Kelly Coogan D. C.
3216 Monte Vista Blvd. NE, Suite A
Albuquerque, New Mexico 87106
ph: 505.247.HEAL fax: 505.247.4326 email: info@chiroveda.com
Privacy Notice to Patients
This notice describes how your medical records and the information that they contain may be disclosed and how you can get access to that information.
POLICY STATEMENT
New Direction Chiropractic is committed to maintaining the privacy of your protected health information (PHI), which includes information about your health information and the care and treatment that you receive at this office and from other health care providers.
USE AND DISCLOSURE OF PHI
New Direction Chiropractic may use and/or disclose your PHI for purposes related to your care, payment for that care and for purposes directly related to the operation of the health care delivered at this office. The following are examples of the times that your PHI may be disclosed or used by this office.
1. Care--In order to provide care to you, we will provide your PHI to those health care professionals, whether directly associated with New Direction Chiropractic or not, that are directly involved with your care so that they may understand your medical condition, treatment needs or recommendations related to your care. For example another physician may need to know what your response is to particular types of treatment provided by us.
2. Payment--In order to be paid for some or all of the care provided to you at this office we may provide your PHI directly or through a billing service to appropriate third parties, pursuant to their billing and payment requirements. For example, New Direction Chiropractic may need to provide your employers' industrial liability carrier with information about the services you receive so that we may be appropriately compensated.
3. Health Care Operations--In order for the company to operate in accordance with applicable law and insurance for credentialing requirements it may be necessary for us to sue, compile and/or disclose your PHI. For example, New Direction Chiropractic may use your PHI in order to evaluate the performance of our personnel in providing care for you of a specific condition.
WHEN YOUR AUTHORIZATION IS NOT REQUIRED
We may use and/or disclose your PHI without your written authorization in the following circumstances:
1. De-identified Information--Your PHI is altered so that it does not identify you and, even without your name, cannot be used to identify you.
2. Business Associates--To a business associate, which is someone that the company does business with through contract, in the course of providing you care, payment for your care or the general operation of the company (billing services, transcription and shredding companies). New Direction Chiropractic will obtain appropriate written assurance, in accordance with applicable law, that the business associate will safeguard your PHI.
3. Personal Representative--To a person who, under applicable law, has the authority to represent you in making health care decisions.
4. Public Health Activities--Such activities include information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability. This includes reports of abuse or neglect of children or the elderly.
5. Food and Drug Administration--If required by the FDA to report adverse reactions, product defects, biological product deviations or to track problems to enable product recall, repair or replacement or to conduct post-marketing surveillance.
6. Abuse, Neglect, or Domestic Violence--To a government authority as required by law. If the company is required by law to make such a disclosure, we will do so if we believe that you have been a victim of abuse, neglect or domestic violence. Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of such disclosure.
7. Health Oversight Activities--Such activities, as required by law, involving government agencies in oversight activities that relate to the health care system, government benefit programs, government regulatory programs and civil rights law. Those activities include criminal investigations, audits, disciplinary actions or general oversight activities related to the community's public health system.
8. Judicial and Administrative Proceedings--Disclosure of your HI in response to a court order or lawfully issued subpoena.
9. Law Enforcement Purposes--In certain instances, your PHI may have to be disclosed to a law enforcement official for enforcement purposes. Law enforcement purposes include: (1) complying with a subpoena; (2) information for identification or location (e.g. suspect or missing person); (3) information about a person who is is suspected of being a crime victim; (4) in situations where the death of a person may have resulted from criminal activity; (5) in the event of a crime occurring on our premises; or (6) when a medical emergency has occurred and it appears that a crime has been committed.
10. Coroner or Medical Examiner--We may disclose your PHI to a coroner or medical examiner for the purposes of identification, aid in determination of the cause of death or to a funeral director as permitted by law and as necessary for them to carry out their duties.
11. Organ, Eye or Tissue Donation--If you are an organ donor, we may disclose your PHI to the entity to whom you have agreed to donate your organs.
12. Research--If the company is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect.
13. Avert a Threat to Health or Safety--The company may disclose your PHI if we believe that such a disclosure is necessary to prevent or lessen a serious and imminent threat tot he health or safety of a person or the public and disclosure is to a person who is reasonably able to lesson or prevent the threat.
14. Specialized Government Functions--When the appropriate conditions apply, the company may use the PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command personnel; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility of benefits; or (3) to a foreign military authority if you are a member of that service. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.
15. Inmates--We may disclose your PHI to a correctional institution or a law enforcement official if you become an inmate of that institution and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals.
16. Workers' Compensation--If you are involved in a Workers' Compensation claim, we may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation program.
17. Disaster Relief Efforts--We may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.
18. Required by Law--If otherwise required by law, but such use and disclosure will be made in compliance with, and limited to the requirements of the law.
AUTHORIZATION
Use or disclosures, other than those described above, will be made only with your written authorization, which may be revoked at any time.
APPOINTMENT REMINDERS
New Direction Chiropractic may contact you occasionally with reminders of scheduled or recommended appointments. We will try and limit the amount of HI contained in these reminders. We may also attempt to contact you by telephone and, if you are not available, we will leave a message for you.
TREATMENT BENEFITS OR ALTERNATIVES
We may contact you regarding treatment alternatives or other health benefits or services that may be of interest to you.
YOUR RIGHTS
You have the right to:
1. Revoke any authorization, in writing, at any time. To request a revocation, you must submit a written request to New Direction Chiropractic Privacy Officer.
2. Request restriction on certain use or disclosure of your PHI as provided by law. The company is not obligated to agree to any request restrictions. To request restrictions, you must submit a written request to the New Direction Chiropractic Privacy Officer. In your request you must inform the company of what information you want to limit, whether you want to limit our use, disclosure or both and to whom you want the limits to apply. If the company agrees with your request, we will comply unless the information is needed to provide you with emergency services.
3. Receive confidential communications of your PHI by alternative means or at alternative locations. You must make your request in writing to the New Direction Chiropractic Privacy Officer. We will honor all reasonable requests.
4. Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to New Direction Chiropractic Privacy Officer. In certain circumstances that are defined by law, your request may be denied. You have the right to have any denial review, by written request. The company will charge a fee for the cost of copying, mailing or other supplies or work effort associate with your request.
5. Amend your PHI as provided by law. To request an amendment to be added to your PHI, you must submit a written request to the New Direction Chiropractic Privacy Officer. You must provide a reason that supports your request. The company may deny your request if it is not in writing, if you do not provide a reason and support for your request, if the information be amended was not created by New Direction Chiropractic, if the information is not a part of information that you would be allowed to inspect and copy or if the information is not accurate and complete. If your written request is denied, you have the right to submit a written statement of disagreement.
6. Receive an accounting of disclosures of your PHI as provided by law. To request an accounting, you must submit a written request to the New Direction Chiropractic Privacy Officer. The request must state a time period that cannot be longer than six years and may not include dates before 1/02/04. Your request should include what form you want that information delivered in, such as mail or electronic means. One list requested during a 12 month period will be provided free of charge. Additional requests during a 12 month period will be provided for a fee. You will be advised of that fee prior to the list being drawn up so that you can withdraw or modify your request before charges are incurred.
7. Receive a paper copy of this Privacy Notice at no charge upon submitting a written request to the New Direction Chiropractic Privacy Officer.
8. File a written complaint to New Direction Chiropractic attention Privacy Officer or to the Secretary of Health and Human Services, Office of Civil Rights, Hubert H. Humphrey Bldg 200 Independence Ave SW, Room 509F, Washington, DC 20201. You may contact the regional office of the Office of Civil Rights at www.hhs.gov/ocr/regmail.html
9. To obtain more information or to have questions about your rights to privacy answered, you may contact the New Direction Chiropractic Privacy Officer at 247-4325 or by fax at 247-4326.
COMPANY REQUIREMENTS NEW DIRECTION CHIROPRACTIC
1. Is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice of our legal duties and privacy practices with respect to your PHI.
2. Is required to abide by the terms of this Privacy Notice.
3. Reserves the right to change the terms of this Privacy Notice and to make the revised provisions effective for all PHI that it maintains.
4. Will not retaliate against you for making a complaint.
5. Must make a good faith effort to obtain your acknowledgement of receipt of this information.
6. Will post this Privacy Policy on any web site that we maintain.
EFFECTIVE DATE: This notice is effective January 2, 2004.