McGuinn Chiropractic

Our pledge regarding your health information:

 We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We will create a record of the care and the services you receive from us. We do so to provide you with quality care and to comply with any legal or regulatory requirements.

 Your health information may be shared as needed for your treatment, payment activities or health care operations relating to our organized health care arrangement. This Notice will tell you the ways in which we may use or disclose health information about you. This Notice also describes your rights to the health information we keep about you, and describes certain obligations we have regarding the use and disclosure of your health information.

 Our pledge regarding your health information is backed up by Federal Law. The privacy and security provisions of the Health Insurance Portability and Accountability Act ("HIPAA") require us to:

• Make sure that health information that identifies you is kept private.

• Make available this Notice of our legal duties and privacy practices with respect to health information about you.

• Follow the terms of the Notice that is currently in effect.

 We reserve the right to make changes to this Notice at any time and make the new privacy practices effective for all information we maintain. You may also request a copy of any Notice from our office.

How We May Use and Disclose Medical Information About You

 The following categories describe different ways that we may use or disclose health information about you. Unless otherwise noted, each of these uses and disclosures may be made without your permission. For each category of use of disclosure, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, unless we ask for a separate authorization, all of the ways we are permitted to use and disclose information will fall within one of the categories.

• For Treatment: We may use and disclose your health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes. For example, we may disclose your health information to a pharmacy to fill a prescription or to a laboratory to order a blood test. We may also disclose health information to physicians who may be treating you or consulting with the provider with respect to your care. In some cases, we may disclose your health information to an outside treatment provider for purposes of the treatment activities of the other provider.

• For Payment: We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you or your insurance company. For example, we may need to give your health plan information about your office visit so your health plan will pay us or reimburse you for the visit. In some instances, we may need to disclose to your health plan health information to demonstrate medical necessity for a treatment you are going to obtain prior approval or to determine whether your plan will cover the treatment.

• For Health Care Operations: We may use and disclose health information, as necessary, for our own health care operations to facilitate the function of the physician(s) office or amublatory surgery center and to provide quality care to all patients. Health care operations include such activities as: quality assessment and improvement activities, employee review activities, training programs including those in which trainees or practitioners in health care learn under supervision, accreditation, certification, licensing or credentialing activities, review and auditing, including compliance review, medical reviews, legal services, and maintaining compliance programs, and business management and general administrative activities.

• Other Uses and Disclosures: As part of treatment, payment and health care operations, we may also use or disclose your health infromation for the following purposes: to contact you as a reminder that you have an appointment; to contact you after you had a procedure in follow up to your treatment; share information with family and friends involved in your care or payment of your care; to inform you of potential treament alternatives or options; to inform you of health-related benefits or services that may be of interest to you.

Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Object

• As required by federal, state or local law.

• We may, consistent with applicable law and ethical standards of conduct, use or disclose your health information if we believe, in good faith, that such use and disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

• When providing emergency health care in response to a medical emergency, other than on our premises.

• For specific Government functions. In certain circumstances, federal regulations authorize the facility to use or disclose your health information to facilitate specified government functions relating to military and verterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.

• For health oversight activities such as audits, civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law.

• For public health purposes such as preventing or controlling disease, injury or disability; to report births or deaths; to conduct public health surveillance, investigations and interventions as permitted or required by law; to report reactions to medications or product defects with medical equipment or implants; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to report to an employer information about an individual who is a member of the workforce as legally permitted or required by law.

• To notify the appropriate government authority if we belive a patient has been the victim of abuse, neglect or domestic violence. We will make this disclosure only specifically required or authorized by law or when the patient agrees to the disclosure.

• For lawsuits and similar proceedings. In certain circumstances, we may disclose your health information in response to a subpoena to the extent authorized by law if we receive satisfactory assurances that you have been notified of the request or that an effort was made to secure a protective order.

• When requested by law enforcement as required by law or court order. For example, in response to a court order, subpoena, warrant; to identify or locate suspect, fugitive, material witness, or a missing person; if you are a victim of a crime and we are unable to obtain your consent; about a death we believe may be the result of criminal conduct; in an instance of criminal conduct at our facilities; in an emergency to report a crime.

• To coroners and health examiners for identification purposes, determine cause of death, or to perform other duties as required by law. We may disclose your health information to funeral directors in order for them to carryout their duties. We may also disclose your health information in reasonable anticipation of death. Your health information may be used and disclosed for organ donation.

• To comply with law relating to workers compensation or other similar programs that are established by law and provide benefits for work-related injuries or illness regardless of fault.

Your Individual Rights:

 You have the following rights regarding health information we maintain about you. Requests marked with a series of stars(**) must be made in writing on appropriate forms. You may request these forms from the Privacy Representative at the office you were treated at.

• Inspect and copy your health information, including medical and billing records. This does not include psychotherapy notes. If you request a copy of your health information, we may charge a fee ($0.75) per page for the costs of locating, copying, or other supplies and services associated with your request. Under limited circumstances, we may deny you access to a portion of your health information and you may request a review of the denial. The person conducting the review will not be the person who denied your request. **

• Request that we use a specific telephone number or address to communicate with you. For example, you can ask that we only contact you at work or by mail to a post office box. During our intake process, we will ask you how you wish to receive communications about your health care or for any other instructions on notifying you about your health information. You may also request that we do not disclose your health information to family members or friends who may be involved in your care or for notification purposes. We will accommodate all reasonable requests.

• Request corrections or additions to your health information. You may request an amendment of health information about you as long as we maintain this information. We may deny your request if you ask us to amend information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the health information kept by or for our physicians or facilities; is not part of the information which you would be permitted to inspect and copy; is accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us to be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to inform others, including people you name, of the change and to include the changes in any future disclosures of that information. Request for amendments must be in writing and must be directed to the Privacy Representative at the office you were seen at. In this written request, you must provide a reason to support the requested amendment(s). **

• Request restrictions on how we use and share your health information for treatment, payment or health care operations. For example, you could ask that access to your health information be denied to a particular member of our workforce who is known to you personally. We will consider all requests for restrictions carefully. We are not required to accommodate restrictions if it is not feasible for us to ensure our compliance with the law or we believe it will negatively impact the care we provide you. **

• Request an accounting of certain disclosures of your health information made by us. The right applies to disclosures for purposes other than treatment, payment, or health care operations as described by this Privacy Notice. We are not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to the Privacy Representative at the office you were seen at. The request should specify the time period sought for the accounting. We are not required to provide an accounting for the disclosures that take place prior to April 14, 2003. The first accounting is free but a fee will apply if more than one request is made in a 12-month period. You will be notified of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date should not exceed a total of 60 days from the date you made the request.

• Request a paper copy of this notice even if you agree to receive it electronically.

 

 A Privacy Representative has been assigned to each of our offices. If you would like further information about our privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your health information, please contact:

 David McGuinn
 McGuinn Chiropractic
 1524 Eisenhower Blvd.
 Loveland, CO 80537
 Telephone: (970) 667-7002

 We will investigate all complaints and will not retaliate against you for filing a complaint. You may also file a written complaint to the Office of Civil Rights of the U.S. Department of Health and Human Services.