Patient Privacy Policy

Chiropractic Associates Inc. Privacy Notice

2050 Cincinnati Dayton Rd., Middletown, OH 45044

THIS NOTICE EXPLAINS HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN CONTROL ACCESS TO IT. PLEASE READ IT CAREFULLY.

This Privacy Notice outlines how we may use and disclose your health information for treatment, payment, and healthcare operations, as well as other purposes allowed by law. It also explains your rights to access and manage your health information. "Health information" includes details about you, such as demographic information, related to your past, present, or future physical or mental health and associated healthcare services.

We are committed to following the terms of this Privacy Notice. Any changes to this notice will be effective for all health information we have at that time. You can request a revised copy by calling the office and asking for one to be sent to you or provided at your next appointment.

1. Use and Disclosure of Health Information

With Your Consent:

When you sign a consent form, your healthcare provider may use or disclose your health information for treatment, payment, and healthcare operations as described in this section. This includes sharing information with others involved in your care and support of the practice's operations.

Examples of uses and disclosures include:

• Treatment: Providing, coordinating, or managing your healthcare and related services. This may involve sharing information with other healthcare providers involved in your care.
• Payment: Using your health information to obtain payment for services, such as billing or obtaining approval from your insurance plan.
• Healthcare Operations: Supporting the practice's activities, such as quality assessment, employee reviews, training, marketing, and fundraising. Information may be shared with third-party associates performing activities for the practice.

With Your Authorization:

Other uses and disclosures of your health information will require your written authorization. You can revoke this authorization at any time, except if actions have already been taken based on the authorization.

Permitted or Required Uses and Disclosures:

We may use or disclose your health information without your consent or authorization in certain situations, such as:

• Required by Law: Disclosure as required by applicable laws.
• Public Health: Sharing information for public health activities.
• Law Enforcement: Disclosure for law enforcement purposes, meeting legal requirements.
• Research: Disclosing information for approved research with appropriate privacy safeguards.

Your Rights

You have the following rights regarding your health information:

• Inspect and Copy: You can inspect and obtain a copy of your health information in designated record sets. Some exceptions apply, such as psychotherapy notes or information used in legal proceedings.
• Request Restrictions: You may request restrictions on the use or disclosure of your health information, though we may not always be required to agree.
• Confidential Communications: You can request to receive communications by alternative means or at an alternative location.
• Amend Health Information: You may request an amendment to your health information, with certain conditions and review processes.
• Accounting of Disclosures: You have the right to receive an accounting of certain disclosures made, with some exceptions.
• Receive a Paper Copy: You can obtain a paper copy of this notice upon request, even if you agreed to receive it electronically.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with us or the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint. Contact our Privacy Officer for more information about the complaint process.

This notice is effective from April 14, 2003.



Practice Compliance

(a) We also adhere to Ohio law where it does not conflict with federal law. See the attached explanation.

(b) We reserve the right to change terms with notice.

If you are dissatisfied with how we handle your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights

200 Independence Avenue, S.W.

Room 509F HHH Building

Washington, DC 20201