Talent Chiropractic LLC
NOTICE OF PRIVACY PRACTICES
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.
If you have any questions about this notice, please contact the designated privacy officer of this office: Joel Goldman, D.C./ Talent Chiropractic LLC, 115 N. Pacific Hwy., Talent, OR 97540.
We take our responsibility to safeguard your protected health information very seriously. This notice is intended to inform you of how we protect, use and disclose your information, as well as to explain your right to control these disclosures.
We are required by law to keep your information private. We must also provide you with this Notice and abide by its terms. We may need to revise our privacy notice practices from time-to-time. We expressly reserve the right to change the terms of our Notice of Privacy Practices and to make the new terms effective for all information covered by our Notice. If such changes occur, we will let you know about the new terms by providing a copy of the changes.
Your Health Information
We may use and disclose health information about you without your permission for the following purposes:
1. We may disclose your information for treatment purposes and to coordinate your care.
2. We may disclose your information to ensure that you receive insurance benefits.
3. We may disclose your information internally to enhance the operation of our practice. This includes our commitment to reviewing the quality of care we provide.
4. We may disclose your information to comply with a limited number of legal requirements, as outlined in this notice.
Additional information regarding each of these disclosures is provided in this notice.
It is the legal responsibility of all health care offices to keep patient health information private and to inform patients of these legal responsibilities and privacy practices. Generally, we do not divulge your health information to any third party without your written consent. In some limited cases, the law does permit release of health information without your consent. You may have previously signed a consent form with your insurance company or state agency which allows them to request that information from this office. In certain cases, we are allowed to refuse to treat you if you do not sign the consent form.
Appointment Reminders and Notifications by Mail
We may call you to remind you of an appointment. You have the right to ask us not to leave messages on your answering machine or with your answering service. You can also designate who may or may not receive messages for you such as a spouse, child, or parent. Additionally, we may send birthday cards, statements, your health information, newsletters and other communications by mail. It is your responsibility to inform us if you prefer specific mailing options in writing and update us with changes as they occur.
Right to Inspect and Copy
You have the right to inspect and copy your health information, such as medical and billing records that we have regarding your care. You must submit a written request to our designated contact in order to inspect and/ or copy your information. The original documents cannot be removed from this clinic.
If you request a copy of your information, we may charge a fee for the costs of copying, mailing or other associated supplies. You have the right to limit disclosure of your health care information. We will accommodate these requests if they are reasonable
Right to Amend
You have the right to ask for an amendment to your health care information, if you believe our records contain errors. If we agree, we will make that amendment within 60 days from when you ask. We are required to place a copy of your proposed amendment in the record, even when we do not agree to amend the record itself.
Right to Request Restrictions
You have the right to request restrictions on the use and disclosure of your information. We are not required to agree to your request. If we do agree, we will comply to the best of our ability unless the information is needed to provide you with emergency treatment. To request restrictions, you may submit the restrictions in writing to our designated privacy officer/ contact. If your restriction invalidates your insurance coverage, we may require you to execute a waiver of insurance benefits and payment agreement.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you may submit in writing a restriction request to our privacy officer/ contact. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and health care operations.
To obtain this list, you must submit your request in writing to our designated Privacy Officer/ Contact. It must state a period no longer than six years.
Complaints and Investigations
We have developed procedures for investigating any complaints or concerns you may have regarding our use and disclosure of your information or any other complaint you may have regarding our services. The law allows you to contact the Secretary of Department of Health and Human Services with complaints about our use and disclosure of information.
You may also contact our on-site Privacy Officer/ Contact, who is dedicated to investigating complaints regarding the use and disclosure of information in our care. We will not, and legally cannot, retaliate against you for any complaint.
We may use or disclose health information about you without your permission for the following purposes:
1. To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
2. Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
3. Organ tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate such donation and transplantation.
4. Military, Veterans, National Security and Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.
5. Worker's Compensation. We may release health information about you for worker's compensation or similar programs. These programs provide benefits for work related injuries or illness.
6. Public Health Risk. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability, or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.
7. Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.
8. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.
9. Law Enforcement. We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.
10. Coroners, Medical Examiners and Funeral directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death.
11. Information Not Personally Identifiable. We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
12. Family and Friends. We may disclose health information about you to your family members or friends if we obtain your verbal or written agreement to do so.
13. Deceased Person's Protected Health Information (PHI) may be disclosed by our practice to family or others involved in the person's care or payment for care, unless our practice knows the deceased preferred that certain people not receive PHI. Disclosures are limited to the PHI directly relevant to the person's involvement. For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room during treatment or evaluation. In situations where you are not capable of giving consent (due to incapacity or medical emergency), we may use our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person's involvement in your care