The Homeplace Chiropractic
2619 W 11th Street Rd, Ste 13
Greeley, Co 80634
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
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:
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.