Zelm Chiropractic Center, S.C. Notice of Privacy Practices
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
Zelm Chiropractic Center, S.C. is required, by law, to maintain the privacy and
confidentiality of your protected health information and to provide
our patients with notice of our legal duties and privacy practices
with respect to your protected health information.
Disclosure
of Your Health Care Information
Treatment
We may disclose your health care information to other healthcare
professionals within our practice for the purpose of treatment,
payment or healthcare operations. (example)
“On
occasion, it may be necessary to seek consultation regarding your
condition from other health care providers associated with Zelm Chiropractic Center, S.C..”
“It
is our policy to provide a substitute health care provider, authorized
by Zelm Chiropractic Center, S.C. to provide assessment and/or treatment
to our patients, without advanced notice, in the event of your
primary health care provider’s absence due to vacation,
sickness, or other emergency situation.”
Payment
We may disclose your health information to your insurance provider
for the purpose of payment or health care operations.
Workers’
Compensation
We may disclose your health information as necessary to comply with
State Workers’ Compensation Laws.
Emergencies
We may disclose your health information to notify or assist in notifying
a family member, or another person responsible for your care about
your medical condition or in the event of an emergency or of your
death.
Public
Health
As required by law, we may disclose your health information to public
health authorities for purposes related to: preventing or controlling
disease, injury or disability, reporting child abuse or neglect,
reporting domestic violence, reporting to the Food and Drug Administration
problems with products and reactions to medications, and reporting
disease or infection exposure.
Judicial
and Administrative Proceedings.
We may disclose your health information in the course of any administrative
or judicial proceeding.
Law
Enforcement.
We may 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
or subpoena, and other law enforcement purposes.
Deceased
Persons.
We may disclose your health information to coroners or medical examiners.
Organ
Donation.
We may disclose your health information to organizations involved
in procuring, banking, or transplanting organs and tissues.
Research.
We may disclose your health information to researchers conducting
research that has been approved by an Institutional Review Board.
Public
Safety.
It may be necessary to disclose your health information to appropriate
persons in order to prevent or lessen a serious and imminent threat
to the health or safety of a particular person or to the general
public.
Specialized
Government Agencies.
We may disclose your health information for military, national security,
prisoner and government benefits purposes.
Change
of Ownership.
In the event that Zelm Chiropractic Center, S.C. is sold or merged with another
organization, your health information/record will become the property
of the new owner.
Your
Health Information Rights
-
You have the right to request restrictions on certain uses and
disclosures of your health information. Please be advised, however,
that Zelm Chiropractic Center, S.C. is not required to agree to the restriction
that you requested.
-
You have the right to have your health information received or
communicated through an alternative method or sent to an alternative
location other than the usual method of communication or delivery,
upon your request.
-
You have the right to inspect and copy your health information.
-
You have a right to request that Zelm Chiropractic Center, S.C. amend your
protected health information. Please be advised, however, that
Zelm Chiropractic Center, S.C. is not required to agree to amend your protected
health information. If your request to amend your health information
has been denied, you will be provided with an explanation of our
denial reason(s)and information about how you can disagree with
the denial.
-
You have a right to receive an accounting of disclosures of your
protected health information made by Zelm Chiropractic.
-
You have a right to a paper copy of this Notice of Privacy Practices
at any time upon request.
Changes
to this Notice of Privacy Practices
Zelm Chiropractic Center, S.C. reserves the right to amend this Notice of
Privacy Practices at any time in the future, and will make the new
provisions effective for all information that it maintains. Until
such amendment is made, Zelm Chiropractic Center, S.C. is required by law
to comply with this Notice.
Zelm Chiropractic Center, S.C. is required by law to maintain the privacy of your
health information and to provide you with notice of its legal duties
and privacy practices with respect to your health information. If
you have questions about any part of this notice or if you want
more information about your privacy rights, please contact: Dr.
Ann Metzler by calling this office at 608.838.7723. If Dr. Ann Metzler
is not available, you may make an appointment for a personal conference
in person or by telephone within 2 working days.
Complaints
Complaints about your Privacy rights, or how Zelm Chiropractic Center, S.C. has handled your health information should be directed to Dr.
Ann Metzler, by calling this office at 608.838.7723 If Dr. Ann Metzler
is not available, you may make an appointment for a personal conference
in person or by telephone within 2 working days.
If
you are not satisfied with the manner in which this office handles
your complaint, you may submit a formal complaint to:
DHHS,
Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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