NOTICE OF PRIVACY POLICIES

This notice​ describes​ how ​health care ​i​nformation ​a​bout​ y​ou​ may​ be used​ a​nd ​disclosed ​a​nd ​how​ y​ou​ c​an​ get​ a​ccess​ t​o ​t​his ​i​nformation. Please ​r​eview​ t​his​ notice​ c​arefully. 

Effective​Date:​ 06/01/2020

Nicole Valio DC,​ ​LLC​ DBA “Couve Chiropractic” ​(“The​ ​Practice”)​ ​is​ ​dedicated​ ​to​ ​ensuring​ ​the​ ​privacy​ ​of​ ​your protected​ ​health​ ​information​ ​(PHI).​ ​The​ ​Practice​ ​is​ ​required​ ​by​ ​law​ ​to​ ​provide​ ​you​ ​with this​ ​Notice​ ​of​ ​Privacy​ ​Practices,​ ​and​ ​to​ ​inform​ ​you​ ​of​ ​your​ ​rights,​ ​and​ ​our​ ​obligations, concerning​ ​your​ ​PHI.​ ​We​ ​are​ ​required​ ​to​ ​follow​ ​the​ ​privacy​ ​practices​ ​described​ ​below while​ ​this​ ​Notice​ ​is​ ​in​ ​effect. 

Uses ​a​nd​ Disclosures ​of​ Your ​PHI 

The​ ​following​ ​sections​ ​describe​ ​different​ ​ways​ ​that​ ​we​ ​may​ ​use​ ​and​ ​disclose​ ​your​ ​PHI. For​ ​each​ ​section​ ​of​ ​uses​ ​or​ ​disclosures,​ ​there​ ​will​ ​be​ ​a​ ​description​ ​given.​ ​Some information,​ ​such​ ​as​ ​certain​ ​drug​ ​and​ ​alcohol​ ​information,​ ​HIV​ ​information​ ​and​ ​mental health​ ​information​ ​is​ ​entitled​ ​to​ ​special​ ​restrictions​ ​related​ ​to​ ​its​ ​use​ ​and​ ​disclosure.​ ​Not every​ ​use​ ​or​ ​disclosure​ ​will​ ​be​ ​listed.​ ​All​ ​of​ ​the​ ​ways​ ​The​ ​Practice​ ​is​ ​permitted​ ​to​ ​use​ ​and disclose​ ​information,​ ​however,​ ​will​ ​fall​ ​within​ ​one​ ​of​ ​the​ ​following​ ​categories. 

Treatment 

We​ ​may​ ​disclose​ ​your​ ​PHI​ ​to​ ​another​ ​chiropractic​ ​facility​ ​and/or​ ​healthcare​ ​provider, transport​ ​company,​ ​community​ ​agency,​ ​family​ ​member​ ​or​ ​other​ ​third​ ​party​ ​to​ ​provide and/or​ ​coordinate​ ​health​ ​care​ ​services​ ​and​ ​treatments. 

Payment 

We​ ​may​ ​use​ ​and/or​ ​disclose​ ​your​ ​PHI​ ​to​ ​bill​ ​and​ ​obtain​ ​payment​ ​for​ ​treatment​ ​and/or services​ ​you​ ​receive​ ​at​ ​The​ ​Practice’s​ ​healthcare​ ​facilities. 

Health ​Care ​Operations

We​ ​may​ ​use​ ​and​ ​disclose​ ​your​ ​PHI​ ​in​ ​connection​ ​with​ ​our​ ​healthcare​ ​operations. Healthcare​ ​operations​ ​include,​ ​but​ ​are​ ​not​ ​limited​ ​to:​ ​clinical​ ​education,​ ​quality assessment​ ​and​ ​improvement​ ​activities,​ ​reviewing​ ​the​ ​competence​ ​or​ ​qualifications​ ​of healthcare​ ​professionals,​ ​evaluating​ ​practitioner​ ​and​ ​provider​ ​performance. 

Business​ Associates

We​ ​may​ ​disclose​ ​your​ ​PHI​ ​to​ ​businesses​ ​performing​ ​services​ ​for​ ​The​ ​Practice​ ​such​ ​as processing​ ​claims,​ ​data​ ​analysis,​ ​billing,​ ​benefit​ ​management,​ ​practice​ ​management, re-pricing​ ​and​ ​legal​ ​assistance.​ ​We​ ​will​ ​have​ ​a​ ​written​ ​contract​ ​in​ ​place​ ​with​ ​the business​ ​associate​ ​requiring​ ​protection​ ​of​ ​the​ ​privacy​ ​and​ ​security​ ​of​ ​your​ ​health information. 

 

Appointment​ Reminders

We​ ​may​ ​contact​ ​you​ ​to​ ​remind​ ​you​ ​that​ ​you​ ​have​ ​an​ ​appointment​ ​at​ ​one​ ​of​ ​the Practice’s​ ​healthcare​ ​facilities. 

Individuals​ I​nvolved ​i​n ​Your ​Care ​or ​Payment 

Unless​ ​there​ ​is​ ​a​ ​specific​ ​request​ ​made​,​ ​we​ ​may​ ​disclose​ ​PHI​ ​to​ ​a​ ​person​ ​who​ ​is​ ​involved​ ​in​ ​your​ ​health​ ​care​ ​or​ ​helps pay​ ​for​ ​your​ ​care,​ ​such​ ​as​ ​a​ ​family​ ​member​ ​or​ ​friend​ ​to​ ​facilitate​ ​that​ ​person’s involvement​ ​in​ ​caring​ ​for​ ​you​ ​or​ ​in​ ​payment​ ​for​ ​your​ ​care. 

Disaster ​Relief​ Efforts

We​ ​may​ ​disclose​ ​your​ ​PHI​ ​to​ ​an​ ​entity​ ​assisting​ ​in​ ​a​ ​disaster​ ​relief​ ​effort​ ​so​ ​your​ ​family can​ ​be​ ​notified​ ​about​ ​your​ ​condition,​ ​status​ ​and​ ​location. 

As ​R​equired ​by ​L​aw

We​ ​will​ ​disclose​ ​health​ ​information​ ​about​ ​you​ ​when​ ​required​ ​to​ ​do​ ​so​ ​by​ ​federal​ ​or​ ​state law. 

To​ Avert​ a ​Serious ​Threat ​t​o ​Health ​o​r ​Safety 

We​ ​may​ ​use​ ​and​ ​disclose​ ​your​ ​PHI​ ​when​ ​necessary​ ​to​ ​prevent​ ​or​ ​lessen​ ​serious​ ​and imminent​ ​threat​ ​to​ ​your​ ​health​ ​and​ ​safety​ ​or​ ​the​ ​health​ ​and​ ​safety​ ​of​ ​the​ ​public​ ​or another​ ​person.​ ​Any​ ​disclosure​ ​would​ ​be​ ​to​ ​someone​ ​able​ ​to​ ​help​ ​stop​ ​or​ ​reduce​ ​the threat. 

Public ​Health ​Purposes

We​ ​may​ ​use​ ​or​ ​disclose​ ​your​ ​PHI​ ​when​ ​we​ ​are​ ​required​ ​to​ ​do​ ​so​ ​by​ ​law,​ ​for​ ​public health​ ​reasons,​ ​including,​ ​but​ ​not​ ​limited​ ​to: 

  • Reporting​ ​certain​ ​communicable​ ​diseases​ ​to​ ​health​ ​officials; 

  • Reporting​ ​child​ ​abuse​ ​or​ ​neglect; 

  • Reporting​ ​elder​ ​abuse,​ ​neglect​ ​or​ ​exploitation. 

 

Lawsuits​ and​ Other ​Legal​ Actions 

We​ ​may​ ​disclose​ ​PHI​ ​in​ ​response​ ​to​ ​judicial​ ​proceedings​ ​and​ ​law​ ​enforcement​ ​inquiries as​ ​permitted​ ​by​ ​law.​ ​We​ ​may​ ​also​ ​disclose​ ​PHI​ ​in​ ​response​ ​to​ ​a​ ​subpoena,​ ​discovery request,​ ​warrant,​ ​summons​ ​or​ ​other​ ​lawful​ ​process. 

 

Worker’s​ Compensation

We​ ​may​ ​disclose​ ​PHI​ ​as​ ​necessary​ ​for​ ​worker’s ​compensation​ ​or​ ​similar​ ​programs​ ​that provide​ ​benefits​ ​for​ ​work-related​ ​injuries​ ​or​ ​illness,​ ​as​ ​authorized​ ​or​ ​required​ ​by​ ​law. 

 

Health-Oversight Activities

We​ ​may​ ​disclose​ ​PHI​ ​to​ ​governmental,​ ​licensing,​ ​auditing​ ​and​ ​accrediting​ ​agencies​ ​as authorized​ ​or​ ​required​ ​by​ ​law. 

 

Military​ and ​Veterans

If​ ​you​ ​are​ ​or​ ​were​ ​a​ ​member​ ​of​ ​the​ ​armed​ ​forces,​ ​we​ ​may​ ​release​ ​PHI​ ​about​ ​you​ ​to military​ ​command​ ​authorities​ ​as​ ​authorized​ ​or​ ​required​ ​by​ ​law. 

 

National​ Security, ​I​ntelligence ​Activities ​and ​Protected​ Services 

Under​ ​certain​ ​circumstances​ ​we​ ​may​ ​disclose​ ​PHI​ ​to​ ​military​ ​authorities​ ​and​ ​to authorized​ ​federal​ ​official’s​ ​PHI​ ​required​ ​for​ ​lawful​ ​intelligence,​ ​counterintelligence,​ ​and other​ ​national​ ​security​ ​activities. 

 

Special​ ​Protections​ ​for​ ​HIV,​ ​Alcohol​ ​and​ ​Substance​ ​Abuse,​ ​Mental​ ​Health​ ​and​ ​Genetic Information

Special​ ​privacy​ ​protections​ ​apply​ ​to​ ​HIV-related​ ​information,​ ​alcohol​ ​and​ ​substance abuse​ ​treatment​ ​information,​ ​mental​ ​PHI,​ ​and​ ​genetic​ ​information.​ ​This​ ​means​ ​that parts​ ​of​ ​this​ ​Notice​ ​may​ ​not​ ​apply​ ​to​ ​these​ ​types​ ​of​ ​information​ ​because​ ​stricter​ ​privacy requirements​ ​may​ ​apply.​ ​

 

Other​ Uses​ o​f ​PHI

Other​ ​uses​ ​and​ ​disclosures​ ​of​ ​PHI​ ​not​ ​covered​ ​by​ ​this​ ​Notice​ ​or​ ​that​ ​laws​ ​what​ ​apply​ ​to us​ ​will​ ​be​ ​made​ ​only​ ​with​ ​your​ ​written​ ​authorization 

YOUR RIGHTS

Access​ t​o ​Y​our ​PHI

You​ ​have​ ​the​ ​right​ ​to​ ​access,​ ​inspect,​ ​and/or​ ​receive​ ​paper​ ​and/or​ ​electronic​ ​copies​ ​of the​ ​PHI​ ​that​ ​we​ ​maintain​ ​about​ ​you,​ ​with​ ​limited​ ​exceptions.​ ​The​ ​Practice​ ​provides​ ​to​ ​an individual,​ ​upon​ ​written​ ​request,​ ​access​ ​within​ ​30​ ​calendar​ ​days​ ​of​ ​the​ ​day​ ​The​ ​Practice receives​ ​a​ ​request,​ ​to​ ​inspect​ ​and/or​ ​copy​ ​their​ ​PHI. 

 

If​ ​you​ ​request​ ​paper​ ​copies,​ ​we​ ​will​ ​charge​ ​you​ ​our​ ​standard​ ​copying​ ​fee​ ​for​ ​each​ ​page, and​ ​postage​ ​if​ ​you​ ​want​ ​the​ ​copies​ ​mailed​ ​to​ ​you.​ ​If​ ​you​ ​request​ ​an​ ​alternative​ ​format, we​ ​will​ ​charge​ ​a​ ​reasonable​ ​cost-based​ ​fee​ ​for​ ​providing​ ​your​ ​PHI​ ​in​ ​that​ ​format.​ ​If​ ​you prefer,​ ​we​ ​will​ ​prepare​ ​a​ ​summary​ ​or​ ​an​ ​explanation​ ​of​ ​your​ ​PHI​ ​for​ ​a​ ​fee. 

Restrictions​ o​n​ Use​ and​ Disclosure ​o​f​ Your ​PHI 

You​ ​have​ ​the​ ​right​ ​to​ ​request​ ​that​ ​we​ ​place​ ​additional​ ​restrictions​ ​on​ ​our​ ​use​ ​or disclosure​ ​of​ ​your​ ​PHI​ ​for​ ​treatment,​ ​payment​ ​and​ ​healthcare​ ​operations​ ​purposes. Depending​ ​on​ ​the​ ​circumstances​ ​of​ ​your​ ​request​ ​we​ ​may,​ ​or​ ​may​ ​not​ ​agree​ ​to​ ​those restrictions.​ ​If​ ​we​ ​do​ ​agree​ ​to​ ​your​ ​requested​ ​restrictions​ ​we​ ​must​ ​abide​ ​by​ ​those restrictions,​ ​except​ ​in​ ​emergency​ ​treatment​ ​scenarios. 

 

Amendments ​t​o​ Y​our ​Records 

You​ ​have​ ​the​ ​right​ ​to​ ​request​ ​that​ ​we​ ​amend​ ​your​ ​PHI.​ ​Such​ ​requests​ ​must​ ​be​ ​made​ ​in writing,​ ​and​ ​must​ ​explain​ ​why​ ​the​ ​information​ ​should​ ​be​ ​amended.​ ​We​ ​are​ ​not​ ​obligated to​ ​make​ ​all​ ​requested​ ​amendments​ ​but​ ​will​ ​give​ ​each​ ​request​ ​careful​ ​consideration.​ ​All amendment​ ​requests,​ ​in​ ​order​ ​to​ ​be​ ​considered​ ​by​ ​us,​ ​must​ ​be​ ​in​ ​writing​ ​and​ ​signed​ ​by you​ ​or​ ​your​ ​representative,​ ​and​ ​must​ ​state​ ​the​ ​reasons​ ​for​ ​the​ ​amendment’​ ​correction request.​ ​If​ ​an​ ​amendment​ ​or​ ​correction​ ​you​ ​request​ ​is​ ​made​ ​by​ ​us,​ ​we​ ​may​ ​also​ ​notify others​ ​who​ ​work​ ​with​ ​us​ ​and​ ​have​ ​copies​ ​of​ ​the​ ​uncorrected​ ​record​ ​if​ ​we​ ​believe​ ​that such​ ​notification​ ​is​ ​necessary.​ ​Please​ ​note​ ​that​ ​even​ ​if​ ​we​ ​accept​ ​your​ ​request,​ ​we​ ​may not​ ​delete​ ​any​ ​information​ ​already​ ​documented​ ​in​ ​your​ ​health​ ​records. 

 

Accounting ​o​f​ Disclosures

Upon​ ​written​ ​request,​ ​you​ ​have​ ​the​ ​right​ ​to​ ​receive​ ​a​ ​list​ ​of​ ​instances​ ​in​ ​which​ ​we​ ​or​ ​our business​ ​associates​ ​disclosed​ ​your​ ​PHI​ ​for​ ​purposes,​ ​other​ ​than​ ​treatment,​ ​payment, healthcare​ ​operations​ ​and​ ​other​ ​activities​ ​authorized​ ​by​ ​you,​ ​for​ ​the​ ​last​ ​6​ ​years.​ ​If​ ​you request​ ​this​ ​accounting​ ​more​ ​than​ ​once​ ​in​ ​a​ ​12-month​ ​period,​ ​we​ ​may​ ​charge​ ​you​ ​a reasonable,​ ​cost-based​ ​fee​ ​for​ ​responding​ ​to​ ​these​ ​additional​ ​requests. 

Confidential​ Communications

You​ ​have​ ​the​ ​right​ ​to​ ​request​ ​that​ ​we​ ​communicate​ ​with​ ​you​ ​about​ ​your​ ​PHI​ ​by alternative​ ​means​ ​or​ ​to​ ​alternative​ ​locations​ ​(e.g.,​ ​at​ ​your​ ​place​ ​of​ ​business​ ​rather​ ​than at​ ​your​ ​home).​ ​Such​ ​requests​ ​must​ ​be​ ​made​ ​in​ ​writing,​ ​must​ ​specify​ ​the​ ​alternative means​ ​or​ ​location,​ ​and​ ​must​ ​provide​ ​a​ ​satisfactory​ ​explanation​ ​how​ ​communication should​ ​be​ ​handled​ ​under​ ​the​ ​alternative​ ​means​ ​or​ ​location​ ​you​ ​request. 

 

Changes​ t​o​ t​his​ Notice 

We​ ​reserve​ ​the​ ​right​ ​to​ ​change​ ​this​ ​Notice​ ​and​ ​the​ ​privacy​ ​practices​ ​described​ ​below​ ​at any​ ​time​ ​in​ ​accordance​ ​with​ ​applicable​ ​law.​ ​Prior​ ​to​ ​making​ ​significant​ ​changes​ ​to​ ​our privacy​ ​practices,​ ​we​ ​will​ ​alter​ ​this​ ​Notice​ ​to​ ​reflect​ ​the​ ​changes,​ ​and​ ​make​ ​the​ ​revised Notice​ ​available​ ​to​ ​you​ ​on​ ​request.​ ​Any​ ​changes​ ​we​ ​make​ ​to​ ​our​ ​privacy​ ​practices and/or​ ​this​ ​Notice​ ​may​ ​be​ ​applicable​ ​to​ ​PHI​ ​created​ ​or​ ​received​ ​by​ ​us​ ​prior​ ​to​ ​the​ ​date of​ ​the​ ​changes. 

 

ADDIIONAL INFORMATION 

Complaints 

If​ ​you​ ​are​ ​concerned​ ​that​ ​we​ ​may​ ​have​ ​violated​ ​your​ ​privacy​ ​rights,​ ​or​ ​you​ ​disagree​ ​with a​ ​decision​ ​we​ ​made​ ​or​ ​any​ ​decisions​ ​we​ ​may​ ​make​ ​regarding​ ​the​ ​use,​ ​disclosure,​ ​or access​ ​to​ ​your​ ​health​ ​information​ ​you​ ​may​ ​make​ ​a​ ​formal​ ​compliant​ ​in​ ​writing​ ​to​ ​the The​ ​Practice​ ​as listed​ ​below.​ ​You​ ​also​ ​may submit​ ​a​ ​written​ ​complaint​ ​to​ ​the​ ​U.S.​ ​Department​ ​of​ ​Health​ ​and​ ​Human​ ​Services​ ​in Washington​ ​D.C.​ ​All​ ​complaints​ ​must​ ​be​ ​made​ ​in​ ​writing​ ​and​ ​in​ ​no​ ​way​ ​will​ ​affect​ ​the quality​ ​of​ ​care​ ​you​ ​receive​ ​at​ ​the​ ​Practice. 

 

Breach​ Notification

We​ ​are​ ​required​ ​to​ ​notify​ ​you​ ​in​ ​writing​ ​of​ ​any​ ​breach​ ​of​ ​your​ ​secured​ ​PHI​ ​as​ ​soon​ ​as possible,​ ​but​ ​in​ ​any​ ​event,​ ​no​ ​later​ ​than​ ​60​ ​days​ ​after​ ​we​ ​discover​ ​it. 

 

Paper​ Copy ​o​f ​t​his ​Notice 

You​ ​have​ ​the​ ​right​ ​to​ ​a​ ​paper​ ​copy​ ​of​ ​this​ ​Notice.​ ​You​ ​may​ ​ask​ ​us ​to​ ​give​ ​you​ ​a​ ​copy of​ ​this​ ​Notice​ ​at​ ​any​ ​time.​ ​Even​ ​if​ ​you​ ​receive​ ​this​ ​Notice​ ​electronically,​ ​you​ ​are​ ​still entitled​ ​to​ ​a​ ​paper​ ​copy.  

HIPAA COMPLIANCE 

As a patient of Couve Chiropractic, you have certain privacy expectations as well as rights and responsibilities. Couve Chiropractic is fully compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security rules for health care providers. The confidentiality of your patient records is of paramount concern to us, and you’ll be asked to review information about how we comply with HIPAA rules and sign the HIPAA consent form when completing your new patient paperwork.

YOUR RIGHTS AS A PATIENT

To​ ​be​ ​treated​ ​with​ ​respect​ ​and​ ​consideration​ ​without​ ​regard​ ​to​ ​race,​ ​creed, national​ ​origin,​ ​disability,​ sexual orientation, ​gender​ ​or​ ​age. 

To​ ​obtain​ ​complete​ ​and​ ​current​ ​information​ ​concerning​ ​all​ ​aspects​ ​of​ ​your​ ​care. 

To​ ​refuse​ ​care​ ​and​ ​to​ ​be​ ​informed​ ​of​ ​the​ ​clinical​ ​consequences​ ​of​ ​this​ ​action. 

To​ ​expect​ ​that​ ​communications​ ​and​ ​records​ ​are​ ​treated​ ​confidentially​ ​according to​ ​current​ ​regulations​ ​and/or​ ​as​ ​required​ ​by​ ​law. 

To​ ​understand​ ​why​ ​tests​ ​and​ ​procedures​ ​are​ ​required. 

To​ ​understand​ ​and​ ​receive​ ​an​ ​explanation​ ​of​ ​your​ ​bill,​ ​regardless​ ​of​ ​source​ ​of payment,​ ​and​ ​options​ ​for​ ​available​ ​payment​ ​plans. 

To​ ​receive​ ​information​ ​to​ ​make​ ​informed​ ​consent​ ​prior​ ​to​ ​the​ ​start​ ​of​ ​any procedure​ ​and/or​ ​provision​ ​of​ ​patient​ ​care. 

To​ ​review​ ​your​ ​personal​ ​healthcare​ ​record​ ​and​ ​to​ ​receive​ ​an​ ​explanation​ ​of information​ ​contained​ ​therein​ ​within​ ​a​ ​reasonable​ ​timeframe, ​​in​ ​accordance​ ​with clinic​ ​policy.

To​ ​be​ ​free​ ​from​ ​all​ ​forms​ ​of​ ​abuse​ ​or​ ​harassment. 

To​ ​receive​ ​care​ ​in​ ​a​ ​safe​ ​and​ ​smoke-free​ ​environment. 

To​ ​submit​ ​a​ ​complaint​ ​or​ ​concern,​ ​verbally​ ​or​ ​in​ ​writing,​ ​without​ ​compromise​ ​to your​ ​care​ ​or​ ​access​ ​to​ ​care. 

 

YOUR RESPONSIBILITIES AS A PATIENT

To​ ​arrive​ ​on​ ​time​ ​for​ ​appointments​ ​and​ ​to​ ​notify​ ​Couve Chiropractic​ ​if​ ​you​ ​must​ ​cancel​ at least 24 hours in advance.  

To​ ​provide​ Couve​ ​Chiropractic​ ​with​ ​a​ ​complete​ ​and​ ​accurate​ ​medical ​history. 

To​ ​ask​ ​questions​ ​if​ ​any​ ​aspect​ ​of​ ​your​ ​care​ ​is​ ​not​ ​clear. 

To​ ​follow​ ​directions​ ​concerning​ ​clinical​ ​management​ ​and​ ​to​ ​express​ ​any concerns​ ​about​ ​your​ ​ability​ ​to​ ​follow​ ​such​ ​directions​ ​throughout​ ​the​ ​course​ ​of care. 

To​ ​treat​ ​all​ ​those​ ​involved​ ​in​ ​the​ ​Couve​ ​Chiropractic​ ​community​ ​with​ ​respect and​ ​consideration. 

To​ ​take​ ​financial​ ​responsibility​ ​for​ ​services​ ​provided​ ​by Couve​ ​Chiropractic. 

To​ ​report​ ​changes​ ​in​ ​health​ ​status/condition​ ​to​ ​your provider. 

To​ ​recognize​ ​the​ ​effect​ ​of​ ​lifestyle​ ​on​ ​personal​ ​health. 

To​ ​be​ ​respectful​ ​of​ ​the​ ​property​ ​of​ ​Couve​ ​Chiropractic.