At Active Family Chiropractic & Acupuncture, your privacy is a top priority. This notice describes how your health information may be used and disclosed, and how you can access this information. Please review it carefully.
Your Health Information Rights
You have the following rights regarding your protected health information (PHI):
- Access to Your Records:
- You may inspect and obtain a copy of your PHI, including medical and billing records. Requests must be made in writing.
- We may charge a reasonable fee for the costs of copying, mailing, or other associated supplies.
- Request Amendments:
- If you believe information in your records is incorrect or incomplete, you may request an amendment.
- We may deny the request if the information was not created by us, is not part of the medical record, or is accurate and complete.
- Request Restrictions:
- You may ask us to restrict the use or disclosure of your PHI for treatment, payment, or healthcare operations.
- While we will consider your request, we are not required to agree to it unless the disclosure is for payment purposes, and you’ve paid for services in full out-of-pocket.
- Confidential Communications:
- You may request that we communicate with you in a specific way (e.g., sending mail to a P.O. box) or at a specific location.
- We will accommodate reasonable requests.
- Accounting of Disclosures:
- You may request a list of certain disclosures we’ve made of your PHI, except for those related to treatment, payment, or healthcare operations.
- Receive a Copy of this Notice:
- You have the right to a paper copy of this notice, even if you received it electronically.
How We Use and Disclose Your Health Information
We may use and disclose your PHI in the following ways:
- For Treatment:
- To provide and coordinate your healthcare services. For example, we may disclose information to other healthcare providers involved in your care.
- For Payment:
- To bill and collect payment for services rendered. For example, we may share your PHI with insurance companies.
- For Healthcare Operations:
- To improve the quality of care we provide and manage administrative functions. For example, PHI may be used for training or quality assurance purposes.
- As Required by Law:
- We will disclose your PHI when required to do so by federal, state, or local laws.
- Public Health and Safety:
- We may disclose your PHI for public health activities, such as reporting communicable diseases or adverse reactions to medications.
- With Your Authorization:
- Other uses and disclosures not described in this notice will only be made with your explicit written permission.
Our Responsibilities
We are required by law to:
- Maintain the Privacy of Your Health Information:
- We will protect your PHI and only disclose it as outlined in this notice or required by law.
- Notify You of Breaches:
- If there is a breach of your unsecured PHI, we will notify you as required by law.
- Abide by this Notice:
- We will follow the terms outlined in this notice and notify you if there are significant changes.
Changes To This Notice
We reserve the right to change this notice and apply the revised practices to any PHI we maintain. The updated notice will be available in our office and on our website.
Questions or Complaints
If you have questions about this notice or believe your privacy rights have been violated, you may contact our Privacy Officer:
Active Family Chiropractic & Acupuncture
Email: activefamilygi@gmail.com
Phone: (308) 384-4955
Address: 2441 Diers Ave, Grand Island, NE 68803
You may also file a complaint with the U.S. Department of Health and Human Services. Filing a complaint will not affect your care.
By receiving treatment at Active Family Chiropractic & Acupuncture, you acknowledge receipt of this HIPAA Notice of Privacy Practices.
Effective Date: November 21, 2024
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