Staker Chiropractic -
Notice of Privacy Practices for Protected Health Information (PHI)

This notice describes how chiropractic and medical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

Our practice is dedicated, and we are required by applicable federal and state laws, to maintain the privacy of your health information. These laws also require us to provide you with this notice of our privacy practices, and to inform you of your rights, and our obligations, concerning your health information. We are required to follow the privacy practices described below while this Notice is in effect. This notice is effective as of April 14, 2003, and will remain in effect until we replace it.

Uses and Disclosures

Here are some examples of how we might have to use or disclose your health care information:

Treatment:

Your chiropractor or staff member may have to disclose your health information including all your clinical records to another health care provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment or your health condition.

Payment:

Our insurance or billing staff may have to disclose your examination and treatment records and your billing records to another party, such as an insurance carrier, an HMO, a PPO, or your employer, if they are potentially responsible for the payment of your services. If necessary, our practice may use your PHI in other collection efforts with respect to all persons who may be liable to the practice for bills related to your care. For example, the practice may need to provide the Medicare program with information about health care services that you receive from our practice so that the practice can be reimbursed. Our practice may also need to tell your insurance plan about treatment you are going to receive so that it can determine whether or not it will cover the treatment expense.

Health Care Operations:

Your chiropractor and members of his staff may need to use your health information, examination and treatment records and your billing records for quality control purposes or for other administrative purposes to efficiently and effectively run our practice. For example, the practice may use your PHI to evaluate the performance of the practice’s personnel in providing care to you.

Advice of Appointment and Services:

Your chiropractor and members of the practice staff may need to use your name, address, phone number, and clinical records to contact you to provide appointment reminders, information about treatment alternatives, or health related information that may be of interest to you. 164.520(b)(1)(iii)(A). If you are not at home to receive an appointment reminder, a message will be left on your answering machine.
You have the right to refuse to give us authorization to contact you to provide appointment reminders, information about treatment alternatives, or other health related information. If you do not give us authorization, it will not affect the treatment we provide to you or methods we use to obtain reimbursement for your care.

You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health related information at any time.

Directory/Sign-In Log:

The practice maintains a sign-in log at its reception desk for individuals seeking care and treatment in the office. The sign-in log is located in a position where staff can readily see who is seeking care in the office, as well as the individual’s location within the practice’s office suite. This information may be seen by, and is accessible to, others who are seeking care or services in the office.

Family/Friends:

The practice may disclose to a family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person’s involvement with your care or the payment for your care. The practice may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply:

If you are present at or prior to the use or disclosure of your PHI, the practice may use or disclose your PHI if you agree, or if the practice can reasonably infer from your circumstances, based upon the exercise of its professional judgment that you do not object to the use or disclosure.
If you are not present, the practice will, in the exercise of professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person’s involvement with your care.

 

Our Privacy Pledge

We have and always will respect your privacy. Other than the uses and disclosures we described above, we will not sell or provide any of your health information to any outside marketing organizations.

Permitted uses and disclosures without your consent or authorization

Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:

  1. Orders of Another Healthcare Provider – We are permitted to use or disclose your health information if we are providing health care services to based on the orders of another health care provider.
  2. Emergency Situations – We are permitted to use or disclose your health information if we provide health care services in an emergency provided that we attempt to obtain your consent as soon as possible. The practice may also disclose PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
  3. De-identified Information – We may use and disclose health information that may be related to your care but does not identify you and cannot be used to identify you.
  4. Business Associate – We may use or disclose PHI to one or more of our business associates if the practice obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists the practice in undertaking some essential function, such as a billing company that assists the office in submitting claims for payment to insurance companies.
  5. Personal Representative – We may use and disclose PHI to a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
  6. Public Health Activities – We may use and disclose PHI when required by law to provide information to a public health authority to prevent or control disease.
  7. Abuse, Neglect, or Domestic Violence – We may use and disclose PHI when authorized by law to provide information if it is believed that the disclosure is necessary to prevent serious harm.
  8. Health Oversight Activities – We may use or disclose PHI when required by law to provide information in criminal investigations, disciplinary actions, or other activities relating to the community’s health care system.
  9. Judicial and Administrative Proceeding – We may use and disclose PHI in response to a court order or a lawfully issued subpoena.
  10. Law Enforcement Purposes – We may use or disclose PHI, when authorized, to a law enforcement official. For example, your PHI may be subject of a grand jury subpoena, or if the practice believes that your death was the result of criminal conduct.
  11. Coroner or Medical Examiner – We may use or disclose PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.
  12. Organ, Eye or Tissue Donation – We may use or disclose PHI if you are an organ donor to the entity to whom you have agreed to donate your organs.
  13. Research – We may use or disclose PHI subject to applicable legal requirements if the Practice is involved in research activities.
  14. Avert a Threat to Health or Safety – We may use or disclose PHI if we believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonable able to prevent or lessen the threat.
  15. Specialized Government Functions – We may use and disclose PHI when authorized by law with regard to military and veteran activity.
  16. Worker’s Compensation – We may use and disclose PHI if you are involved in a Workers’ Compensation claim to an individual or entity that is part of the Workers’ Compensation system.
  17. National Security and Intelligence Activities - The practice may use and disclose PHI to authorized governmental officials with necessary intelligence information for national security activities.
  18. Military and Veterans – We may use and disclose PHI if you are a member of the armed forces, as required by the military command authorities.

 

Uses and/or disclosures, other than those described above, will only be made with your written authorization.

Your right to revoke your authorization

You may revoke your authorization to us at any time; however, your revocation must be in writing. There are two circumstances under which we will not be able to honor your revocation request:

  1. If we already released your health information before we received your request to revoke authorization. 164.508(b)(5)(i)
  2. If you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information is they decide to contest any of your claims. If you wish to revoke your authorization please write to us at:

Staker Chiropractic Center
Attn: Privacy Officer
916 NE Maynard Road
Cary, NC 27513

Your right to limit uses or disclosures

If there are health care providers, hospitals, employers, insurers or other individuals or organizations to whom you do not want us to disclose your health information, please let us know, in writing, what individuals or organizations to whom you do not want us to disclose your health care information. In general, this relates to your right to request special restrictions concerning disclosures of your PHI regarding uses for treatment, payment and operational purposes under Privacy Rule, Section 164.522(a) and related to disclosures to your family and other individuals involved in your care under Privacy Rule, Section 164.510(b). To request restrictions, you must submit a written request to the Privacy Officer. In your written request, you must inform the officer of what information you want to limit, whether you want to limit the practice’s use or disclosure, or both, and to whom you want the limits to apply. Except in certain circumstances, we are not required to agree to your restrictions. However, if we agree to your restrictions, the restriction is binding on us unless the information is needed in order to provide you with emergency treatment. If we do not agree to your restrictions, you may drop your request or you are free to seek care from another health care provider.

Your right to receive confidential communication regarding your health information

We normally provide information about your health to you in person at the time you receive chiropractic services from us. We may also mail you information regarding your health or about the status of your account. We will do our best to accommodate any reasonable request if you would like to receive information about your health or the services that we provide at a place other than your home or, if you would like the information in a different form. To help us respond to your needs, please make any request in writing.

Your right to inspect and copy your health information

You have the right to inspect and/or copy your health information as provided by federal (including Privacy Rule, Section 164.524) and state law. We require your request to inspect and/or copy your health information be in writing. We can charge you a fee for the cost of copying, mailing or other supplies associated with your request. In certain situations that are defined by law, we may deny your request, but you will have the right to have the denial reviewed as set forth more fully in the written denial notice.

Your right to amend your health information

You have the right to request that we amend your health information as provided by federal law (including Privacy Rule, Section 164.526) and state law. We require your request to amend your records to be in writing and for you the give us a reason to support the change you are requesting us to make. We may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by our practice (unless the individual or entity created the information is no longer available), if the information is not part of the your PHI maintained by our practice, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with our denial, you will have the right to submit a written statement of disagreement.

Your right to receive an accounting of the disclosures we have made of your records

You have the right to request that we give you an accounting of the disclosures we have made of your health information for the last six years before the date of your request excluding dates before April 14, 2003. The accounting will include all disclosures except:

  1. Those disclosures required for your treatment, to obtain payment for your services, or to run our practice.
  2. Those disclosures made to you.
  3. Those disclosures necessary to maintain a directory of the individuals in our facility or to individuals involved with your care.
  4. Those disclosures for national security or intelligence purposes.
  5. Those disclosures made to correctional officers or law enforcement officers.
  6. Those disclosures that were made prior to the effective date of the HIPAA privacy law.

We will provide the first accounting within any 12-month period without charge. There is a fee for any additional requests during the next 12 months. When you make your request we will tell you the amount of the fee and you will have the opportunity to withdraw or modify your request.

Your right to obtain a paper copy of this notice

If you have agreed to receive privacy notices via e-mail or by review of the web site, you may request a paper copy of this notice at any time.

Our duties

We are required by law to maintain the privacy of your health information. We are also required to provide you with this notice of our legal duties and our privacy practices with respect to your health information.

We must abide by the terms of this notice while in effect. However, we reserve the right to change the terms of our privacy notices. If we make a change to the terms of our privacy agreement we will notify you in writing when you come in for treatment or by mail. If we make a change in our privacy terms, the change will apply for all of your health information in our files.

Re-disclosure

Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by federal privacy rules.

Your right to complain

You may complain to us or to the Secretary for Health and Human Services if you feel that we have violated your privacy rights. We respect your right to file a complaint and will not take action against you if you file a complaint. While you may make an oral complaint at any time, written comments should be addressed to:

Staker Chiropractic Center
Attn: Privacy Officer
916 NE Maynard Road
Cary, NC 27513

To contact us

If you would like further information about our privacy policies and practices please contact:

Staker Chiropractic Center
Attn: Privacy Officer
916 NE Maynard Road
Cary, NC 27513
919-460-1515.