Amherst Family Chiropractic
Center for Natural Health
Center for Natural Health
Notice of Privacy Practice for Protected Health Information
This notice describes how chiropractic and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights.
This section explains your rights and our responsibilities to help you.
Get an electronic or paper copy of your record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health info about you that you think is incorrect or incomplete. Ask us how to do this.
• If we say "no" to your request, we'll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will agree to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health informa- tion for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say "no" if it would affect your care.
• If you pay for a service or health care item out-of-pocket you can ask us not to share that information for the purpose of payment or operations with your insurer.
• We will say "yes" unless a law requires us to share that information.
Get a list of those with whom we've shared your info
• You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice.
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated.
• You can complain if you feel we have violated your rights by contacting us using the information on the back page.
• You can file a complaint with the U.S. Department of Health & Human Services Office for Civil Rights by sending a letter to:
200 Independence Ave. S.W., Washington, D.C. 20201,
or calling: 1-877-696-6775,
or visiting: http://www.hhs.gov/hipaa/filing-a-complaint/index.html
• We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we'll follow your instructions.
You have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.
We never share your information unless you give us written permission:
• Marketing purposes
• We will never sell your information
• We will not contact you for fundraising.
We must abide by the terms of this notice while it is in effect. However, we reserve the right to change the terms of our privacy notices. If we make a change to the terms of our privacy agreement we will notify you in writing when you come in for treatment or by mail. If we make a change in our privacy terms the change will apply for all of your health information in our files.
How do we typically use or share health information?
We typically use or share your information in these ways:
To treat you
• We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
To run our organization
• We can use and share your health information to run our practice, improve your care, & contact you when necessary.
Example: We use health information about you to manage your treatment and services.
To bill for your services
• We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
Help with public health and safety issues
• We can share health information about you for certain situations, such as:
•Helping with product recalls
•Reporting adverse reactions to drugs.
•Reporting suspected abuse, neglect, or violence
•Preventing or reducing a serious threat to anyone's health or safety
• We can use or share your info for health research.
Comply with the law
• We will share information about you if state or federal laws require it, including with the Department of Health & Human Services if it wants to see that we are complying with federal privacy law.
Address workers' compensation, law enforcement, and other government requests
• We can use or share your health information:
•For workers' compensation claims
•For law enforcement purposes
•With health agencies for activities authorized by law
•For special government functions such as military, national security, & presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see:
Changes to the Terms of This Notice.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
This notice is effective 10/01/2013.