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This is the HIPPA Privacy Act and how it pertains to Heard Chiropractic Clinic.

 

Notic Of Privacy Act

of

April 14, 2003

Our clinic is dedicated, as always to respect the privacy of our patients.  For us nothing has changed except we are now requiredby Federal and State Laws to advise our patients of this law by written Notice of our Privacy practices.  This is to inform you of your rights and of how we will maintain the privacy of your Patient Health Information; hereafter referred to as (PHI). which includes information about your health condition, care, and treatment from our clinic.  This notice is effective as of April 14, 2003 and will be maintained in accordance with applicable law.  If significant changes are needed, this Notice will be revised and available to you upon request.

This Notice outlines your rights in regard to your PHI and may be used or disclosed to third parties.  The privacy of PHI in your patient file will be maintained when files are removed from teh Clinic premises for authorized purpose of review by either the doctor or designated employee of the Clinic.  The file will be removed in an envelope, box, or briefcase and view ate home, perhaps taken to a patient's home where they are being treated or to a Court setting for your legal representation.

NO CONSENT REQUIRED:

The Clinic may use and/or disclose your PHI for the purpose of:

TREATMENT- In order to provide you with quality healthcare, the Clinic will provide your PHI to health care professionals, whether on staff with our Clinic or not, directly involved in your case so that they may better understand your condition or disease.  Sometimes it is necessary for them to have the latest results of examinations or treatment that you have received.

PAYMENT- In order to receive reimbursement for the services rendered to you, the Clinic will provide your PHI directly or through billing service, to appropriate third party payers, in accordance with their billing requirements.  For example, the Medicare program or other insurance companies require us to relate to them the services or treatment you are going to receive or have received in this Clinic, so as they may determine coverage or benefit information.

HEALTH CARE OPERATIONS- In order that our Clinic may operate in accordance with the current laws and insurance requirements and of course to provide high quality care to you, our patient; it may be necessary to compile or disclose you PHI.  For example, it may be necessary to use your PHI for the purpose of evaluating the performance and care that is give by the personnel in this Clinic.

The Clinic may use or disclose you PHI without written consent from you in the following additonal instances:

1. De-identified Information-This is information whcih does not identify you and even without your name could not be used to identify you.

2. Business Associate-If the Clinic obtains satisfactory written agreement, that in accordance with current law, that the Business Associate will safeguard you PHI.  A Business Associate is an entity that assists the Clinic in performing essential functions, such as a billing company that assists the Clinic in submitting claims for reimbursement from insurance companies or other payers.

3. Personal Representative-A person who you have designated, under applicable law, with the authority to represent you in decisions related to your health care.

4. Emergency Situations-A. For the purpose of obtaining or rendering emergency treatment to you, with the provision that the Clinic will attempt to obtain you Consent as soon as possible; or B. To a public or private entity authorized by law or its' charter to assist with such entities in an emergency situation.

5. Communication Barriers-If there are communication barriers or an inability to communicate, the Clinic has been unable to obtain your Consent and the Clinic determines, in the exercise of its' professional judgment, that your Consent to receive treatment is clearly inferred from the circumstances.

6. Public Health Activities-Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease and that does not identify you and, even without your name, cannot be used to identify you.

7. Abuse, Neglect, or Domestic Violence-To a government authority if the Clinic is required by law to make such disclosure; if the Clinic is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm.

8. Health Oversight Activities-Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight actvities relating to the community's health care system.

9. Judicial and Administrative Proceeding-The Clinic may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.

10. Law Enforcement Purposes-In certian instances, your PHI may have to be disclosed to a law enforcement official.  For example, your PHI may be subject of a Grand Jury subpoena. Or, the Clinic may disclose your PHI if the Clinic believes that your death was the result of criminal conduct.

11. Coroner or Medical Examiner-The Clinic may disclose your 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-If you are an organ donor, the Clinic may disclose your PHI to the entity to whom you have agreed to donate your organs.

13. Research-If the Clinic is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI and that does not identify you and even without your name, cannot be used to identify you.

14. Avert a Threat to Health or Safety-The Clinic may disclose your PHI if it believes 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 ad the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

15. Workers' Compensation-If you are involved in a Workers' Compensation claim, the Clinic may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.

APPOINTMENT REMINDER:

The Clinic may, from time to time, contact you in regard to your appintment reminder or information about health related benefits or services that may be of interest to you.  The following appointment reminders are used by the Clinic: (A) a postcard or letter mailed to you at the address provided by you; and (B) telephoning your home and leaving a message on your answering machine or with the individual answering your phone.

SIGN IN SHEET:

The Clinic may use a sign-in sheet or some other format for those individuals seeking care or treatment in our clinic.  The sign-in sheet/travel card is located in a position where staff can readily see who is seeking care in this Clinic, as well as the location of other individuals within the Clinic's office suite.  This information may be seen by, and is accessible to, others who are seeking care or services in the Clinic's offices.

FAMILY/FRIENDS:

The Clinic may disclose to your family members, 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 for the reimbursement for your care.  The Clinic may also use or disclose your PHI to notify or assist in the notificaiton (including identifying or locating) of 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:

(A) If you are present at or prior to the use or disclosure of your PHI, the Clinic may use or disclose your PHI if you agree, or if the Clinic can reasonably infer from the circumstances, based on the exercise of its' professional judgment, that you do not object to the use or disclosure.

(B) If you are not present, the Clinic 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.

AUTHORIZATION:

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

YOUR RIGHTS:

1. You have the right to:

(A) Revoke any Authorization and/or Consent, in writting, at any time and to request a revocation, you must submit a written request to the Clinic's COMPLIANCE OFFICER.

(B) Request restrictions on certian use and/or disclosure of your PHI as provided by law, however; the Clinic is not obligated to agree to any requested restrictions.  To request restrictions, you must submit a written request to the Clinic's COMPLIANCE OFFICER.  In your written request, you must inform the Clinic of what information you want to limit, whether you want to limit the Clinic's use or disclosure, or both, and to whom you want the limits to apply.  If the Clinic agrees to your request, the Clinic will comply with your request unless the information is needed in order to provide you with emergency treatment.

(C) Receive confidential communications or PHI by alternative means or at alternative locations; you must make your request in writing to the Clinic's COMPLIANCE OFFICER. The Clinic will accommodate all reasonable requests.

(D) Inspect and obtain a copy of your PHI as provided by law.  To inspect and copy your PHI, you are requested to submit a written request to the Clinic's COMPLIANCE OFFICER.  The Clinic can charge you a fee for the cost of copying, mailing, or other supplies associated with your request.

(E) Amend your PHI as provided by law.  To request and amendment, you must submit a written request to the Clinic's COMPLIANCE OFFICER.  You must provide a reason that supports your request.  The Clinic 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 the Clinic (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by the Clinic, 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 the Clinic's denial, you will have the right to submit a written statement of disagreement.

(F) Receive an accounting of disclosures of your PHI as provided by law.  The request should indicate i what form you want the list (such as a paper or electronic copy).

(G) Receive a paper copy of this Privacy Notice from the Clinic upon request to the Clinic's COMPLIANCE OFFICER.

(H) Complain the the Clinic or to the Office of Civil Rights, U.S. Department of health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201, 202-619-0257.  To file a complaint with the Clinic, you must contact the Clinic's COMPLIANCE OFFICER.  All complaints must be in writing.

(I) To obtain more information on, or hae your questions answered, you may contact the Clinic's COMPLIANCE OFFICER,

_________________________________, at ____________________________________.

CLINIC REQUIRMENTS

1. The Clinic:

(A) Is required by Federal law to maintain the privacy of your PHI and to provide you with this Privacy Notice detailing the Clinic's legal duties and privacy practices with respect to your PHI.

(B) Is required by State law to maintain a higher level of confidentiality with respect to certain portions of your medical information that is provided for under Federal law. In prticular, the CLinic is required to comply with the following State statutes:

Section 381.004 relating to HIV testing, Chapter 384 relating to sexually trasmitted diseases and Section 456.057 relating to patient records ownership, control, and disclosure.

(C) Is required to abide by the terms of this Privacy Notice.

(D) Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for all of your PHI that it maintains.

(E) Will distribute any revised Privacy Notice to you prior to implementation.

(F) Will not retaliate against you for filing a complaint.

QUESTIONS AND COMPLAINTS

You may obtain additional information about our privacy practices or express concerns or complaints to the person identified below who is the COMPLIANCE OFFICER and Contact person appointed for this practice.  The COMPLIANCE OFFICER is Sandi Merriott.

You may file a complaint with the COMPLIANCE OFFICER if you beliee that your privacy rights have been violated relating to release of your protected health information.  You may, also, submit a complaint to the Department of Health and Human Services.  The addresss of which will be provided to you by the COMPLIANCE OFFICER.  We will not retaliate against you in any way if you file a complaint.

EFFECTIVE DATE

This Notice is in effect as of 04/24/2006.

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