42 Klicks Chiropractic: HIPAA Privacy Notice
Protected health information about you is maintained as a record of your contacts or visits for healthcare services with Laketia Johnson, D.C. Specifically, protected health information is information about you, including demographic information (i.e. name, address, phone, etc.) that may identify you and relates to your past, present, and future physical or mental health condition and related health care services.
Laketia Johnson, D.C. is required to follow specific rules on maintaining the confidentiality of your protected health information, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your protected health information. It also describes how we follow applicable rules and use and disclose your protected health information to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law. If you have any questions about this Notice, contact Dr. Johnson.
Your Rights Under the Privacy Rule
Following is a statement of your rights, under HIPAA’s Privacy Rule, in reference to your protected health information. Please feel free to discuss any questions with Dr. Johnson.
You have the right to receive, and we are required to provide you with a copy of this HIPAA Privacy Notice. We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. If needed, new versions of this notice with be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised HIPAA Privacy Notice if you call or email and request that a revised copy be sent to you in the mail or if you ask for one at the time of your next appointment.
You have the right to authorize other use and disclosure. This means you have the right to authorize or deny any other use or disclosure of protected health information that is not specified within this notice. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative. That means you may designate a person with the delegated authority to consent to, or authorize the use or disclosure of, protected health information.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in your patient record.
You have the right to request a restriction of your protected health information. This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this HIPAA Privacy Notice. In certain cases, we may deny your request for a restriction.
You have the right to request an amendment to your protected health information. This means that you may request an amendment of your protected health information for as long as we maintain this information. In certain cases, we may deny your request for an amendment.
You have the right to request disclosure accountability. This means that you may request a listing of disclosures that we made, of your protected health information, to entities or persons outside of our practice other than for the purposes of treatment, payment, healthcare operations, or a purpose authorized by you.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosure of your protected health information that we are permitted to make.
Treatment – We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that is involved in your care and treatment. For example, we would disclose your protected health information, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose protected health information to other healthcare providers who may be involved in your care and treatment. We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointments. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternative regarding your care.
Healthcare operations – We may use or disclose, as needed your protected health information in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, and auditing functions. It also includes education, provider credentialing, certification, underwriting, rating, or other insurance-related activities. Additionally, it includes business administrative activities such as customer service, compliance with privacy requirements, internal grievance procedures, due diligence in connection with the sale or transfer of assets, and creating de-identified information.
Payment – Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination or eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Other Permitted and Required Uses and Disclosures
We may also use and disclose your protected health information in the following instances as outlined below. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.
To Others Involved in Your Healthcare – Unless you object, we disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member or personal representative or any other person that is responsible for your care, general condition or death. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.
As required by law – We may use or disclose your protected health information to the extent that lay requires the use or disclosure.
For public health – we may disclose your protected health information for public health activities and purpose to a public health authority that is permitted by law to collect or receive the information.
For communicable diseases – we may disclose your protected health information, if authorized by law, to a person who may have been exposed to communicable diseases or may otherwise be at risk of contracting or spreading the diseases or condition.
For health oversight – we may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
In case of abuse or neglect – we may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made in a manner that is consistent with the requirements of applicable federal and state laws.
For legal proceedings – we may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order or a court or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to subpoena, discovery request or other lawful process.
To coroners, funeral directors, and organ donation – we may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death of for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, to permit the funeral director to carry out his/her duties. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
In cases of criminal activity – consistent with applicable federal and state law, we may disclose your protected health information if we believe that the use or disclose is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
For military activity and national security – when the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the department of Veteran Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service.
For Workers’ Compensation – your protected health information may be disclosed by us, as authorized, to comply with workers’ compensation laws and other similarly legally established programs.
When an inmate – we may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Required uses and disclosures – under the law, we must make disclosures about you and when required but the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule.
You may address complaints to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our practice by email at firstname.lastname@example.org.
Laketia Johnson, D.C.
Effective Date: 05/01/2017