the Framingham experience." Arch Intern Med 9 Sep 2002; 162(16): 1867-72. 
  • Wassertheil-Smoller, S., "Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women's Health Initiative: A Randomized Trial." JAMA, 28 May 2003; 289(20): 2673-84. 
  • Lavallée, P., "Association between influenza vaccination and reduced risk of brain infarction."Stroke 01 Feb 2002; 33(2): 513-8. 

ABOUT

The HealthTools™ assessment is an educational tool made available to you at no charge.  It is designed for adults 18 years and older living in the United States.  It was developed using current national standard guidelines.

Your participation in completing the HealthTools assessment is voluntary and you may exit the HealthTools assessment at any time. The HealthTools assessment is for personal use only.  It is not intended to diagnose, treat or prevent medical or other health conditions.  If you have a medical emergency, call 911 immediately.

The HealthTools assessment questionnaire is a series of questions about important personal health behaviors that can put you at increased risk for injury, illness and disease. It identifies your specific modifiable health risks and suggests simple actions you can take to maintain or improve your current and future health. It does not cover all of the health risks that could be of concern to you, especially if you are pregnant or have a serious health problem.

The Health Risk Assessment is not a substitute for information given to you by a licensed healthcare provider, nor is it a substitute for a medical exam. If you have any concerns about your health or if the Health Risk Assessment raises any questions consult a licensed healthcare professional.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.

The HealthTools assessment is strictly voluntary. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that the security and privacy of your personal health information remains confidential.  The HealthTools assessment is compliant with Title II of the Genetic Information Nondiscrimination Act of 2008. When questions about family medical history are included, you will not be required to answer those questions in order to complete the HealthTools assessment.

A personalized summary of the results and recommendations based on your responses to the HealthTools assessment questionnaire will be ready for you within minutes after completing the questionnaire. Your personalized summary will be displayed on a webpage within the HealthTools assessment and you may choose to use the “email my report” function from the results page send a copy of your personalized summary to an email address that you provide.  The webpage displaying your personalized summary will expire when you close your web browser and will not be retrievable via HealthTools assessment.  Please note, if you do not close your web browser, your personalized summary may be accessible by a subsequent user utilizing the web browser’s “back” button.

Section 2 – Disclaimer Review and Approval

Health Grades, Inc. designed and licenses the HealthTools assessment. Healthgrades hosts and operates the HealthTools assessment pursuant to a license agreement entered with its licensee and in compliance with the Terms of Use & Privacy Policy entered between its licensee and each HealthTools assessment user.

NOTICE

This HealthTools assessment is for general information purposes only.  It should not be used during a medical emergency or for diagnosis or treatment purposes.  If you have a medical emergency, call 911 immediately.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.

TERMS OF USE & PRIVACY POLICY

Acceptance

Please read these Terms of Use & Privacy Policy carefully.  By clicking on the “I agree to these terms” box and then clicking on “Continue”, you agree that these Terms of Use & Privacy Policy govern your access and use of the HealthTools assessment.  You must agree to the terms and conditions of these Terms of Use and Privacy Policy to use the HealthTools assessment.  If you do not agree to these Terms of Use & Privacy Policy, please click on the “X” in the lower left corner of this pop-up box and then exit the HealthTools assessment webpage.

Representations

You represent that you are at least 18 years old, a resident of the United States and not subject to the care of a legal guardian.

Acknowledgments

You acknowledge and agree that this HealthTools assessment is provided by the hospital or other healthcare entity (“Hospital”) identified in the HealthTools assessment and these Terms of Use & Privacy Policy.  You further acknowledge and agree that the Hospital’s Privacy Policy set forth in the Privacy Policy section below will govern the Hospital’s us of the information you provide via the HealthTools assessment.

NOTICE OF PRIVACY PRACTICES

Revised: June 15, 2014

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.

You may call the Patient Relations office if you have questions about this Notice. The number is

(913) 588-1290.

Who Will Follow This Notice

The KU Medical Center is made up of the health care providers listed below. To serve you better, we give you this Notice about our privacy practices and your privacy rights. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) guarantees your privacy rights. Each provider will follow the terms of this Notice. This Notice applies to our various sites of service. If you ask, we will give you a list of our sites that are subject to this Notice.

The KU Medical Center includes: The University of Kansas Hospital (its affiliates, including: Mid-America Cardiology, Inc.; Mid- America Cardiothoracic Surgeons, Inc.; Ambulatory Surgery Center, LLC; Jayhawk Primary Care, Inc.; and The University of Kansas Cancer Center),

The University of Kansas Medical Center, The University of Kansas Physicians, and affiliated Clinical Foundations, and KU HealthPartners, Inc. These providers include their employees, staff, trainees, volunteer groups and other health care workers. We may share medical information with each other for treatment, payment and operational purposes. The law allows us to do so to provide efficient health care services.

Important Disclaimer

The above providers are giving you this joint Notice. Each provider in this joint Notice is its own

health care provider. Each provider is individually responsible for its own activities. This includes

complying with privacy laws and all health care services it provides. We are not providing health

care services mutually or on each other’s behalf. We may share health information as allowed by

law.

Our Pledge Regarding Medical Information

We know that your medical information is personal. We will protect your medical information. We create a record of the care and services you receive at KU Medical Center. We need this record to give you complete and comprehensive care. We also need this record to comply with the law. This Notice applies to records we create for your care at KU Medical Center.

This Notice tells you about the ways that we may use and share your medical information. It also

describes your rights. We are required by law to: make sure that medical information that identifies you is kept private, give you this Notice of our legal duties and privacy practices concerning your medical information, and follow the terms of this Notice currently in effect.

How We May Use and Share Your Medical Information

We may use and share your medical information as listed below. Not every possible use or disclosure will be listed. However, all of the ways we may use and share information falls into one of these areas.

For Treatment.

We may use your medical information to give you medical care. We may share your medical information with doctors, nurses, technicians, students or other KU Medical Center workers. For example, departments may share your medical information to plan your care. This may include prescriptions, lab work, and x-rays. We may share your medical information with people not at KU Medical Center. This may include referring physicians and home health care nurses who are treating you.

For Payment.

We may use and share your medical information with your insurance plan or others who help pay for your care. For example, we may tell your health plan about a treatment you are going to receive. We do this to find out if your plan will pay for the treatment.

For Health Care Operations.

We may use and share your medical information for our operations. These uses and disclosures help us run our programs and make sure our patients receive quality care. For example, we may use medical information to review our treatment and services. We may use medical information to measure the performance of our staff and how they care for you. We may share medical information with doctors, nurses, technicians, students, and other health care workers for teaching purposes or preparatory to research.

Business Associates.

We may contract with outside businesses to provide some services for us. For example, we may use the services of transcription or collection agencies. Under such contracts, we may share your medical information with them to do the job we have asked them to do. These contracts require businesses to protect the medical information we share with them and to provide you with access to your medical information and a list of any of your medical information that they disclose.

Appointment Reminders.

We may contact you to remind you about your appointment for medical care.

Treatment Alternatives.

We may use and share medical information to tell you about different types of treatment available to you. We may use and share medical information to tell you about other benefits and services related to your health.

Hospital Directory.

We may include limited information about you in the hospital directory while you are a patient in the hospital. This information may include your name, location in the hospital, general condition (fair, stable, etc.), and religion. We may share the directory information, except for religion, with people who ask for you by name. We provide this service so your family, friends and others close to you can visit you and generally know how you are doing. If you do not want people to know that you are in the hospital, we will not share this information. You must let the Admitting Department know that you do not want this information to be shared. Call the Admitting Department at (913) 588-7431 if you do not want this information to be shared.

People Involved In Your Care.

Unless you ask us not to, we may share your medical information with a family member or friend who helps with your medical care. We may share your medical information with a group helping with disaster relief efforts. We do this so your family can be told about your location and condition. If you are not present or able to say no, we may use our judgment to decide if sharing your information is in your best interest.

Research.

As an academic medical center, we may use and share your medical information for research. We may share your medical information with researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your medical information. We may also share your medical information with people preparing to conduct a research project. We may also use and share your medical information to contact you about the possibility of enrolling in a research study.

As Required By Law.

We will share your medical information when required to do so by federal, state or local law.

Fundraising Activities.

We may use your information to contact you for efforts to raise funds for KU Medical Center. We may share your information with foundations and other entities related to KU Medical Center. Such foundations or entities may contact you to raise funds. For example, you may get invitations to fundraising events. You may get annual reports and other types of mailings for programs to raise funds. We may share contact information. We may also share the following types of information: dates of service, treating physician and department, outcome and health insurance status. You may call KU Endowment at (913) 588-5249 or the Hospital Fund Development office at (913) 588-2800 if you do not want us to contact you for KU Medical Center fundraising purposes.

To Prevent A Serious Threat To Health Or Safety.

We may use and share your medical information to prevent a serious threat to your health and safety and that of others. We will only share your medical information with persons who can help prevent the threat.

How We May Use and Share Your Medical Information - Special Situations

Organ and Tissue Donation.

We may share medical information with groups that handle and monitor organ donations and transplants.

Military.

If you are in the U.S. or foreign armed services, we may share your medical information as required by the proper military authorities.

Workers’ Compensation.

We may share your medical information for workers’ compensation or programs like it. We may do this to the extent required by law.

Public Health Risks.

We may share your medical information for public health activities. We may do so as required by law. For example, we may share your medical information: to prevent or control disease, injury or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medicines or problems with products; to tell you about product recalls; to tell you if you have been exposed to a disease or may be at risk for catching or spreading

a disease or condition; and to tell the proper government department if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only share this information when ordered or required by law.

Health Oversight Activities and Registries.

We may share your medical information with government agencies that oversee health care. We may do so for activities approved by law. For example, these activities include: audits, investigations, inspections and licensure surveys. The government uses these activities to monitor the health care system. It also monitors the outbreak of disease, government programs, compliance with civil rights laws, and patient outcomes. We may share medical information with government registries.

Lawsuits and Disputes.

If you are in a lawsuit or a dispute, we may share your medical information in response to a court order, legal demand or other lawful process.

Law Enforcement.

We may share medical information if asked to do so by a law enforcement official: to report certain types of wounds; to respond to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime, if under certain limited circumstances, we are unable to obtain the victim’s agreement; about a death we believe may be caused by a crime; about suspected crimes on our premises; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who may have committed the crime.

Coroners, Medical Examiners and Funeral Directors.

We may share medical information with a coroner or medical examiner. For example, we may do this to identify a deceased person or to determine the cause of death. We may share medical information with funeral directors as necessary to carry out their duties.

National Security.

We may share your medical information with the proper federal officials for national security reasons.

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

Right To Access and To Receive Copies

You have the right to look at and to receive copies of the medical information used to make decisions about your care, including information kept in an electronic health record, and/or to tell us where to send the information. Usually, this includes medical and billing records. It does not include some records such as psychotherapy notes. To look at and to receive copies of medical information used to make decisions about you, you must submit your request in writing. We may charge a fee for the costs of processing your request. If the copies provided are in an electronic form, we can only charge you for our labor costs. Call Release of Information at (913) 588-2454 to get more details. In some limited cases, we may say no to your request, such as a request for psychotherapy notes. You may ask that such a decision be reviewed. To ask for a review, contact Patient Relations at (913) 588-1290.

Right To Amend

You have the right to ask for an amendment of your protected health information or your record. To ask for a change to your record, you must make your request in writing and submit it to the Director of Medical Records; 3901 Rainbow Blvd.; Kansas City, KS 66160. Also, you must give a reason that supports your request. We may say no to your request for an amendment to your record. We may do this if it is not in writing or does not include a reason to support the request. We also may say no to your request if you ask us to amend information that: we did not create, unless the person or entity that created the information is no longer available to make the amendment; is not part of the records used to make decisions about you; is not part of the information which you are permitted to inspect and to receive a copy; or is accurate and complete.

Right To an Accounting of Disclosures.

You have the right to get a list of the disclosures we made of your medical information including medical information we maintain in an electronic health record. This list may not include all disclosures that we made. For example, this list will not include disclosures that we made for treatment, payment or health care operations purposes. You have the right to request a list of disclosures from us and any of our business associates. Any accounting will not include disclosures made before April 14, 2003, or disclosures you specifically approved.

Website Privacy Policy

The University of Kansas Hospital is committed to protecting your online privacy. In general, you can visit kumed.com without revealing any personal information. However, you may be asked to provide personal information to gain access to some of our content and services. This information helps us to better ascertain and address the health care needs and concerns of site visitors.

All personally identifiable data that you enter on this site is encrypted with secure server software (SSL) to protect it while it is being transferred to our servers, where it is guarded with state-of-the art security software. It is not sold or given to any third parties.

Registering on kumed.com may also provide you with the opportunity to receive free print or e-mail newsletters, or electronic updates on topics of particular interest to you. You may unsubscribe from these items at any time by e-mailing hospweb@kumc.edu

Web Site Accessibility- The University of Kansas Hospital is committed to providing access to its web pages for individuals with disabilities. The Hospital recognizes the importance of making its web site available to the largest possible audience and the goal is to attempt to design the web site to be accessible by everyone.

To meet this commitment, the goal is to attempt to voluntarily comply with requirements of Section 508 of the Rehabilitation Act Amendments of 1998, and Level 1.0 Accessibility Guidelines proposed by World Wide Web Consortium (W3C). Section 508 requires that individuals with disabilities, who are members of the public seeking information or services, have access to and use of information and data that is comparable to that provided to the public who are not individuals with disabilities, unless an undue burden would be imposed on the Hospital.

Web Site Disclaimer- The University of Kansas Hospital provides its web site as a public service. Users of the hospital web site are responsible for checking the accuracy, completeness, content, currency, suitability, and timeliness of all information. The University of Kansas Hospital makes no representations, guarantees, or warranties, expressed or implied, as to the accuracy, completeness, content, currency, suitability, and timeliness of the information provided via its web site. The information is provided on an "as is" basis.

The University of Kansas Hospital specifically disclaims any and all liability for any claims or damages that may result from providing the web site or the information it contains, including any web sites maintained by third parties and linked to or from The University of Kansas Hospital web site. The University of Kansas Hospital makes no effort to independently verify, and does not exert editorial control over, information or services provided on pages outside the kumed.com domain. The University of Kansas Hospital does not endorse any of the products, vendors, consultants, or documentation referenced in the Hospital web site. Any mention of vendors, products, or services is for informational purposes only.

Web Site Linking- The information posted on The University of Kansas Hospital web site may include hypertext links or pointers to information created and maintained by other public and/or private organizations, either affiliated with, or in partnership with, The University of Kansas Hospital. The hospital provides these links and pointers solely for the web site users' information and convenience. The inclusion of links on the web site should not be construed as an endorsement by The University of Kansas Hospital of those links or their contents. When users select a link to an outside web site, they are leaving The University of Kansas Hospital web site and are subject to the privacy and security policies of the owners/sponsors of the outside web site.

Web Site Recognition of Sponsors and Partners- The information posted on The University of Kansas Hospital web site may include acknowledgements or promotional materials and information regarding other public and/or private organizations, either affiliated with, or in partnership with, The University of Kansas Hospital. The hospital provides the material solely for the web site users' information and convenience as part of agreements with its sponsors and community partners. The inclusion of this material on the Hospital web site should not be construed as an endorsement by The University of Kansas Hospital.

IP addresses- We collect and log the IP address (an identification number associated with your computer) of all visitors to kumed.com. This allows us to administer our system and gather aggregate information about how our site is being used. To maintain your anonymity, we do not associate IP addresses with records containing personal information. We will use IP address information, however, as needed to enforce our legal rights or when required to do so by law enforcement authorities.

How we use "cookies"- “Cookies" are small pieces of information that some Web sites store on your computer's hard drive when you visit them. Like many other Web sites, kumed.com uses aggregate data compiled by cookies to provide us with information about traffic to our site. Collecting this information does not allow us to personally identify you. If you modify your web browser to reject cookies from our site, the functions and conveniences of our site may not work properly.

E-mail communications- E-mail communication that you send to us via the e-mail links on our site may be shared with a customer service representative, employee, or medical expert that is most able to address your inquiry. We make every effort to respond in a timely fashion once communications are received.

Because e-mail does not provide a completely secure and confidential means of communication, please do not use e-mail if you wish to keep your communication private. Instead, call (913) 588-1227 or toll-free (800) 332-6048 with your request.

Complaint process- If you have a complaint or concern, or if you believe your privacy rights have been violated, you may e-mail us at hospweb@kumc.edu. Please indicate the reason for contacting us and we will forward your complaint to the appropriate department for response or resolution.

License

Subject to the terms and conditions of these Terms of Use & Privacy Policy, Hospital grants you a non-exclusive, non-transferable license to access and use the HealthTools assessment and any reports provided to you via the HealthTools assessment solely for your personal information purposes.  Hospital and its licensors retain all intellectual property rights in the HealthTools assessment, including any reports, and any enhancements to it.  Hospital, in its sole discretion, may terminate your license to access and use the HealthTools assessment at any time, for any reason and without any prior notice; provided, that, you may continue to access and use any reports in accordance with this license that you saved outside of the HealthTools assessment.   

Reservation of Rights

Hospital and its licensors are the exclusive suppliers of the HealthTools assessment and the exclusive owners of all right, title and interest in and to the HealthTools assessment, including reports, and all intellectual property related to the HealthTools assessment, any enhancements thereto, and any materials provided to you in connection with the HealthTools assessment.  You may not use the HealthTools assessment, including reports, except pursuant to the limited rights expressly granted in these Terms of Use & Privacy Policy.

Warranties Disclaimer

Hospital provides the HealthTools assessment and reports to you via the HealthTools assessment on an “AS IS “BASIS WITHOUT ANY WARRANTIES OF ANY KIND.  TO THE FULLEST EXTENT PERMITTED BY LAW, HOSPITAL DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT AND FITNESS FOR A PARTICULAR PURPOSE.  HOSPITAL MAKES NO WARRANTIES ABOUT (i) THE ACCURACY, RELIABILITY, ACCESSIBILITY, COMPLETENESS, OR TIMELINESS OF ANY INFORMATION SUPPLIED TO YOU VIA THE HEALTHTOOLS assessment.

Disclaimer Review and Approval

Limitation of Liability

IN NO EVENT SHALL HOSPITAL OR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS OR LICENSORS BE LIABLE TO YOU FOR INCIDENTAL AND CONSEQUENTIAL DAMAGES, RESULTING FROM YOUR USE OR INABILITY TO USE THE HEALTHTOOLS assessment OR ANY REPORTS OR OTHER INFORMATION PROVIDED VIA THE HEALTHTOOLS assessment, OR FOR ANY DAMAGES WHATSOEVER, WHETHER SUCH LIABILITY IS BASED ON WARRANTY, CONTRACT, TORT, NEGLIGENCE OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT HOSPITAL OR ITS LICNESORS ARE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

Responsibility for Safety

The HealthTools assessment may advocate or involve physical activity.  You hereby expressly assume all risk associated with any physical activity you undertake in connection the HealthTools assessment or any reports or other information provided via the HealthTools assessment. It is your responsibility to consult with a physician to determine your fitness to engage in any physical activities. It is also your responsibility to use appropriate equipment, clothing and techniques.

Governing Law

THIS USER AGREEMENT, AND YOUR USE AND ACCESS OF THE ASSESSMENT IS GOVERNED BY THE LAWS OF THE STATE OF COLORADO, WITHOUT REGARD TO ITS CONFLICT OF LAWS RULES. JURISDICTION AND VENUE FOR ANY CAUSE OF ACTION ARISING UNDER THIS AGREEMENT SHALL BE IN DENVER, COLORADO. “HOSPITAL” makes no representation that the Assessment is appropriate or available for use in locations outside the United States of America. You agree not to access the Assessment from any country or jurisdiction where its content is illegal or prohibited. If you choose to access the Assessment from outside the United States, you do so on your own initiative and you are responsible for compliance with local laws.

Entire Agreement

You agree that these Terms of Use & Privacy Policy set forth the entire understanding between you and Hospital with respect to the HealthTools assessment. You further agree that if any provision of these Terms of Use & Privacy Policy is held invalid, the remaining provisions shall continue in full force and effect.

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