Chiropractic
Health Center
James A. Dray, D.C.
3320 Clinton Pkwy. Ct.,
Suite 200
Lawrence, KS 66047
(785)843-0367 w Fax: (785)843-1166
NOTICE OF PRIVACY
PRACTICES
Effective Date 04/14/2003
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 regarding this notice you may contact our privacy officer at:
Chiropractic Health Center, Attn: Privacy Officer
3320 Clinton Pkwy. Ct., Ste. 200. Lawrence, KS 66047
Telephone: (785) 843-0367 w Fax: (785) 843-1166 w E-mail: jenchc01@cs.com
I)
YOUR PROTECTED INFORMATION (PHI)
The Chiropractic Health Center is required by the Health Insurance Portability and Accountability Act (hereafter referred to as HIPAA) to maintain the privacy of health information that is protected by HIPAA to provide you with notice of our privacy practices regarding your Protected Health Information (hereafter referred to as PHI.)
Your PHI is any information that concerns your past, present, or future medical condition, the provision of health care to you, or payment for health care provided to you, and individually identifies you or can reasonably be used to identify you.
Your medical and billing records are examples of information that will usually be regarded as your PHI.
II)
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH
INFORMATION (PHI).
a) This section describes the uses and disclosures for treatment, payment, and health care purposes.
i) Treatment
· During an office visit, Dr. Dray and other staff involved in your care may review your medical record and discuss your medical information. (Example: Dr. Dray may share notes with staff regarding plan of treatment.)
· We may share and discuss your medical information with an outside physician to whom we have referred you for care. (Example: Dr. Dray may send reports and notes to an orthopedic physician.)
· We may share and discuss your medical information with an outside physician with whom we are consulting regarding you. (Example: Our office may forward a report regarding your condition with your primary care physician.)
· We may share and discuss your medical information with an outside radiology center or other health care facility where you have been referred for testing. (Example: Dr. Dray may forward your x-rays to a chiropractic radiologist for examination.)
· We may share and discuss your medical information with a hospital or other health care facility that seeks this information for the purpose of treating you. (Example: Dr. Dray may forward office notes to another chiropractor currently treating you.)
· We may page a patient in the waiting room when it is time to go to an exam room.
· We may contact you with appointment reminders.
ii) Payment
We may use and disclose your PHI for our payment purposes as well as the payment purposes of other health care providers and health plans. Some examples of payment uses and disclosures include:
· Sharing information to obtain reimbursement from your health insurer.
· Sharing information to determine coverage eligibility with your health insurer.
· Submitting claim forms to your health insurer.
· Sharing supplemental information to your health insurer so they can coordinate benefits with a secondary insurer.
· Mailing bills or letters to you in envelopes with our practice name and address.
· Mailing bills to a family member or other person designated as the party responsible for payment.
· Providing medical records to your insurer to determine medical necessity or quality review audits.
· Providing information to the Collection Bureau of Lawrence or our attorney for securing payment of a delinquent account.
iii) Health Care Operations
We may use and disclose your medical information for our health care operation purposes as well as certain health care operation purposes of other health care providers or health plans. These include:
· Quality assessment and improvement activities.
· Population based activities relating to improving health or reducing health care costs.
· Reviewing the qualifications, competence, or performance of health care professionals.
· Accreditation, certification or credentialing activities.
· Health care fraud or abuse detecting and compliance programs.
· Medical review, legal services and auditing function.
· Business planning and developing activities such as conducting cost management and planning analysis.
· Sharing information regarding patients with entities interested in purchasing the practice and turning over patient records to those who have purchased the practice.
· Other general administrative business practices such as resolution of patient grievances.
b) Other purposes for uses and disclosures of PHI.
i) Individuals
involved in care or payment for care
We may disclose your PHI to someone involved in your care or payment of your care such as a spouse, family member, or close friend. (Example: we may discuss your physical limitations with a family member assisting in your care.
ii) Notification
We may use or disclose your PHI to notify a family member or another person responsible for your care regarding your location, general condition, or death.
iii)
Preemption by Law
We may use and disclose PHI as required by local, state and federal law. For example, in reporting suspected child abuse or public health warnings in the case of communicable diseases.
iv)
Workers’ compensation and similar programs
We may use and disclose PHI as authorized and as necessary to comply with laws regarding workers’ compensation or similar programs that provide benefits for work related injuries or illness regardless of fault. (Example: submitting a claim to your employer’s workers’ compensation carrier if treated for a work related injury.)
v)
Creation of de-identified information
We may use PHI about you in the process of removing those aspects that could identify you so the information can be disclosed to a researcher without your authorization.
vi) Incidental disclosure
We may disclose PHI as a by-product of an otherwise permitted use or disclosure. (Example: other patients may hear your name being called in the waiting room.)
c) Uses and disclosures with authorization
For all other purposes not listed previously any
other uses and disclosures will be made only with the patient’s authorization.
III) Patient Privacy Rights
d)
Further restriction on
use or disclosure
You have the right to request restrictions on certain uses and disclosures of PHI to (a) carry out treatment, payment or health care operations, (b) someone who is not involved in their care or payment of care, or (c) for notification purposes. We are not required to agree to a requested restriction.
To request a restriction you must submit a written request to our privacy officer. This request must include (a) the information you wish restricted; (b) how you wish it to be restricted; and (c) to whom the restriction applies.
e) Confidential Communication
You have the right to request that we communicate your PHI to you in a certain manner. For example, that we only contact you by mail or at work. We have the right to refuse a request that is unreasonable.
To request confidential communications a written request must be submitted to our privacy officer.
f) Inspection and Copying
You have the right to inspect or obtain a copy of your PHI. This right is subject to limitations and we may impose a charge for the labor and supplies involved in providing copies.
To exercise your right of access a written request must be submitted to our privacy officer. The request must include the following: (a) a description of the information to which access is requested, (b) state how you want to access the information such as inspection, pick-up copy of mailing of copy, (c) specify any requested format such as paper copy or electronically, and (d) current mailing address.
g) Accounting of Disclosure
You have a right to obtain an “accounting” of certain disclosures of PHI by us. This right is limited to within six years of the request. This request must be submitted in writing to our privacy officer. The applicable time period must be included.
h)
Corrections and
Amendments
You have the right to request that we amend PHI
about you if you feel that the information is incomplete or inaccurate. This right is subject to limitations. This request must be submitted in writing to
our privacy officer and must include the requested changes and a reason to
support each change.
i)
Copies of privacy
notices
You have the right to receive the notice of privacy
practices electronically or on paper by request. A copy is also available for viewing on our website, www.thechirodoc.com
IV) Our
Requirements
We are required by HIPAA to (a) maintain the privacy of PHI and notify individuals with notice of our legal duties and privacy practices with respect to PHI, (b) abide by the terms of the notice currently in effect and to (c) provide notification to individuals if there is any change to our handling of PHI.
We are required to promptly revise and distribute our notice of privacy practices whenever there is a material change. Any material change to the notice may not be implemented prior to the effective date on the notice.
We reserve the right to change this notice at any time. A current copy will be posted in the waiting room and may also be viewed by contacting our privacy officer.
V) Complaints
If you believe your privacy has been violated, you may submit a complaint to us or to the Secretary of Health and Human Services. To file a complaint with our offices please submit to our privacy officer:
Jennifer Flippin
Privacy Officer
Chiropractic Health Center
3320 Clinton Pkwy. Ct., Ste. 200
Lawrence, KS 66047
You will not be retaliated against in any way for filing a complaint.
