HIPPA REGULATIONS

 

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

 

THIS NOTICE DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Uses & Disclosures

 

Here are some examples of how we might have to use or disclose your health care information.

 

1. Your chiropractor or a stage member may have to disclose your health information including all of your clinical records to another health care provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.

2. Our insurance and billing staff may have to disclose your examination and treatment records and your billing records to another party, such as an insurance carrier and HMO, a PPO, or your employer, if they are potentially responsible for the payment of your services.

3. Your chiropractor and members of the staff may need to use your health information, examination and treatment records and your billing records for quality control purposes.

4. Your chiropractor and members of the practice staff may need to use your name, address, phone number, and your clinical records to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information that may be of interest to you. If you are not at home to receive an appointment reminder, a message will be left on your answering machine.

 

You have the right to refuse and give us the authorization to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information. If you do not give us the authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.

 

You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information at any time.

 

OUR PRIVACY POLICY

 

We have and always will respect your privacy. Other than the uses and disclosures we described above, we will not sell provide any of your health information to any outside marketing organization.

 

Permitted uses and disclosures without your consent or authorization

 

Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances.

 

1. We are permitted to use or disclose your health information if we are providing health care services to you based on the orders of another health care provider.

2. We are permitted to use or disclose your health information if we provide health care services to you as an inmate.

3. We are permitted to use or disclose your health information if we provide health care services to you as an emergency.

4. We are permitted to use or disclose your health information if we are required by law to treat you as were are unable to obtain your consent after attempting to do so.

5. We are permitted to use or disclose your health information if there are substantial barriers in communication with you. In our professional judgment, we believe that you intend for us to provide care.

 

Other than the circumstances described in the preceding examples, any other use or disclosure of your health information will only be made with your written authorization.

 

Your right to amend your health information

 

You have the right to request that we amend your health information for six years from the date that the record was created or as long as the information remains in our files. We require your request to amend your records to be in writing and for you to give us a reason to support the change you are requesting us to make.

 

Appointment reminders and healthcare information authorization

 

Your chiropractor and members of the practice staff may need to use your name, address, phone number, and your clinical records to contact you with appointment reminders, information about treatment alternatives, or other health-related information that may be of interest to you. If this contact is made by phone and you are not at home, a message will be left on your answering machine. By signing this form below, you are giving us the authorization to contact you with these reminders and information.

 

 

By filling out the information below, you are acknowledging your knowledge and signature. This approves Dr. David "Kip" Corbin to continue with treatment.