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REHRIG CHIROPRACTIC & WELLNESS CENTER 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. We are required by applicable federal and state law to maintain the privacy of your protected health information. We are also required by law to give you this Notice about our privacy practices, our legal duties and your rights concerning your protected health information. This Notice is effective as of April 14, 2003. We must abide by the privacy practices that are described in this Notice while it is in effect. However, we reserve the right to change the terms of our privacy practices, provided applicable law permits such changes. If we make any changes to the terms, the new provisions will apply to all of your health information that we maintain at that time. If we make a material change to our privacy practices, we will change this Notice and make the new Notice available upon request. Uses and Disclosures Treatment: We may use or disclose your health information to provide, coordinate or manage your health care and related services, such as to a physician, another health care provider or a hospital involved in your care Payment: We may use and disclose your health information to obtain payment for services we provide to you, such as to an insurance carrier, a PPO or an HMO. Health Operations: We may use and disclose your health information to support our operations, such as for quality reviews, audits of our activities or business planning. Persons 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 health information that directly relates to that person’s involvement in your healthcare or payment for your healthcare. In the event of your incapacity or in emergency circumstances, we may use or disclose health information that is directly relevant to those participating in providing your care, if we determine that it is in your best interest based on our professional judgement. We will use our professional judgment and our experience with common practice to make reasonable inference of your best interest in allowing a person to make an appointment for you or to pick up vitamins, medical supplies, x-rays or other similar forms of health related products or information. Contact: We may contact you regarding appointment reminders. If you are not at home to receive our call regarding an appointment reminder, we will leave a message on your answering machine or with a family member or other person who answers the telephone. We may contact you to discuss your treatment, to inform you of treatment alternatives or to provide you with health related information that we believe may be of interest to you. The following is a description of other possible ways in which we may use and/or disclose your protected health information. Abuse or Neglect: We may disclose your health 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. Legal: We may use or disclose your health information when we are required to do so by law or for certain legal proceedings (such as in response to a subpoena) or for certain law enforcement purposes (such as relating to a crime) or for compliance with legally established programs (such as Workers’ Compensation). Public Health or Safety: As authorized by law, we may disclose your health information to the extent necessary to avert a serious threat to your health or safety or to the health or safety of others, such as to a public health authority or the Food & Drug Administration. We may also disclose your health information to a health oversight agency for audits, investigations and inspections. Although possible but not likely in our office, we may disclose your health information to coroners or funeral directors for performing duties authorized by law or to federal officials for conducting national security and intelligence activities. Under certain circumstances, we may use or disclose health information for individuals who are Armed Forces personnel or who are inmates. Unless you give us written authorization, we cannot use or disclose your protected health information for any reason except those described in this Notice. If you give us authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Allowable Business Practices: We maintain patient sign-in sheets that are visible and accessible to patients and others who may enter this office. Communicating with our patients is an important part of our business philosophy. Therefore, we will periodically send cards, postcards, flyers, letters, newsletters and/or e-mails. These communications may contain information about products and services offered by our office. You may “opt out” by advising us in writing that you want to be removed from our mailing list. Patient RightsYou have the following rights relating to your health information: Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to additional restrictions, but if we do, we will abide by our agreement. Your request to restrict use and disclosure must be put in writing. A form for your request can be obtained from a staff member. Access: You have the right to inspect and/or obtain copies of your health information. We will charge you a cost-based fee of 5 cents per page for copying and time of staff. We will also charge for postage if you want your copies mailed to you. Your request to access your records must be put in writing. A form for your request can be obtained from a staff member. Amendment: You have the right to request that we amend your health information. We may deny your request under certain circumstances. Your request for amendment must be put in writing. A form for your request can be obtained from a staff member. Disclosure Accounting: You have a right to request that we give you an accounting of the disclosures we have made of your health information after April 14, 2003 for purposes other than for treatment, payment, healthcare operations and certain other activities. Your request for disclosure accounting must be put in writing. A form for your request can be obtained from a staff member. Confidential Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations (other than your home). Your request regarding confidential communication must be put in writing. A form for your request can be obtained from a staff member. Copy of Notice: You have a right to obtain a paper copy of our Notice of Privacy Practices at any time. Questions & Complaints You may complain to us if you believe that we have violated your privacy rights. You may file a complaint with us by notifying our Privacy Contact of your complaint in writing. You may also complain to the U.S. Department of Health and Human Services. We support your right to the privacy of your health information and will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. For questions, complaints or additional information, please contact: Privacy Contact: Doreen Rehrig Address: 200 E. State Street - Suite 104, Media, PA 19063 Telephone: 610-566-9040 |