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This notice describes how health
information about you may be used and disclosed and how you can get
access to this information. It is effective April 14, 2003, and applies
to all protected health information contained in your health records
maintained by us. We have the following duties regarding the
maintenance, use and disclosure of your health records:
(1)
We are required by law to maintain the privacy of the protected health
information in your records and to provide you with this Notice of our
legal duties and privacy practices with respect to that information.
(2)
We are required to abide by the terms of this Notice currently in
effect.
(3)
We reserve the right to change the terms of this Notice at any time,
making the new provisions effective for all health information and
records that we have and continue to maintain. All changes in this
Notice will be prominently displayed and available at our office.
There are a number of
situations in which we may use or
disclose to other persons or entities your confidential
health information. Certain uses and disclosures will require you to
sign an acknowledgement that you received this Notice of Privacy
Practices. These include treatment, payment, and health care
operations. Any use or disclosure of your protected health information
required for anything other than treatment, payment or health care
operations requires you to sign an Authorization. Certain disclosures
that are required by law, or under emergency circumstances, may be made
without your Acknowledgement or Authorization. Under any circumstance,
we will use or disclose only the minimum amount of information necessary
from your medical records to accomplish the intended purpose of the
disclosure.
We will attempt in good faith to obtain
your signed Acknowledgement that you received this Notice to use and
disclose your confidential medical information for the following
purposes. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our
office once you have provided Consent.
Treatment:
We will use your health information to make decisions about the
provision, coordination or management of your healthcare, including
analyzing or diagnosing your condition and determining the appropriate
treatment for that condition. It may also be necessary to share your
health information with another health care provider whom we need to
consult with respect to your care. These are only examples of uses and
disclosures of medical information for treatment purposes that may or
may not be necessary in your case.
Payment:
We may need to use or disclose information in your health record to
obtain reimbursement from you, from your health-insurance carrier, or
from another insurer for our services rendered to you. This may include
determinations of eligibility or coverage under the appropriate health
plan, pre-certification and pre-authorization of services or review of
services for the purpose of reimbursement. This information may also be
used for billing, claims management and collection purposes, and related
healthcare data processing through our system.
Operations:
Your health records may be used in our business planning and development
operations, including improvements in our methods of operation, and
general administrative functions. We may also use the information in
our overall compliance planning, healthcare review activities, and
arranging for legal and auditing functions.
There are certain circumstances under
which we may use or disclose your health information
without first obtaining your
Acknowledgement or Authorization. Those circumstances
generally involve public health and oversight activities,
law-enforcement activities, judicial and administrative proceedings, and
in the event of death. Specifically, we may be required to report to
certain agencies information concerning certain communicable diseases,
sexually transmitted diseases or HIV/AIDS status. We may also be
required to report instances of suspected or documented abuse, neglect
or domestic violence. We are required to report to appropriate agencies
and law-enforcement officials information that you or another person is
in immediate threat of danger to health or safety as a result of violent
activity. We must also provide health information when ordered by a
court of law to do so. We may contact you from time to time to provide
appointment reminders or information about treatment alternatives or
other health-related benefits and services that may be of interest to
you. You should be aware that we utilize an “open adjusting room” in
which several people may be adjusted at the same time and in close
proximity. We will try to speak quietly to you in a manner reasonably
calculated to avoid disclosing your health information to others;
however, complete privacy may not be possible in this setting. If you
would prefer to be adjusted in a private room, please let us know and we
will do our best to accommodate your wishes.
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. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if
we determine that it is in your best interest based on our professional
judgment. We may use or disclose protected health information to notify
or assist in notifying a family member, personal representative or any
other person that is responsible for your care of your location, general
condition or death. Finally, 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 healthcare.
Communication Barriers
and Emergencies:
We may use and disclose your protected health information if we attempt
to obtain consent from you but are unable to do so because of
substantial communication barriers and we determine, using professional
judgment, that you intend to consent to use or disclosure under the
circumstances. We may use or disclose your protected health information
in an emergency treatment situation. If this happens, we will try to
obtain your consent as soon as reasonably practicable after the delivery
of treatment. If we are required by law or as a matter of necessity to
treat you, and we have attempted to obtain your consent but have been
unable to obtain your consent, we may still use or disclose your
protected health information to treat you.
Except as indicated above, your health
information will not be used or disclosed to any other person or entity
without your specific Authorization, which may be revoked at any time.
In particular, except to the extent disclosure has been made to
governmental entities required by law to maintain the confidentiality of
the information, information will not be further disclosed to any other
person or entity with respect to information concerning mental-health
treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted
diseases that may be contained in your health records. We likewise will
not disclose your health-record information to an employer for purposes
of making employment decisions, to a liability insurer or attorney as a
result of injuries sustained in an automobile accident, or to
educational authorities, without your written authorization.
You have certain
rights regarding your health record
information, as follows:
(1)
You may request that we restrict the uses and disclosures of your health
record information for treatment, payment and operations, or
restrictions involving your care or payment related to that care. We
are not required to agree to the restriction; however, if we agree, we
will comply with it, except with regard to emergencies, disclosure of
the information to you, or if we are otherwise required by law to make a
full disclosure without restriction.
(2) You have a right to request receipt of confidential communications
of your medical information by an alternative means or at an alternative
location. If you require such an accommodation, you may be charged a
fee for the accommodation and will be required to specify the
alternative address or method of contact and how payment will be
handled.
(3)
You have the right to inspect, copy and
request amendments to you health records. Access to your health records
will not include psychotherapy notes contained in them, or information
compiled in anticipation of or for use in a civil, criminal or
administrative action or proceeding to which your access is restricted
by law. We will charge a reasonable fee for providing a copy of your
health records, or a summary of those records, at your request, which
includes the cost of copying, postage, and preparation or an explanation
or summary of the information.
(4)
All requests for inspection, copying and/or amending information in your
health records, and all requests related to your rights under this
Notice, must be made in writing and addressed to the Privacy Officer at our
address. We will respond to your request in a timely fashion.
(5)
You have a limited right to receive an accounting of all disclosures we
make to other persons or entities of your health information except for
disclosures required for treatment, payment and healthcare operations,
disclosures that require an Authorization, disclosure incidental to
another permissible use or disclosure, and otherwise as allowed by law.
We will not charge you for the first accounting in any twelve-month
period; however, we will charge you a reasonable fee for each subsequent
request for an accounting within the same twelve-month period.
(6)
If this notice was initially provided to you electronically, you have
the right to obtain a paper copy of this notice and to take one home
with you if you wish.
You may file a written complaint to us or
to the Secretary of Health and Human Services if you believe that your
privacy rights with respect to confidential information in your health
records have been violated. All complaints must be in writing and must
be addressed to the Privacy Officer (in the case of complaints to us)
or to the person designated by the U.S. Department of Health and Human
Services if we cannot resolve your concerns. You will not be retaliated
against for filing such a complaint. More information is available
about complaints at the government’s web site,
http://www.hhs.gov/ocr/hipaa.
All questions concerning this Notice or
requests made pursuant to it should be addressed to:
Privacy Officer, Atlas Family Chiropractic, 2310 Mildred St. W
#130, University Place,
WA 89466
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