THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU FOR SERVICES DELIVERED AT HEALTHLETICS CHIROPRACTIC CLINIC MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Healthletics Chiropractic Clinic’s core values are to provide quality patient care and outstanding patient satisfaction to all our patients. Part of providing quality patient care and outstanding patient satisfaction is respecting your privacy rights and maintaining the confidentiality of your medical records. Healthletics Chiropractic Clinic will not use or disclose your health information for any purpose not described in this Notice without your written authorization.
Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, a plan for future care or treatment and billing related information. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel, agents of the hospital or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your health information created in the doctor's office or clinic.
Information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.
Our Responsibility to Our Patients
We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.
We will not use or disclose your health information without your authorization, except as described in this notice.
We reserve the right to change this Notice and to make the revised or changed notice effective for medical information it already has about you as well as any information received in the future. A copy of a current Notice will be posted at all times in Healthletics Chiropractic Clinic common areas as well as on Healthletics Chiropractic Clinic’s website.
Questions About This Notice
If you have questions about your privacy rights as described in this Notice and/or about our responsibilities as to your health information, please contact Healthletics Chiropractic Clinic Privacy Officer at the following address and/or phone number: Privacy Officer Healthletics Chiropractic Clinic 2005 NW Grant Avenue Corvallis, OR 97330 Phone: (541) 758-9393 Fax: (541) 738-0704
How We May Use and Disclose Health Information About You
Healthletics Chiropractic Clinic will not use or disclose your health information for any purpose not described in this Notice without your written authorization.
1. Treatment: Your information will be used and disclosed in the course of providing, coordinating and/or managing your health care and related services provided at Healthletics Chiropractic Clinic by one or more health care providers. This may include making disclosures of health information about you to your family members, your personal representative, or other persons identified by you who are involved in your health care.
For example: Information obtained by a nurse, physician or other healthcare provider will be recorded in your medical record and used in determining the course of your treatment.
2. Payment: We will use your health information in order to bill and collect payment from you, an insurance company or other third-party payers for services you receive at Healthletics Chiropractic Clinic.
For example: Your health plan may be contacted to get prior approval for coverage of treatment you are going to receive or to determine whether your plan will pay for the treatment and services you receive in the hospital.
3. Healthcare Operations: We may use the health information in your medical record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all our patients. Our health care operations include, among other things, the following functions: quality assessment and improvement activities; reviewing the qualifications and competence of health care providers; education and training programs for health care providers and students; medical review compliance, accreditation, certification, licensing, credentialing activities; legal and auditing services; underwriting activities; business planning and development; and hospital management and administration.
For example: Your information could be used to assist in the evaluation of the quality of care that you were provided, or your information may be combined with health information of other patients to evaluate the need for new services or treatment.
4. Patient Care: You may be contacted by nursing personnel to evaluate your condition, medications, etc. after discharge from the hospital.
5. Appointment reminders: Your health information may be used or disclosed to contact you for other procedures or to remind you of an appointment for care at Healthletics Chiropractic Clinic.
6. Pursuant to state and/or federal law: Your health information may be used or disclosed:to law enforcement officials as required by law or in response to a valid court order, subpoena or warrant, or in response to a official request for the purpose of identifying or locating a missing person, suspect or fugitive; for judicial or administrative proceedings in response to an order, subpoena, discovery request or other lawful process;to the Food & Drug Administration (FDA) relative to adverse events with respect to food, medications, products and product defects to facilitate product recalls, repairs or replacement, or for post marketing surveillance;to an agency for health oversight activities authorized by law, such as to prevent or control disease, injury or disability;to a social service or protective agency authorized by law to receive reports of abuse, neglect or domestic violence;when required by federal, state or local law;to avert a serious threat to health or safety to you, or that of the public or of another person able to help prevent the threat;as required by military or Department of Veterans' Affairs authorities if you are a member of the military or a veteran;to authorized federal officials for conduct of intelligence or national security activities, including protective services to the President or other persons as authorized by law.
Other Uses and Disclosures of Health Information About You
Uses and disclosures of your health information that are not covered by this Notice or laws that apply to Healthletics Chiropractic Clinic will be made only with your written authorization. If you provide us with written authorization to use or disclose information about you, you may revoke that authorization in writing at any time. If you revoke your authorization, such information will not be used or disclosed. However, a revocation of an authorization does not apply to uses and disclosures prior to the date of the revocation.
Your Health Information Rights
Although your medical record is the physical property of Healthletics Chiropractic Clinic, the information belongs to you.
You have the right to:
1. Request a restriction on certain uses and disclosures of your health information as described above in this Notice. Although the patient has a right to make such a request, please note that we are not required to agree to a requested restriction.
2. By written request, inspect and obtain a copy of your health record except for psychotherapy notes, information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding, or clinical laboratory information access to which is prohibited by law.
3. Request amendment of your health information record. Please see below for more detailed information concerning this right.
4. Obtain an accounting of disclosures of your health information in the six years prior to your request. An accounting will not include disclosures for treatment, payment and health care operations described in this Notice or disclosures made pursuant to your written authorization.
5. Request confidential communications. You have the right to request that we contact you about medical matters in a certain way or at a certain location.
6. Revoke your authorization to use or disclose health information except as to the extent that action has already been taken.
7. Obtain a paper copy of this Notice upon request.
Right to Amend Your Health Information Record
If you feel that medical information in your record is incorrect or incomplete, you may ask that the information be amended. You have this right for as long as the information is maintained by Healthletics Chiropractic Clinic. Your request must be in writing with the reason(s) supporting your request and submitted to Healthletics Chiropractic Clinic's Privacy Officer.
Your request to amend your medical record may be denied if:it is not in writing;it does not include a reason to support the request;the information was not created by a provider while you were a patient at Healthletics Chiropractic Clinic;the information is not part of the medical record;the information is not part of the record which you would be permitted to inspect or copy;the information is not accurate and complete.
Questions Concerning Your Rights
If you have questions about how to exercise your rights described above, please contact Healthletics Chiropractic Clinic's Privacy Officer.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Healthletics Chiropractic Clinic's Privacy Officer or with the Secretary of the Department of Health and Human Services.
All complaints to Healthletics Chiropractic Clinic's Privacy Officer must:
1. Be submitted in writing;
2. Describe how you believe your privacy rights were violated; and
3. Be delivered in person, via fax or U.S. Mail to Healthletics Chiropractic Clinic's Privacy Officer.
If you wish to file a complaint with the Secretary of the Department of Health and Human Services, please contact the Regional office of Civil Rights for more information:Region X, Office for Civil Rights, U.S. Department of Health and Human Services, 2201 Sixth Avenue--Suite 900, Seattle, Washington 98121-1831.
Disclaimer - Healthletics Chiropractic Clinic's core values are to provide quality patient care and outstanding patient satisfaction to all our patients. Part of providing quality patient care and outstanding patient satisfaction is respecting your privacy rights and maintaining the confidentiality of your medical records. Healthletics Chiropractic Clinic will not use or disclose your health information for any purpose not described in this Notice without your written authorization.
Health information provided on Healthletics Chiropractic Clinic's web page is intended as a guideline and not as a specific medical protocol. Every actual medical situation - emergency or non-emergency - is unique to each individual, and requires the clinical judgment of a qualified physician. For more information, or clarification, we recommend that individuals contact their personal physician.
Our Web site may include information and other material prepared by other sources. We also link to other Internet sites and resources. This information and links are provided as a courtesy. We are not responsible for the availability, updating, and accuracy of any information provided on these outside sites or for the privacy or security of these outside sites.
The information on this Web site is general in nature and is not intended as a substitute for consultation with a doctor and a particular treatment plan. The material provided is not intended to create, and the receipt of it does not constitute, a doctor-patient relationship. Should you have any health-care-related question, you should contact a doctor and arrange a consultation. Any e-mail generated from this Web site may not be secure and is not intended to create, and the receipt of it does not constitute, a doctor-patient relationship. E-mail communication is not intended as a substitute for consultation with a doctor.
