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.

This practice creates a medical record of your health information in order to treat you, receive payment for services delivered, and to comply with certain policies and laws.  We are also required by law to provide you with this Notice of our legal duties and privacy practices. In addition, the law requires us to ask you to sign an Acknowledgement that you have received this Notice.

We are required by federal and state law to maintain the privacy of your medical information.  Medical information is also called “protected health information” or “PHI.”

This is a list of some of the types of uses and disclosures of PHI that may occur:

·         Treatment:  We obtain health information, or PHI, about you to treat you. . We may also send your PHI to another physician or facility to which we refer you for treatment, care, procedures, or testing. 

·         Payment:  We use your PHI to obtain payment for the services we render.  For example, we send PHI to Medicare or your insurance plan for you or us to obtain payment for services.

·         Health Care Operations:  We may use your PHI for our operations.  For example, we may use your PHI to contact you to remind you of an appointment.

Legal Requirements:  We may use your PHI as required or authorized by law.  For example, we may use or disclose your PHI for the following reasons:

·         Public Health:  We may disclose your health information to prevent or control disease, injury or disability, or to report suspected cases of abuse or neglect.

·         Health Oversight Activities:  We may use and disclose your PHI to state agencies and federal government authorities when required to do so.

·         Judicial and Administrative Proceedings:  We may use and disclose your PHI in judicial and administrative proceedings.  Efforts may be made to contact you prior to a disclosure of your PHI to the party seeking the information.

·         Law Enforcement:  We may use and disclose your PHI in order to comply with requests pursuant to a court order, warrant, subpoena, summons, or similar process. We may use and disclose PHI to locate someone who is missing, to identify a crime victim, to report a death, to report criminal activity at our office, or in an emergency.

·         Avert a Serious Threat to Health or Safety:  We may use or disclose your PHI to stop you or someone else from getting hurt.

·         Coroners, Medical Examiners, and Funeral Directors:  We may use or disclose PHI to a coroner or medical examiner in some situations.  For example, PHI may be needed to identify a deceased person.

·         Armed Forces:  We may use or disclose the PHI of Armed Forces personnel to the military for proper execution of a military mission.

·         National Security and Intelligence: We may use or disclose PHI to maintain the safety of the President or other protected officials.  We may use or disclose PHI for the conduct of national intelligence activities.

·         Correctional Institutions and Custodial Situations:  We may use or disclose PHI to correctional institutions or law enforcement custodians for the safety of individuals at the correctional institution, those that are responsible for transporting inmates, and others.

·         Research:  You will need to sign and Authorization form before we use or disclose PHI for research purposes except in limited situations.

Your Rights:  You have certain rights under federal and state laws relating to PHI.  Some of these rights are described below.

• Restrictions:  You have a right to request restrictions on how your PHI is used for purposes of treatment, payment, and health care operations.  We are not required to accommodate your request.
• Communications:  You have a right to receive confidential communications about your PHI.  For example, you may request that we only call you at home.  If your request is reasonable, it may be accepted.
• Inspect and Access:  You have a right to inspect your health care information.  This information includes billing and medical record information.  You may not inspect your record in some cases.  If your request or inspect your record is denied, we will send you a letter letting you know why and explaining your options.  You may have a copy of your PHI in most situations.  If you request a copy of your PHI, we may charge you a fee for making the copies and mailing fee, if mailing is requested.
• Amendments of Your Records:  If you believe there is an error in your PHI, you have a right to request that we amend your PHI.  We are not required to agree with your request to amend.
• Accounting of Disclosures:  You have a right to receive an accounting of disclosures that we have made of your PHI for purposes other than treatment, payment, and health care operations, or release made pursuant to your authorization.
• Copy of Notice:  You have a right to obtain a paper copy of this Notice, even if you originally received the Notice electronically.  We have also posted this Notice at our office.
• Complaints:  If you feel that your privacy rights have been violated, you may file a complaint with us by calling our Privacy Officer at (847)-205-0830.  You may also file a complaint with the Secretary of Health and Human Services in Washington, DC if you feel your rights have been violated.

We are required to abide with the terms of the Notice currently in effect, however, we may change this Notice.  If we materially change this Notice, you can get a revised Notice by stopping by our office to pick up a copy.  Changes to the Notice are applicable to the health information we already have.

EFFECTIVE DATE:  November 1, 2007

2007 Light Touch Chiropractic