Privacy Policy
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.
Explanation of Forms. Feldkamp
Chiropractic, Inc. handles medical information about you, and law regulates how
that information is handled. To
comply with the law, Feldkamp Chiropractic, Inc. asks you to receive this notice
and, in some circumstances, to sign an authorization form.
Feldkamp Chiropractic, Inc.
is allowed by law to use and disclose information about you for the purposes
essential to providing care (treatment, payment collection, and operating
Feldkamp Chiropractic, Inc.).
An authorization allows
Feldkamp Chiropractic, Inc. to use and disclose information about you for any
other reason that is listed in the authorization. Feldkamp Chiropractic, Inc. may not refuse to treat you for
refusing to sign the authorization. Other
rules about your rights regarding medical information are described in this
notice.
Types of Uses and Disclosures.
Medical information about you may be used or disclosed by Feldkamp
Chiropractic, Inc. for treatment, payment, and health care operations.
Treatment includes consultation, diagnosis, provision of care, and
referrals. Payment includes all
those things necessary for billing and collection, such as claims processing.
Health care operations include things Feldkamp Chiropractic, Inc. does to
assess the quality of care, train staff, and manage Feldkamp Chiropractic,
Inc.’s business. Some examples of
disclosures and use are below.
·
Example
of Treatment Disclosure. Feldkamp
Chiropractic, Inc. may disclose medical information about you to your treating
physician, a hospital or other providers to help them diagnose and treat an
injury or illness.
·
Example
of Payment Disclosure. Feldkamp
Chiropractic, Inc. may disclose medical information about you when health plans
or insurers, Medicare, Medicaid, or other payors require the information before
paying for your health care services.
·
Example
of Health Care Operations Use. Feldkamp
Chiropractic, Inc. may use medical information about you when it hires new staff
whose training requires information about the medical needs of our patients.
Feldkamp Chiropractic, Inc. may also contact the patient to provide
appointment reminders.
Other Uses and Disclosures. We may use or disclose your
protected health information in the following situations without your
authorization. These situations include:
·
As
Required By Law. We may use or
disclose your protected health information to the extent that the use or
disclosure is required by law. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements of the law. You
will be notified, as required by law, of any such uses or disclosures.
·
Public
Health. We may
disclose your protected health information for public health activities and
purposes to a public health authority that is permitted by law to collect or
receive the information. The disclosure will be made for the purpose of
controlling disease, injury or disability. We may also disclose your protected
health information, if directed by the public health authority, to another
government agency that is collaborating with the public health authority.
·
Communicable
Diseases. We may
disclose your protected health information, if authorized by law, to a person
who may have been exposed to a communicable disease or may otherwise be at risk
of contracting or spreading the disease or condition.
·
Health
Oversight. We may
disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include government agencies that
oversee the health care system, government benefit programs, other government
regulatory programs and civil rights laws.
·
Abuse
or Neglect. We may
disclose your protected health information to a public health authority that is
authorized by law to receive reports of child abuse or neglect. In addition, we
may disclose your protected health information if we believe that you have been
a victim of abuse, neglect or domestic violence to the governmental entity or
agency authorized to receive such information. In this case, the disclosure will
be made consistent with the requirements of applicable federal and state laws.
·
Food
and Drug Administration. Feldkamp Chiropractic, Inc. may disclose a
patient’s health information to a person subject to the jurisdiction of the
Food and Drug Administration if that person has responsibility to report adverse
events, product defects or problems, or biologic product deviations; to track
products; to enable product recalls, repairs or replacements; or, to conduct
post marketing surveillance.
·
Legal
Proceedings. We may
disclose protected health information in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful process.
·
Law
Enforcement. We may also
disclose protected health information, so long as applicable legal requirements
are met, for law enforcement purposes. These law enforcement purposes include
(1) legal processes and otherwise required by law, (2) limited information
requests for identification and location purposes, (3) pertaining to victims of
a crime, (4) suspicion that death has occurred as a result of criminal conduct,
(5) in the event that a crime occurs on the premises of Feldkamp Chiropractic,
Inc., and (6) medical emergency (not on Feldkamp Chiropractic, Inc.’s
premises) and it is likely that a crime has occurred.
·
Coroners,
Funeral Directors, and Organ Donation.
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for the
coroner or medical examiner to perform other duties authorized by law. We may
also disclose protected health information to a funeral director, as authorized
by law, in order to permit the funeral director to carry out his duties. We may
disclose such information in reasonable anticipation of death. Protected health
information may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
·
Research.
We may disclose your protected health information to researchers when the
research has been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy of your
protected health information.
·
Criminal
Activity. Consistent
with applicable federal and state laws, we may disclose your protected health
information, if we believe that the use or disclosure is necessary to prevent or
lessen a serious and imminent threat to the health or safety of a person or the
public. We may also disclose protected health information if it is necessary for
law enforcement authorities to identify or apprehend an individual.
·
Military
Activity and National Security.
When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel (1) for
activities deemed necessary by appropriate military command authorities; (2) for
the purpose of a determination by the Department of Veterans Affairs of
eligibility for benefits, or (3) to foreign military authority if you are a
member of that foreign military services. We may also disclose your protected
health information to authorized federal officials for conducting national
security and intelligence activities, including for the provision of protective
services to the President or others legally authorized.
·
Workers’
Compensation. Your protected
health information may be disclosed by us as authorized to comply with
workers’ compensation laws and other similar legally established programs.
·
Inmates.
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received your
protected health information in the course of providing care to you.
·
Required
Uses and Disclosures. Under
the law, we must make disclosures to you and when required by the Secretary of
the Department of Health and Human Services to investigate or determine our
compliance with the law.
Others Involved in Your Healthcare.
Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person you identify, your
protected health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that
it is in your best interest based on our professional judgment. We may use or
disclose protected health information to notify or assist in notifying a family
member, personal representative or any other person that is responsible for your
care of your location, general condition or death. Finally, we may use or
disclose your protected health information to an authorized public or private
entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your health care.
Authorized Uses and Disclosures.
Additional uses and disclosure may be made if you have given written
authorization, which may be revoked at any time in writing delivered to the
Feldkamp Chiropractic Clinic Privacy Officer, except to the extent Feldkamp
Chiropractic, Inc. acted in reliance on the authorization.
Restrictions. You
have the right to request restrictions on the use and disclosure of medical
information about you; however, Feldkamp Chiropractic, Inc. will only be bound
by the restrictions if Feldkamp Chiropractic, Inc. notifies you that it agrees
with them.
Confidentiality. You
have the right to have Feldkamp Chiropractic, Inc. use only confidential means
of communicating with you about medical information. This means you may have information delivered to you at a
certain time or place, or in a manner that keeps your information confidential.
Access. You have the
right to see and receive a copy of information about you kept by Feldkamp
Chiropractic, Inc. under most circumstances.
Amendment. You
have the right to have Feldkamp Chiropractic, Inc. amend its records of
information about you. Feldkamp
Chiropractic, Inc. may refuse to amend information that is accurate, that was
created by someone else, or is not disclosable to you.
Accounting. You
have the right to see a list of disclosures of medical information about you by
Feldkamp Chiropractic, Inc., which includes the purposes and recipients of the
information.
Copy. You have the
right to receive a paper copy of this notice.
Privacy Notice. Feldkamp
Chiropractic, Inc. is required by law to keep medical information about you
private and to give you this notice. Feldkamp
Chiropractic, Inc. must abide by this notice; however, Feldkamp Chiropractic,
Inc. reserves the right to amend this notice and make such change applicable to
all medical information maintained by Feldkamp Chiropractic, Inc..
A revised notice will be provided to patients by Feldkamp Chiropractic,
Inc. by posting the new notice at 4227 Hoover Road, Grove City, Ohio 43123.
Complaints. You may
complain to Feldkamp Chiropractic, Inc. if you believe your privacy rights have
been violated by giving a written complaint to Dr. Peter Feldkamp, DC at (614)
875-3338 at 4227 Hoover Road, Grove City, Ohio 43123. You may also complain to the Secretary of the U.S. Department
of Health and Human Services. Feldkamp
Chiropractic, Inc. will not retaliate against you for making a complaint.
Effective Date. This
notice is effective from April 14, 2003 until revised by Feldkamp Chiropractic,
Inc.