NOTICE OF PRIVACY POLICIES
This notice describes how health care information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.
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 and 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.
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.
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.
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.
We may contact you to remind you that you have an appointment at one of the Practice’s healthcare facilities.
Individuals Involved in 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 Required by Law
We will disclose health information about you when required to do so by federal or state law.
To Avert a Serious Threat to Health or 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.
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.
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, Intelligence 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 of 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
Access to Your 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 on Use and Disclosure of 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 to Your 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 of 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.
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 to this 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.
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.
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 of this 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.
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.