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Taylor Chiropractic

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Friendly Affordable Care

(419) 232-4470

Additional Section
 

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NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOU’RE HEALTH INFORMATION

MAY BE USED AND DISCLOSED AND HOW TO

ACCESS THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact Darrin M. Taylor of our clinic at 419-232-4470 at 1185 Westwood Drive, Van Wert, Ohio 45891

WHO WILL FOLLOW THIS NOTICE

This notice describes the health information privacy practices followed by our employees, staff and other clinic personnel. The practices described in this notice will also be followed by the healthcare providers you consult with by telephone (when your regular healthcare provider from our clinic is not available) who will provide "on-call coverage" for your healthcare provider.

YOUR HEALTH INFORMATION

This notice applies to the information and records we have about your health, health status, and services you receive at our clinic.

We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

For Treatment

For example, your doctor may be treating you for a heart condition and may need to know if you have other health problems that could complicate your treatment. The doctor may use your health history to decide what treatment is best for you. The doctor may also tell another doctor about your condition so that doctor can help determine the most appropriate care for you.

Different personnel in our clinic may share information about you and disclose information to people who do not work in our clinic in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays. Family members and other health care providers may be part of your health care outside this clinic and may require information about you that we have.

For Payment

For Health Care Operations

Appointment Reminders

Treatment Alternatives

Health-Related Products and Services

Please notify us if you do not wish to be contacted for appointment reminders, or if you do not wish to receive communications about treatment alternatives or health-related products and services. If you advise us in writing (at the address listed at the top of this Notice) that you do not wish to receive such communications, we will not use or disclose your information for these purposes.

You may revoke your Consent at any time by giving us written notice. Your revocation will be effective when we receive it, but it will not apply to any uses and disclosures that occurred before that time.

If you do revoke your Consent, we will not be permitted to use or disclose information for purposes of treatment, payment or health care operations, and we may therefore choose to discontinue providing you with health care treatment and services.

SPECIAL SITUATIONS

We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:

To Avert a Serious Threat to Health or Safety

Required By Law

Research

Organ and Tissue Donation

Military, Veterans, National Security and Intelligence

Workers' Compensation

Public Health Risks

Health Oversight Activities

Lawsuits and Disputes

Law Enforcement

Coroners, Health Examiners and Funeral Directors

Information Not Personally Identifiable

Family and Friends

In situations where you are not capable of giving consent (because you are not present or due to your incapacity or health emergency), we may, using 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. For example, we may inform the person who accompanied you to the emergency room that you suffered a heart attack and provide updates on your progress and prognosis. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions, health supplies, or X-rays.

OTHER USES AND DISCLOSURES OF HEALTH INFORMATION

We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.

If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization (different than the Authorization and Consent mentioned above) from you. In order to disclose these types of records for purposes of treatment, payment or health care operations, we will have to have both your signed Consent and a special written Authorization that complies with the law governing HIV or substance abuse records.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy

Right to Amend

To request an amendment, complete and submit a Health Record Amendment/Correction Form to Darrin M. Taylor, DC. We retain the right to deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

a) We did not create, unless the person or entity that created the information is no longer available to make the amendment.

b) Is not part of the records maintained at our clinic.

c) You would not be permitted to inspect and copy.

d) Is accurate and complete.

Right to an Accounting of Disclosures

Right to Request Restrictions

We are Not Required to Agree to Your Request

To request restrictions, you may complete and submit the Request For Restriction On Use/Disclosure Of Health Information to Darrin M. Taylor, DC.

Right to Request Confidential Communications

To request confidential communications, you may complete and submit the Request For Restriction On Use/Disclosure Of Health Information And/Or Confidential Communication to

\Darrin M. Taylor, DC

Right to a Paper Copy of This Notice

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THIS NOTICE IS SUBJECT TO CHANGE

We reserve the right to change this notice, and to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a summary of the current notice in the clinic with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our clinic or with the Secretary of the Department of Health and Human Services. To file a complaint with our clinic, contact Darrin M. Taylor, DC at 419-232-4470 located at 1185 Westwood Drive Van Wert, OH 45891. You will not be penalized for filing a complaint.

EFFECTIVE DATE OF THIS NOTICE

Please note that the effective date of this notice shall be April 13, 2003 as mandated by Federal Law and subject to change.

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. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact Darrin M. Taylor, DC.
. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
You have the right to request that we communicate with you about health 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.
If we agree, we will comply with your request unless the information is needed to provide you emergency treatment.
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health 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 Darrin M. Taylor, DC. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Should you believe that your health information in our records are incorrect or incomplete, you may submit a request to amend the alleged incorrect or incomplete information. Such right to request an amendment is available as long as your health records are maintained by our clinic.
You have the right to inspect and copy your health information, such as health and billing records, that we use to make decisions about your care. You must submit a written request to Darrin M. Taylor, DC in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed. Should such a review be required be mandated by Federal or State law, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object. 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 while treatment is discussed.
We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
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.
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.
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.
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.
We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
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.
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.
We may use and disclose health information about you for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the clinic.
We will disclose health information about you when required to do so by federal, state or local law.
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.
We may tell you about health-related products or services that may be of interest to you.
We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may contact you as a reminder that you have an appointment for treatment or health care at the clinic.
We may use and disclose health information about you in order to run the clinic and make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
We may use and disclose health information about you so that the treatment and services you receive at this clinic may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment.
We may use health information about you to provide you with health treatment or services. We may disclose health information about you to doctors, nurses, technicians, clinic staff or other personnel who are involved in taking care of you and your health.