Chiropractor in Holt, MI

Notice of Privacy Practices for Protected Health Information

Effective Date: June 20, 2024

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

 

We are permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information (“PHI”) is the information we create and obtain in providing our services to you. This may include documenting your symptoms, examination, test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

 

We may use your health information, such as your medical history, to help us advise you of your options, including healthcare options.

 

Depending on your form of payment, we submit requests for payment to your health insurance company. The health insurance company (or other business associate helping us obtain payment) may request information from us regarding medical care given. We will provide information to them about you and the care you received.

 

We may obtain services from business associates for quality assessment, improvement, outcome evaluation, protocol and clinical guideline development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or business associates as necessary to obtain these services.

 

Your Rights:

 

You have the right to:

 

    •    Request a restriction on certain uses and disclosures of your health information by delivering the request to us. We are not required to grant the request, but we will comply with any granted request.

    •    Request a restriction on disclosures of medical information to a health plan for payment or health care operations, provided it is not for treatment purposes and pertains solely to a health care service for which you have paid out-of-pocket in full. We must comply with this request.

    •    Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information by requesting one from us.

    •    Inspect and copy your health record and billing record by submitting a request to us.

    •    Appeal a denial of access to your protected health information, except in certain circumstances.

    •    Request an amendment to your health care record to correct incomplete or incorrect information by submitting a request to us. We may deny your request under specific conditions, such as if the information was not created by us or is accurate and complete. If denied, you will be informed of the reason and have the opportunity to submit a statement of disagreement to be maintained with your records.

    •    Request confidential communications by alternative means or at an alternative location by submitting the request in writing to us.

    •    Obtain an accounting of disclosures of your health information, except for uses and disclosures related to treatment, payment, operations, or disclosures made to you or at your request, among other exceptions.

    •    Revoke any authorization you previously made to use or disclose your information by delivering a written revocation, except where action has already been taken.

 

If you wish to exercise any of the above rights, please contact David Severance, DC at (517) 581-2785 in person or in writing during regular business hours. You will be informed of the necessary steps to take to exercise your rights.

 

Our Duties:

 

We are required to:

 

    •    Maintain the privacy of your health information as required by law.

    •    Provide you with a notice of our duties and privacy practices as to the information we collect and maintain about you.

    •    Abide by the terms of this Notice.

 

We reserve the right to amend or change our privacy practices and to enact new provisions regarding the PHI we maintain. If our practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by contacting our office or visiting us in person.

 

To Request Information or File a Complaint:

 

If you have any questions, need additional information, or wish to report a problem regarding the handling of your information, you may contact David Severance, DC at (517) 581-2785.

 

If you believe your privacy rights have been violated, you may file a complaint in writing at our office by delivering the complaint to David Severance, DC, or file a complaint with the Secretary of Health and Human Services at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf.

 

    •    We will not require you to waive your right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment from us.

    •    We will not retaliate against you for filing a complaint with the Secretary of Health and Human Services.

 

Other Uses:

 

Any uses and disclosures not described in this Notice will only be made as required by law or with your written authorization. You may revoke the authorization at any time, as described above.