Welcome to Northwest Renal Clinic
Providing comprehensive nephrology care
The largest nephrology practice in Oregon
Serving Patients throughout the Northwest

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Notice of Privacy Practices

 

Notice of Privacy Practices


This Notice is being provided to you as part of our compliance with a series of Federal Regulations which fall under what is described as HIPAA rules. HIPAA stands for the Health Insurance Portability and Accountability Act. The rules mandating this notice are only part of the HIPAA regulations. You may be provided other documents as part of our effort to stay in compliance with these laws. The regulations also require we obtain from you a signed acknowledgement that you have been provided this information. This form is included in this packet.

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

If you have any questions about this notice please contact the office manager of the location you normally receive services.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected Health Information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. This request may be made by calling the office and requesting that a revised copy be sent to you in the mail. You may also ask for a copy at the time of your next appointment.

The following is a condensed version of our Notice of Privacy Practices. It is being provided to you in accordance with the regulations set forth under HIPAA. Our complete Notice of Privacy Practices is  available upon request in any of our offices.

Uses and Disclosures of Protected Health Information with or without your Written Consent

Revisions to HIPAA regulations published in the August 14, 2002 Federal Register indicate that Protected Health Information may be disclosed without consent so long as disclosures are made in connection with routine health care delivery purposes.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment, employee review, employee training and licensing.

Other Permitted and required uses and disclosures that may be made with your consent, authorization or opportunity to object.

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.

Others involved in your healthcare: Unless you object, we may disclose to a member of your family, a close friend or any other person you identify, your protected health information that directly relates to that persons involvement in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation.

Communication Barriers: We may use or disclose your protected health information if your physician or another physician within this practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object.

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

Required by law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. You will be notified of any such disclosures.

Public Health: We may use or disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.

Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health oversight: We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect.

Food and Drug Administration: We may disclose your protected health information to a person or company required by the FDA to report adverse events, product defects or problems, etc.

Legal Proceedings: We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of the court.

Law Enforcement: We may disclose your protected health information for law enforcement purposes.

Coroners, Funeral Directors, and Organ Donations: We may disclose your protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the performance of duties authorized by law.

Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board.

Criminal Activity: We may disclose your protected health information if we believe that the use is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Military Activity and National Security: We may disclose your protected health information if you are a member of the Armed Forces and certain conditions apply.

Workers Compensation: We may disclose your protected health information to comply with workers compensation laws.

Your Rights

  • You have the right to inspect and copy your protected health information.
  • You have the right to request a restriction of your protected health information.
  • You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
  • You may have the right to have your physician amend your protected health information.
  • You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
  • You have the right to obtain a paper copy of this notice from us.

Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

Further information about the complaint process can be obtained by contacting the office manager of the location at which you receive services. The manager will work with our privacy officer to address your concerns.

Protein Foods Handout
Phosphorus Foods Handout
Potassium In Foods
  • Low Potassium foods (one portion= ½ cup raw or as stated) to 150mg 
  • Apple juice, ½ cup, 148 
  • Coffee, 6oz, brewed, 124 
  • Cranberry juice, ½ cup, 31 
  • Ginger ale, 12 oz, 4 
  • Tea, 6oz, brewed, 27 to 120mg 
  • Apples, peeled, sliced 62 applesauce, canned, sweetened, 78; unsweetened, 92 
  • Apricot, 1 medium, 105 
  • Blueberries, raw, 65 
  • Cherries, sour, red, canned, water pack, 120 
  • Cranberries, raw, 39 
  • Cranberry sauce, canned, sweetened, 36 
  • Fig, 1 medium, 116 
  • Fruit cocktail in heavy syrup, 112 
  • Grapes, Thompson seedless, ten, 93 
  • Grapes, seeded, Tokay, ten, 105 
  • Lemon, 1 medium, 80 
  • Lime, I medium, 68 
  • Peaches, canned, heavy syrup, 118 
  • Pears, heavy syrup, 83 
  • Pineapple, raw, diced, 88 
  • Plums, canned, heavy syrup, 118 
  • Plums, raw, 1 medium, 114 
  • Raspberries, raw, 94 
  • Rhubarb, cooked, with sugar, 115 
  • Watermelon, diced, 93 
  • To 125mg 
  • Alfalfa seeds, sprouted, raw, 13 
  • Arugula, raw, 37 
  • Bagel plain, 50 
  • Bamboo shoots, canned, 53 
  • Beans, green, cooked, from frozen, 76 
  • Bean sprouts, raw, 78 
  • Bread, 1 slice, white, 28 
  • Cabbage, raw, red 72 
  • Cabbage, raw, green, 86 
  • Carrots, cooked from frozen, 116 
  • Cauliflower, cooked from frozen, 125 
  • Collards, leaves, cooked from raw, 84 
  • Corn, cooked, from frozen, 114 
  • Cucumbers, sliced, 84 
  • Dandelion greens, cooked, 121 
  • Eggplant, steamed, 119 
  • Endive, raw, 79 
  • Jicama, raw, 98 
  • Leeks, cooked from raw, 46, raw, 94 
  • Lettuce, iceberg, 1 cup 87 
  • Mustard greens, cooked from frozen, 104 
  • Oatmeal, regular, ¾ cup, 99 
  • Onions, raw, diced, 124 
  • Pasta, plain, 1 cup, 103 
  • Peppers, sweet, raw, 89, cooked, 113 
  • Popcorn, air popped, 1 cup, 20 
  • Rice, cooked, white, 29; brown, 69 
  • Turnips, white, cubes, cooked from raw, 106 
  • Water chestnuts, canned, 83 
  • Higher Potassium 
  • From 151 to 200mg 
  • Grape juice, canned or bottled, ½ cup, 167 
  • Grapefruit juice, canned, unsw, ½ cup, 189 
  • Pineapple juice, canned, unsw, ½ cup 168 From 121-250mg 
  • Apricots, canned, heavy syrup, 181 
  • Juice pack, 205 
  • Blackberries, raw, 141 
  • Cherries, sweet, ten, 152 
  • Grapefruit, ½ medium, 167 
  • Grapefruit, canned, with syrup, 164 
  • Orange, 1 medium, 237 
  • Peach, 1 medium, 171 
  • Peaches canned, juice pack, 159 
  • Pear, Asian, 1 medium, 148 
  • From 121-250mg continued. 
  • Pear, 1 medium, Bosc, 176 
  • Pear, 1 medium, Bartlett, 208 
  • Pineapple, canned, heavy syrup, 133 
  • Pineapple, canned, juice packed, 153 
  • Plums, canned, juice packed, 194 
  • Raspberries, frozen, sweetened, 143 
  • Strawberries, raw, 124 
  • Tangerine, 1 medium, 132 
  • From 126-250mg 
  • Asparagus, cooked, from frozen, 196 
  • Beans, green, cooked from raw, 185 
  • Bread, pumpernickel, 1 slice, 141 
  • Broccoli, cooked, from frozen, 167 
  • Broccoli, cooked, from raw, 
  • 127Brussel sprouts, cooked, from raw, 246 
  • Cabbage, common, cooked, 154 
  • Carrots, cooked, from raw, 177 
  • Cauliflower, cooked, from raw, 202 
  • Cauliflower, raw florets, 178 
  • Celery, raw, diced, 171 
  • Chickpeas, cooked, drained, 239 
  • Corn, cooked, from raw, 204 
  • Fennel bulb, raw, sliced, 180 
  • Kale, cooked, from frozen, 209 
  • Kale, cooked, from raw, 148 
  • Lettuce, romaine, 1 cup, 148 
  • Mushrooms, raw, 130 
  • Mustard greens, cooked, from raw, 141 
  • Okra, sliced, cooked, from frozen, 215 
  • Onions, cooked, 160 
  • Parsley, raw, 166 
  • Peas, edible pod, cooked, 192 
  • Peas, green, cooked, from frozen, 134 
  • Peppers, hot chili, 1 raw, 153 
  • Radishes, raw, 144 
  • Scallions, raw, 138 
  • Squash, summer, cooked, all 
  • types, 173 
  • Spinach, raw, chopped, 154 
  • Tortillas, corn, flour, 172 
  • Turnip greens, cooked, from raw, 146 
  • Highest Potassium 
  • 201 or more mg 
  • Milk, whole, 1 cup, 370 
  • Milk, skim, 412 
  • Milk 1% reduced fat, 381-397 
  • Orange juice, fresh, ½ cup, 248 
  • Soy milk, 1 cup, 338 
  • 251 or more mg 
  • Apricots, dried, uncooked, 896 
  • Apricots, dried, cooked, 611 
  • Artichoke, 1 medium, 425 
  • Avocado, ½ medium, 549 
  • Banana, medium, 451 
  • Beans, black, cooked, drained, 306 
  • Beans, kidney, cooked, 355 
  • Beets, cooked, 265 Cantaloupe, ¼ medium, 413 
  • Dates, chopped, 581 
  • Figs, 5 dried, 666 
  • Honeydew melon, ¼ medium, 875 
  • Kiwifruit, 1 medium, 252 
  • Lentils, cooked, 366 
  • Mango, 1 medium, 323 
  • Nectarine, 1 medium, 288 
  • Papaya, ½ medium, 390 
  • Peaches, dried, cooked, 413 
  • Peaches, dried, uncooked, 797 
  • Peanuts, oil roasted, unsalted, 491 
  • Pomegranate 1 medium, 399 
  • Potato, baked, large, with skin, 844 
  • Potato, boiled, no skin, 256 
  • Prunes, 5 dried, uncooked, 365 
  • Pumpkin, canned, 253 
  • Raisins, seedless, 545 
  • Soy beans, cooked, 486 
  • Spinach, cooked, from frozen, 283 
  • Tomato, raw, 1 medium, green, 251 
  • Tomato, raw, 1 medium, red, 273 

 

What is Chronic Kidney Disease?
What is chronic kidney disease? 
Chronic kidney (renal) failure is a gradual shutdown of your kidneys.  This problem is also called chronic renal failure or chronic renal insufficiency. Your kidneys are located on each side of your spine above your waist.  They make urine by filtering waste products from your blood, control the balance of salt and water in your body and help regulate your blood pressure.  As long as you have at least one kidney that is working, your body can get by. When you have kidney failure, the kidneys are no longer able to make urine, rid your body of wastes, or keep a healthy balance of minerals such as sodium and potassium.

How does it occur? 
Chronic kidney failure is caused by continuous damage to the kidneys over the years by diseases such as: 
  • High blood pressure ( Hypertension) 
  • Cysts in the kidney ( Polycystic Kidney Disease) 
  • Diabetes 
  • Heart or lung disease 
Acute kidney failure, which is a sudden shutdown of your kidneys, may develop into chronic kidney failure.  Prolonged use of nonprescription painkillers, such as acetaminophen, aspirin, and NSAIDS (such as ibuprofen or naproxen) can also cause chronic kidney failure. 

What are the symptoms? 
Symptoms include: 
  • A need to pass urine often, or urinating less often or not at all. 
  • Pale and diluted-looking urine 
  • Tiredness, weakness, headaches, loss of appetite, nausea and vomiting 
  • Coated tongue 
  • Itchy skin 
  • Muscle cramps 
  • Skin or breath that smells like urine 
  • Trouble concentrating How is it diagnosed? 
Your healthcare provider will ask you about your symptoms and your medical history, including medications that you are taking.  Your provider will examine you. You will have urine and blood tests to determine how well your kidneys are working. 
 
You may also have special x-rays, ultrasound, and or CT scan of your kidneys.  In some cases you may need to have a biopsy, a test in which tissue or cell samples are taken from your kidney and examined. Your provider will look for diseases that could be causing damage to your kidneys, such as high blood pressure, diabetes, heart or lung problems, or cancer. 

How long will the effects last? 
Chronic kidney failure develops slowly, and you will have it for the rest of your life unless you have a kidney transplant.  Without treatment, kidney failure is fatal. 

How is it treated? 
Your provider will probably prescribe medication to: 
  • Treat the disease that is causing the kidney failure 
  • Keep your blood pressure under control 
  • Keep the balance of liquid in your body normal 
  • Keep the balance of minerals in your body normal 
If these treatments are not enough, you may need dialysis.  
Whether dialysis is used depends on: 
  • Why your kidneys stopped working 
  • Your other health conditions 
  • Your overall health 
For many people, dialysis can extend life and improve quality of life. Dialysis is a mechanical way to do the work your kidneys normally do. It removes waste products and extra water from the blood and can be lifesaving.  Dialysis can be done in a dialysis facility, but many people can operate the equipment themselves in their own homes. For those whose health is good other than their kidney failure, kidney transplants can be a welcome alternative to dialysis
Your Dialysis Access

To be placed on the dialysis machine, you must have a “blood access”. A blood access provides a way from blood to flow to your body into the dialysis machine, and back into your body. 

There are 3 types of accesses that a dialysis patient may have.  The decision of which type is made by you and your kidney doctor, based on your personal medical history. 
 
The preferred access is the A-V fistula, which is made by a surgeon using your own blood vessels. The next choice is an A-V graft. This is when a small tube is placed in your arm or leg.  The least favored access is a catheter.  A catheter should only be used as a temporary access until your fistula or graft is ready to use.

What is a fistula?

An A-V fistula is the joining of an artery and a vein together.  This will enlarge the veins in your access arm and allows us to connect your blood to the dialysis machine.  This requires a minor surgery that is done in the outpatient operating room by a specially trained surgeon or interventional nephrologist. Following surgery most people go home the same day.

PROS
  • The preferred access 
  • Lower chance of infection 
  • Lower chance of clotting 
  • Fistulas last the longest time of all types of access 
  • Only your natural blood vessels are used 
CONS 
  • Once a fistula has been created, it can take up to 6 months before it can be used for dialysis. Special exercises of your arm can shorten this time 
  • Bruises from needle sticks may cause some minor discomfort.
What is a graft?

An A-V Graft is a plastic tube placed in your arm under your skin, which is attached to an artery and a vein.  This allows for a way to carry blood to the dialysis machine.  This is a surgery that is done by a specially trained surgeon or an interventional nephrologist in the outpatient operating room.  Following surgery, most people go home the same day.   Immediately after the surgery, there may be some swelling, but it goes down after a few days.  You may be able to see the outline of the graft in your arm. There will be a scar from surgery, and “needle sticks” will leave small marks until they heal.

PROS 
  • Allows a large volume of blood to flow to the dialysis machine
  • Once a graft has been placed it can be used for dialysis in a short period of time. 
CONS 
  • Artificial item in your body 
  • Increased chance of clotting 
  • Increased chance of infection  
  • Bruises from needle sticks may cause some minor discomfort 
  • Clots can build up inside the graft 
  • A graft lasts for a shorter period of time than a fistula 
What is a Dialysis Catheter?

A catheter is a plastic tube placed with one end in a large vein near the heart. The other end of the catheter exits through the skin near the collar bone or on the neck. Catheters do not provide a large blood flow to the dialysis machine, and they can be easily infected.  This is why catheters are temporary until your permanent access is ready to be used. A catheter can be placed by your kidney doctor or by your surgeon, and does not require a hospital stay.

PROS 
  • A catheter can be used immediately after it is placed
CONS 
  • Longer treatment times due to low blood flow 
  • Low amounts of blood provided for dialysis 
  • Highest chance of infection of all types of access 
  • Increased chance of blood loss 
  • Catheters can only stay inside the body for a certain time period, and then they need to be replace

 

Registration Information
Anemia
If you have kidney problems, you may feel extremely tired and weak.  If you have been especially tired, you may have a condition called anemia.  Anemia is a condition in which the body does not have enough red blood cells. Red blood cells carry oxygen throughout your body. 

Symptoms of anemia include: 
  • Tiredness 
  • Shortness of breath 
  • Muscle pain when exercising 
  • Trouble sleeping 
  • Depression 
  • Dizziness
Our kidneys play many roles in our overall health. One of the things they do is produce a hormone called erythropoietin.  This hormone signals the bone marrow to make more red blood cells when we run low.  If your kidneys are struggling to filter the blood, they have a harder time sending the hormone signals to the bone marrow, and you can become anemic.
 
There are a number of ways to treat anemia including medications and blood transfusions.  
 
The following terms relate to anemia:
 
Hematocrit (HCT) -a way of measuring the red cell content of the blood. Measured as a percentage of the total blood volume.
 
Hemoglobin (Hb) – The part of the red blood cell that carries oxygen throughout the body.  Hb is measured on grams (g) per deciliter (dL)
 
Erythropoietin – The hormone usually produced in the kidneys to stimulate red blood cell production.
 
Fatigue – Extreme weakness, exhaustion, or tiredness. Can be a symptom of anemia.