Heartland Chiropractic Clinic Privacy Policy

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.

A-Understanding Protected Health Information

A record of your visit is made each time that you receive a medical service from your health care professional. This record generally contains documentation of your symptoms, examination, diagnosis, test results, and treatment plan. 

This medical record is called protected health information (PHI) and serves as:

• A basis for planning your care and treatment.
• A means of communication among the many health professionals who participate in your care.
• A legal document describing the care you receive.
• A means by which you or a third-party payer (ex. Insurance, Medicare, Medicaid) can verify that services billed were provided.
• A tool for educating health professionals (ex. Chiropractic students).
• A source of data for medical research.
• A source of information for public health officials for improving national health.
• A source of data for facility planning and marketing.

B-Designated PHI Record Set Include:

• Itemized statement
• Explanation of benefits
• Medicare/insurance card copies
• Status of account
• Medical care information
• PHI authorizations/ amendments
• Insurance referrals/ information
• Demographic information

C- Patient Rights Regarding Own PHI

Although your PHI is the physical property of Heartland Family Health and Chiropractic Clinic, Inc., you have the following rights.

1. Right to inspect and obtain a copy of your PHI. We must have a written request for this information. 
2. Right to request a restriction to use or disclose any part of your PHI for the purpose of treatment, payment, or health care operations.
3. Right to ask for confidential communications from Heartland Family Health and Chiropractic Clinic, Inc. through a written request entailing how, when, and where you wish to be contacted.
4. Right to a paper copy of this Notice of Privacy Practice.
5. Right to receive a written account of disclosures of release PHI within 60 days. You must have a written request stating a time period no longer than 6 years.
6. Right to request an amendment to your PHI.
7. Right to revoke your authorization to use or disclose health information. Must be a written revocation statement.
8. Other uses of your PHI that require your authorization.

We may condition these previously listed rights of you by asking you for information as to how payment may be handled.

D-Heartland Family Health and Chiropractic Clinic, Inc. Responsibilities

• Maintain the privacy of your PHI.
• Provide you with this notice as our legal duties and privacy practices with respect to the information we collect and maintain about you.
• Notify any affected individuals following a breach of any unsecured PHI.
• Abide by the terms of this notice.
• Notify you if we are unable to agree to a requested restriction.
• Accommodate reasonable requests.
• Reserve the right to change our practices and to make new provisions effective for all maintained PHI, with good intentions of providing the changed policy to you.
• Will not use or disclose your PHI without your authorization, except as in this notice.
• Train all employees on the PHI policies and procedures.

E-Change to this Notice of Privacy Practices

Heartland Family Health and Chiropractic Clinic, Inc. maintains the right or may be required by law to change its privacy practices, which may result in the direct notice. The most current Notice of Privacy Practices shall be effective for any pre-existing or future information. Updated copies of the Notice of Privacy Practice, noting the effective date, will be posted in our office and if applicable on our website. In addition, a copy is available to you at each office visit.

F-Permitted or Required PHI Use and Disclosure

No patient authorization is required to use or disclose PHI for treatment, payment, and health care operations. Additionally, no patient authorization is required to use or disclose if permitted or required by law. In all other circumstances, a signed authorization is required from an individual or their personal representative prior to the use or disclosure of PHI including highly protected information.

1. For Treatment: Your health information may be used by staff members or disclosed to other healthcare professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment.
2. For Payment: A bill may be sent to you, your financially responsible party, an insurance company, or a third-party payer. The billing may include information that identifies you, the date of service, your diagnosis, supplies used, and medical treatment rendered. For example, in order to obtain prior approval for a specific treatment, we may need to disclose PHI. Also, in order to determine coverage, PHI may need to be released. 
3. For Health Care Operations: Your health information may be used as necessary to support the day-to-day activities and management of Heartland Family Health and Chiropractic Clinic, Inc. For example, information on the service you received may be used to support budgeting and financial reporting and activities to evaluate and promote quality.
4. Department of Health and Human Services: Under the law, we must make a disclosure to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Sections 164.500 et.seq.
5. Public Health: We may disclose your PHI to the public health authority or to a foreign agency that is collaborating with public health, for public health activities and for purposes permitted by law to collect or receive the information. The disclosure will be made for the purposes of:
6. Prevention or control of disease, injury, or disability
7. Reporting deaths or births
8. Reporting reactions to medications or problems with products
9. Notification of product recall
10. Notification of possible disease exposure or risk of spreading a disease or condition
11. Notification of suspected abuse, neglect, or domestic violence
12. Health Oversight Agencies: We may disclose to health oversight agencies activities authorized by law, such as audits, investigations, inspections, and licensure. Oversight agencies seeking this information include government agencies that regulate our operations, government benefits programs, and civil rights law.
13. Workers Compensation: We may release PHI compliant with the workers' compensation laws and other legally-established programs that provide benefits for work-related injuries or illness.
14. Legal Proceedings: If you are involved in a lawsuit or dispute, we may disclose PHI in response to a court administrative order. We may also disclose PHI in a response to a subpoena, discovery request, or another lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
15. Law Enforcement: We may disclose PHI for law enforcement to support government audits and inspections to facilitate law-enforcement investigations and to comply with government-mandated reporting.
16. Criminal Activity: Consistent with the applicable federal and state laws we may disclose your PHI 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.
17. Military Activity and National Security: When appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personal (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs on you eligibility benefits or (3) to foreign military authority if you are a member of the foreign military services.
18. Business Associates: We may provide PHI to other persons or organizations, known as business associates (ex. Attorney, Collection Agency, etc.) who provide services for us under contract. We required that our business associates protect the PHI we may provide them. 

G-PHI Use and Disclosure in Special Situations

We may use or disclose your PHI in certain situations as described below. For these situations, you have the right to limit these uses and disclosures.

1. Family Members and Friends: We may disclose PHI to individuals who are involved in your care or who help pay for your care.
2. Appointment Reminders: We may use or disclose PHI for purpose of contacting you to remind you of an appointment.
3. Other Health-Related Services: We may contact you to provide you with information about treatment alternatives or other health-related services that may be of interest to you.
4. Research: We may use or disclose PHI about you for the purposes of medical research.
5. Patient Statements/ Correspondence: Billing statements for family members on the same account are mailed in the same envelope of the account Guarantor to the address listed in our computer for the account.

H-Questions or Concerns

If you have any questions or concerns regarding your privacy rights, feel free to contact our Office at (402) 721-1060.