Privacy Practices

This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully. At Activated Family Chiropractic & Wellness, we have always kept your health information secure and confidential. We are required by law to maintain your privacy, to provide you this notice and follow the terms of this notice, and to notify affected individuals following a breach of unsecured protected health information. The law permits us to use or disclose your health information to those involved in your treatment. For example, a review of your file by a specialist doctor whom may be involved in your care. It also describes your rights and our legal obligations with respect to your medical information.

What We (Medical Provider)May Do:

• We may use or disclose your health information for payment of your services. For example, we may send a report of your progress or provide information it requires to your insurance company. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
• We may use or disclose your health information for our normal healthcare operations. For example, one of our staff will enter your information into our computer, we may share your medical information with other physicians or other health care providers who will provide services that we do not provide, and we may use and disclose this information to review and improve the quality of care we provide. We may also disclose this information to your health plan to authorize services or referrals.
• We will share your medical information with our business associates, such as a billing service. We have a written contract with each business associate and their subcontractors that requires them to protect your private health information.
• We may use your information to contact you. For example, we may send you a newsletter, email, or other information.
• We may also want to text and/or call and remind you about your appointments. If you are not home, we may leave this information on your answering machine or with the person who answers the phone. In an emergency, we may disclose your health information to a family member or another person responsible for your care.
• We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
• We may disclose your health information to notify or assist in notifying a family member, your parent/guardian, or another person responsible for your care about your location and your general condition. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. We will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
• We may contact you to give you information about products or services related to your treatment, case management, or to recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We will not be receiving payment for these communications and will just describe products or services provided by this practice and tell you which health plans this practice participates in. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.
• We will not sell your health information without your prior written authorization. The authorization can be revoked at any time and will disclose that we will receive compensation for, required by Law.
• We will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth by disclosing your health information to public health authorities to prevent or control disease, injury or disability; report elder, dependent adult, or child abuse or neglect; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medications; and report infection exposure or disease. In the case of abuse, we will inform you or your guardian promptly unless, in our best professional judgement, we believe the notification would place you at risk of serious harm or would require informing the guardian we believe is responsible for the abuse or harm. We may also, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
• We may, and are sometimes required by law, to disclose your health information in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
• Subject to limitations imposed by law, we may disclose your health information to health oversight agencies during the course of audits, licensure, investigations, inspections, and other proceedings.
• We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
• We may disclose your health information, as necessary, to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, we will make periodic reports to your employer about your condition.
• In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner. You will maintain the right to request that copies of your health information be transferred to another physician or medical group.
• We may release some or all of your health information when required by law. Except as described above, this practice will not use or disclose your health information without your prior written authorization. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach. In some circumstances our business associates may provide the notification. We may also provide notification by other methods as appropriate.

What You (Patient) May Do:

• You have a right to request special privacy protections, specifically the uses and disclosures of your health information. You can submit a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. For example, if you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any request and we will let you know if we can fulfill your request.
• You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to a particular e-mail account or to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
• You have the right to know of any uses or disclosures we make with your health information beyond the above normal uses.
• You have the right to see and receive a copy your health information, with few exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If you are a guardian of a patient and we deny your request due to a likely cause of substantial harm to the patient, you will have a right to appeal our decision.
• As we will need to contact you from time to time, we will use whatever address, email address, or telephone number you prefer.
• You have the right to transfer copies of your health information to another practice. We will need a request in writing by you or the other practice to request records via fax.
• You have the right to request an amendment or change to your health information. Give us your request to make changes in writing. If you wish to include a statement in your file, please give it to us in writing. We may or may not make the changes you request, but will be happy to include your statement in your file. If we agree to an amendment or change, we will not remove nor alter earlier documents, but will add new information.
• You have the right to receive a copy of this notice.
• You may file a complaint with the Privacy Officer, Dr. Joseph Surace, D.C., regarding your privacy practices or how this chiropractic office handles your health information. You can file the complaint in person, email, phone call, or by letter. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to the Department of Health and Human Services, 200 Independence Avenue, S.W. Room 509F, Washington, DC 20201. You will not be retaliated against for filling a complaint.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed above.

Changes to this Notice of Privacy Practices:

We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. We will also post the current notice on our website.