ONE EIGHTY CHIROPRACTIC – NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION
I understand that health information about you and your care is personal. I am committed to protecting your information. I create a record of the care and services you receive at One Eighty Chiropractic, which is necessary to provide quality care and comply with legal requirements.
This notice applies to all records of your care generated by this practice. It describes how I may use and disclose your health information, your rights regarding this information, and my obligations under the law.
I am required to:
Keep your protected health information (PHI) private.
Provide this notice of my legal duties and privacy practices.
Follow the terms of the notice currently in effect.
I may update this notice from time to time. Any changes will apply to all your health information, and the new notice will be available upon request, in the office, and on our website.
II. HOW I MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
For Treatment, Payment, and Health Care Operations:
I may use or disclose your PHI without your written authorization for:
Providing chiropractic care and related treatments.
Communicating with other health care providers involved in your care.
Billing, insurance, and other operational purposes.
Lawsuits and Disputes:
I may disclose PHI in response to a court or administrative order, subpoena, or lawful process. Efforts will be made to notify you or obtain legal protection for your information whenever possible.
III. USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Certain information, such as session notes, requires your written authorization for use or disclosure except in the following situations:
For my use in treating you.
For training or supervision purposes.
For legal defense, government investigations, or public safety.
Marketing and Sale of PHI:
I will not use or disclose your PHI for marketing purposes.
I will not sell your PHI in the normal course of business.
IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION
I may use or disclose your PHI without your written consent for:
Compliance with federal or state laws.
Public health and safety purposes, including reporting suspected abuse.
Health oversight activities (audits, investigations).
Judicial or administrative proceedings.
Law enforcement purposes.
Coroners or medical examiners performing legal duties.
Research purposes, under regulated conditions.
Workers’ compensation compliance.
Appointment reminders and health-related benefits or services.
V. DISCLOSURES TO FAMILY OR OTHERS
I may share your PHI with family members, friends, or others involved in your care or payment for care unless you object. In emergencies, consent may be obtained retroactively.
VI. YOUR RIGHTS REGARDING YOUR PHI
Request Limits: You can request limits on how I use or disclose your PHI. I may deny a request if it affects your care.
Out-of-Pocket Payments: You may request that disclosures to your health plan be restricted if you paid in full out-of-pocket for a service.
Method of Contact: You may request that I contact you by a specific method (phone, email, mail).
Access and Copies: You may request copies of your PHI (except session notes) in paper or electronic form. Requests will be fulfilled within 30 days for a reasonable fee.
Accounting of Disclosures: You can request a list of disclosures made for purposes other than treatment, payment, or health care operations.
Corrections: You may request corrections or additions to your PHI. I will respond in writing within 60 days.
Notice Copy: You may request a paper or electronic copy of this notice at any time.
EFFECTIVE DATE: This notice is effective as of 1/11/2021