NOTICE OF HIPAA PRIVACY 


Effective Date: 01/01/2024

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

Your Privacy Matters

We are committed to protecting your medical information and ensuring its confidentiality. This Notice of Privacy Practices outlines how we handle your Protected Health Information (PHI), how it may be used and disclosed, and your rights regarding this information.

We are legally required to:

  • Maintain the privacy of your health information.

  • Provide you with this detailed notice of our legal duties and privacy practices.

  • Notify you in case of a breach of your unsecured PHI.

If you have questions, contact our Privacy Officer at the details listed above.

How We Use and Disclose Your Health Information

The following categories describe the ways we are permitted to use and disclose your health information. Please note that this list is not exhaustive, but provides examples of the most common uses.

1. Treatment

We may use and share your PHI to provide, coordinate, or manage your healthcare. This includes sharing information with other healthcare providers involved in your care. For example:

  • If we refer you to another doctor, we may provide them with your medical information to ensure proper care.

  • If we order tests or send you to a specialist, we will share your information with that provider.

2. Payment

We may use and disclose your PHI to bill and collect payment for the services we provide. This includes activities such as:

  • Submitting claims to your health plan.

  • Disclosing necessary information to collection agencies or other entities when payment is not received.

3. Healthcare Operations

We may use and disclose your PHI as part of our healthcare operations, including:

  • Quality assessments to improve services.

  • Training of staff and healthcare professionals.

  • Reviewing the competence and qualifications of healthcare providers.

  • Auditing and legal services.

  • Business planning, management, and administration.

For example, we may share your information with billing services (called business associates). These entities are legally obligated to protect your information through signed contracts.

4. Appointment Reminders

We may use your contact information to remind you of upcoming appointments, via phone calls, emails, or text messages. If you prefer not to receive such reminders, you may request this in writing.

5. Family Notification & Communication

With your consent, we may share your health information with family members or friends who are involved in your care. This might be necessary during emergency situations or to keep them informed about your condition.

6. Marketing and Fundraising

  • Marketing: We may contact you about services related to your treatment or recommend treatment alternatives. However, we will not use or disclose your information for marketing purposes without your explicit consent if we receive any financial benefit from such communication.

  • Fundraising: We may contact you as part of fundraising efforts. You have the right to opt out of receiving such communications.

7. Public Health and Safety

In specific situations, we may be required by law to disclose your PHI, including:

  • Reporting disease outbreaks to public health authorities.

  • Notifying authorities of suspected child, elder, or dependent adult abuse.

  • Reporting adverse reactions to medications or defective products to the FDA.

8. Legal Requirements

We may disclose your health information if required to do so by federal, state, or local law, including:

  • Responding to court orders, subpoenas, or government agencies during audits or investigations.

  • Assisting law enforcement when required by law, such as locating missing persons or reporting criminal activities.

  • Reporting to military authorities if you are a member of the armed forces.

9. Workers' Compensation

We may disclose your PHI as necessary to comply with workers’ compensation laws or similar programs that provide benefits for work-related injuries or illnesses.

10. Organ and Tissue Donation

In case of your death, we may release your medical information to organizations involved in organ or tissue donation if you are a donor.

Your Rights Regarding Your Health Information

You have several rights concerning your PHI, as outlined below:

1. Right to Request Special Privacy Protections

You may request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. If we agree to your request, we will comply unless the information is needed for emergency treatment or legal reasons.

2. Right to Request Confidential Communications

You may request that we communicate with you using alternative means or at a specific location (e.g., sending appointment reminders to your work email instead of your home email). We will accommodate all reasonable requests.

3. Right to Inspect and Copy Your Health Information

You have the right to review and receive a copy of your medical records. If you would like access to your health information, submit a written request specifying the records you wish to access. We may charge a reasonable fee for copying or mailing your records.

4. Right to Amend Your Health Information

If you believe that any information in your medical record is incorrect or incomplete, you may submit a written request for an amendment. If we deny your request, we will provide a reason for the denial and inform you of your right to submit a statement of disagreement.

5. Right to an Accounting of Disclosures

You may request a list of the times we disclosed your health information for purposes other than treatment, payment, or healthcare operations. This list will not include disclosures made to you or with your authorization.

6. Right to a Copy of This Notice

You may request a paper or electronic copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Changes to This Notice

We reserve the right to change this Notice at any time. If we make significant changes, we will update the Notice on our website and in our office, and the revised version will apply to all health information we maintain, regardless of when it was created or received.

Complaints and Questions

If you have concerns or believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at [contact details] or with the Office for Civil Rights at the U.S. Department of Health and Human Services.

You will not be penalized for filing a complaint. 

Office for Civil Rights
U.S. Department of Health and Human Services
You can also file a complaint using the form found at: www.hhs.gov/ocr/privacy/hipaa/complaints/

Ultimate Spine Health & Chiropractic 3900 University Dr. Ste 100, Fairfax, VA 22030
Cheon Park, D.C.  571-513-7070 ultimatespinehealthchiro@gmail.com