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THIS NOTICE DESCRIBES HOW CHIROPRACTIC INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice takes effect on April 14, 2003 and remains in effect until we replace it. It is your duty to ask if this notice has been revised on any subsequent visit.
1. OUR PLEDGE REGARDING CHIROPRACTIC INFORMATION
The privacy of your chiropractic information is important to us. We understand that your chiropractic information is personal and we are committed to protecting it. We create a record of the care and services you receive at our clinic. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share chiropractic information about you. We also describe your rights and certain duties we have regarding the use and disclosure of chiropractic information.
2. OUR LEGAL DUTY
Law Requires Us To:
1. Keep your chiropractic information private.
2. Give you this notice describing our legal duties, privacy practices, and your rights regarding your chiropractic information.
3. Follow the terms of the notice that is now in effect.
We Have The Right To:
1. Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.
2. Make the changes in our privacy practices and the new terms of our notice effective for all chiropractic information that we keep, including information previously created or received before the changes.
Notice Of Change To Privacy Practices:
1. Any changes to our "Notice of Privacy Practices" will be available to you upon your request.
3. USE AND DISCLOSURE OF YOUR HEALTH RECORDS
The following section describes different ways that we use and disclose chiropractic information. Not every use or disclosure will be listed.
FOR TREATMENT: We may use chiropractic information about you to provide you with chiropractic treatment or services. We may disclose chiropractic information about you to other health care professionals or other people who are taking care of you. We may also share chiropractic information about you to your other health care providers to assist them in treating you.
FOR PAYMENT: We may use and disclose your chiropractic information for payment purposes.
FOR HEALTH CARE OPERATIONS: We may use and disclose your chiropractic information for our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
ADDITIONAL USES AND DISCLOSURES: In addition to using and disclosing your chiropractic information for treatment, payment, and health care operations, we may use and disclose chiropractic information for the following purposes. Not every use or disclosure will be listed.
Facility Directory: Unless you notify us that you object, the following chiropractic information about you will be placed in our facilities' directories: your name; your location in our facility; your condition described in general terms; your religious affiliation; if any. We may disclose this information to members of the clergy or, except for your religious affiliation, to others who contact us and ask for information about you by name.
Notification: Chiropractic information to notify or help notify: a family member, your personal representative or another person responsible for your care. We will share information about your location, general condition, or death. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are not able to give or refuses permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up chiropractic, chiropractic supplies, x-ray or chiropractic information for you.
Disaster Relief: Chiropractic information with a public or private organization or person who can legally assist in disaster relief efforts.
Funeral Director, Coroner, Medical Examiner: To help them carry out their duties, we may share the chiropractic information of a person who has died with a coroner, medical examiner, funeral director, or an organ procurement organization.
Court Orders and Judicial and Administrative Proceedings: We may disclose chiropractic information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your chiropractic information with law enforcement officials. We may share limited information with a law enforcement official concerning chiropractic information of a suspect, fugitive, material witness, crime victim or missing person. We may share the chiropractic information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.
Public Health Activities: As required by law, we may disclose your chiropractic information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your chiropractic information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs or replacements, to track products, or to conduct activities required by the Food and Drug Administration. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose chiropractic information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your chiropractic information if it is necessary to prevent a serious threat to your health or safety or the health and safety of others. We may share chiropractic information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.
Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.
Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
Marketing and Communication: We may send you Birthday Cards, Thank You Cards, Special Event Cards, Clinic Advertisements, Educational Material and Special Announcements via the Telephone, Email or Postal Service.
4. YOUR INDIVIDUAL RIGHTS
You Have A Right To:
1. Look at or get copies of your chiropractic information. You must make your request in writing to our office. If you request copies we will charge you .25 cents per sheet for a single side copy, general excise tax, and postage if you want the copies mailed to you.
2. Request that we place additional restrictions on our use or disclosure of your chiropractic information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
3. Request that we communicate with you about your chiropractic information by different means or to different locations. Your request that we communicate your chiropractic information to you by different means or at different locations must be made in writing to our office.
4. Request that we change your chiropractic information. We may deny your request if we did not create the information you want changed or for certain other reasons.
QUESTIONS AND COMPLAINTS
If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact your compliance officer Dr. Kathleen Yim, D.C.. You may also submit a written complaint to the U.S. Department of Health and Human Services.
NOTE: This office does not file insurance claims electronically.
Revised and Approved on January 1, 2004 by Dr. Kathleen W.H. Yim, D.C..
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