HIPAA Notice of Privacy Practices

The Homeplace Chiropractic

2619 W 11th Street Rd, Ste   13

Greeley, Co 80634

(970) 673-8486

https://thehomeplacechiropractic.com

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. HOW WE USE YOUR HEALTH INFORMATION:

The Homeplace Chiropractic, LLC is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment and health care operations. The following provides explanations and examples of how The Homeplace Chiropractic, LLC (often referred to herein as the Homeplace or “we”) may use or disclose your health information and will protect your health information.

“Protected Health Information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health, condition(s) and related health care services. We are required by law to maintain the privacy of PHI. We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at that time.

Upon your request, we will provide you with any revised Notice of Privacy Practices when you call the office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. We will inform you in a timely manner if there is a case of a breach of unsecured health information.

II. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

1. Treatment: We may use and/or disclose PHI about you to provide treatment or coordinate or manage your health care and related services. For example, our chiropractic assistants may access your PHI to transcribe treatment notes or assist the doctor in your care, or we may use your PHI while training or supervising associates to help them improve their clinical skills.
2. Payment: Generally, we may use and give your medical information to others to bill and collect payment for the treatment and services provided to you by us or by another provider. For example, before you receive scheduled services, we may share information about these services with your health plan(s) to ask for coverage under your plan or policy and for approval of payment before we provide the services.
3. Healthcare Operations: We may use and/or disclose PHI in performing business activities called “health care operations.” Examples of the way we may use or disclose PHI about you for “health care operations” include the following:

• Appointment Reminders. We may use and/or disclose health information to contact you as a reminder of your appointments.
• Treatment Alternatives/Benefits. We may contact you about a treatment alternative, the benefits it offers, or other health benefits or services that may be of interest to you.
• Cooperating with outside organizations that assess the quality of the care that our practice provides. These organizations might include government agencies or accrediting bodies.
• Reviewing activities and using or disclosing PHI in the event that we sell our business, property, or give control of our business or property to someone else.

Written Authorization: Other uses and/or disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

III. USES AND/OR DISCLOSURES THAT WILL NOT OCCUR WITHOUT YOUR EXPRESSED WRITTEN AUTHORIZATION

Marketing/Sales: We will obtain prior authorization before disclosing PHI in connection with advertising or sales activities.

IV. USES AND/OR DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO OBJECT

We may use and/or disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use and/or disclosure of the PHI, then we may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI 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 and/or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location, general condition, or death.

Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, we shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.

V. OTHER PERMITTED AND REQUIRED USES AND/OR DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO OBJECT We may use or disclose your PHI in the following situations without your consent or authorization.

Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law, but such uses or disclosure will be made in compliance with the law and limited to the requirements of the law.

Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.

Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your PHI to an appropriate government agency that is authorized by law to receive reports of abuse or neglect of a child, an elderly person or a disabled person. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information.

Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in response to a subpoena, discovery request or other lawful process, subject to certain conditions.

Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure 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 PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

Coroners, Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.

De-identified Information: We may use and/or disclose your PHI after it has been altered so that it does not identify you.

Military Activity and National Security: We may disclose your PHI to authorized federal officials for conducting national security and intelligence activities or specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.

Workers’ Compensation: Your PHI may be disclosed by us to comply with workers’ compensation laws and other similar legally established programs. Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and your health care provider created or received your PHI in the course of providing care to you.

Business Associate: We may use or disclose your PHI to a business associate, who is someone we contract with to provide service necessary for your treatment, payment for your treatment, and/or health care operations (e.g., billing service, or transcription service). We will obtain satisfactory written assurance, in accordance with applicable law, that the business associate and their subcontractors will appropriately safeguard your PHI.

Treatment Coordination/Marketing: Face to face communications directly with the patient, treatment and coordination of care activities, refill reminders, or promotional gifts of nominal value do not require authorization as long as we receive no financial remuneration for making the communications.

VI. YOUR RIGHTS

Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.

You have the following rights with respect to your PHI:

1. You have the right to revoke any authorization, in writing, any time.
2. You have the right to inspect and copy your PHI. With limited exceptions, you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that we use for making decisions about you. You must submit a request in writing. We may deny the request. We may charge a fee for processing costs.
3. You have the right to request a restriction of your PHI. You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and may say “no” if we believe it would affect your health care. The request must be submitted in writing.
4. You have the right to request restrictions for out-of-pocket expenses paid for in full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
5. You have the right to request to receive confidential communications from us by alternative means or at an alternative location or in a specific way; for example, to use your home or office phone, or to send mail to a different address, and we will agree to all reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the reason for the request. Please make this request in writing.
6. You have the right to ask us to amend your PHI. If you believe there is a mistake in your PHI or that an important piece of information is missing in your PHI, you may request an amendment to correct the existing information or add the missing information in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us, and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. The request must be submitted in writing.
7. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. You may request a list of disclosures we have made of your PHI. Your request may cover disclosures for up to six years prior to the date on which you make a the request. This list does not include disclosures for treatment, payment, or healthcare operations, disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. The request must be submitted in writing. We may charge a fee for processing costs.
8. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
9. You have the right to obtain a paper copy of this notice from us, upon written request, even if you have agreed to accept this notice electronically.

VII. COMPLAINTS

Our HIPAA Contact Officer is Jolene Laughlin, DC. Please contact her at 970-673-8486 if you have any questions or concerns referenced in this Notice of Privacy Practices. Additionally, if you believe your privacy rights may have been violated by our office, please file a written complaint with Jolene Laughlin, DC. We will not retaliate or treat you any differently for filing a complaint. Another resource that you may contact is the Secretary of Health and Human Services.

EFFECTIVE DATE OF THIS NOTICE

This notice was revised, published, and became effective on March 3, 2023.

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.