Notice of Privacy Practices

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.

If you have any questions about this Notice please contact our Privacy Contact who is: Dr. Willcockson

This Notice of Privacy practices describes how we may use and disclose your protected health information to carry out treatment, payment and 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 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 by calling the office and requesting that a revised copy be sent to you in the mail or by asking for one at your next appointment.

1.  Uses and Disclosures of Protected Health Information
Permitted Uses or Disclosures without your Consent or Authorization.  Your protected health information may be used by your physician, our office staff and others outside our office that are involved in your care and treatment for the purpose of providing health care services to you.  Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of this office.

Following are examples of the types of uses and disclosures of your protected health information that the physician’s office is permitted to make.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment:  We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  For example we may disclose protected health information to another physician who is treating you.

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 this office.  This may involve quality assessment, employee review and licensing.

We will share your information with third party business associates that perform various activities such as billing and collections.  Whenever an arrangement between our office and a business associate involves the use or disclosure of protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Uses and Disclosures of Protected health Information Based Upon Your Written Authorization.  Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke this authorization, at any time, in writing except to the extent that your physician ‘s practice has taken action in reliance on the use or disclosure indicated in the authorization.

Other permitted and Required Uses and Disclosures that May Be Made With Your 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, 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 relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.  We may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies:  We may use or disclose your protected health information in an emergency treatment situation.  
Required By Law:  We may use or disclose your protected health information to the extent use or disclosure is required by law.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, as required by law, of any such uses or disclosures. 

Public Health:  We may 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 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.  In addition we may disclose your protected health information if we believe that you have been the victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information.

Legal Proceedings:  We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of court or administrative tribunal, in certain conditions in response to a subpoena, discovery request or other lawful process.

Law Enforcement:  We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.

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

Research:  We may disclose your protected health information to researchers when their research has been approved by and institutional review board that had reviewed the research proposal and established protocol to ensure the privacy of your protected health information. 

Criminal Activity:  Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person of the public.  We may also disclose protected health information if it is necessary for law enforcement activities to identify or apprehend and individual.

Military Activity and National Security:  When appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel.

Worker’s Compensation:  Your protected health information may be disclosed by us as authorized to comply with worker’s compensation laws and other similar legally established programs.

Required Uses and Disclosures:  Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

Sign in Sheets:  You will be required to sign a sign in sheet when you arrive for treatment at ChiropracticUSA.  You will also be able to sign up for classes on sign in sheets located in the patient area of the office.

2. Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy our protected health information.  You may inspect and copy protected health information about you that is contained with in a designated record set.  Such a set will contain billing and medical records and any other records that your physician and uses for making decisions about you.  There are certain circumstances under which we can deny your request to inspect your protected health information.  A decision to deny you access to your protected health information may be reviewable.  Please contact our privacy contact person if you have any questions.

You have the right to request a restriction of your protected health information:  This means that you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care for notification purposes as described in this Notice of Privacy practices.  Your request must state the specific restriction requested and to whom you want to restriction to apply.

Your physician is not required to agree to the restriction that you may request.

You have the right to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable requests.  We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address of other method of contact.  We will not request an explanation from you as to the basis for the request.  Please make your request in writing.

You may have the right to have your physician amend your protected health information.  You may request and amendment of your protected health information about you in a designated records set for as long as we maintain this information.  In certain cases, we may deny your request for an amendment.  If we deny your request for an amendment then you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  Please contact our Privacy Officer with questions regarding the amendment of your information.

You have the right to receive an accounting of certain disclosures we have made of your protected health information.  This right applies to disclosures for purposes other than treatment, payment or healthcare operation as described in this Notice of Privacy practices.  It excludes disclosures we made to your, family members or friends, or for notification purposes.  You have the right to receive specific information regarding disclosures that occurred after April 14, 2003.  You may request a shorter time frame.  The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us.  Direct your request to the privacy officer.

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

You may contact our privacy officer Dr. Willcockson for further information about the complaint process.

This notice may be modified and updated from time to time with out your approval and without notification to you that the modifications have been made.  You may request a copy of this and any subsequent Notice of Privacy Practices.  The most current Notice of Privacy Practices will be posted in our patient area and will also be available on our web site.

This Notice was published and becomes effective on APRIL 14, 2003.