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HIPAA Privacy Policy

Cole Chiropractic Clinic

Your Information.

Your Rights.

Our Responsibilities.

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.


 When it comes to your health information,   you have certain rights. This section explains your rights and some of our responsibilities to   help you.
Get an electronic or   paper copy of your medical 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 information about you that you think is   incorrect or incomplete. Ask us how to do this.•   We may say “no” to your request, but 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 say “yes” to all reasonable requests.


Ask us to limit what we   use or share •   You can ask us not to use or share certain health information 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 in full, you can   ask us not to share that information for the purpose of payment or our   operations with your health insurer.•   We will say “yes” unless a law requires us to share that information.
Get a list of those   with whom we’ve shared information •   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 page 1.•   You can file a complaint with the U.S. Department of Health and Human Services   Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W.,   Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.•   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 will follow your instructions.
In these cases, 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• Include your information in a hospital directory• Contact you for fundraising effortsIf you are not able to tell us   your preference, for example if you are unconscious, we may go ahead and   share your information if we believe it is in your best interest. We may also   share your information when needed to lessen a serious and imminent threat to   health or safety.
In these cases we never share your   information unless you give us written permission: • Marketing purposes• Sale of your information• Most sharing of psychotherapy notes
In the case of   fundraising: • We may contact you   for fundraising efforts, but you can tell us not to contact you again.


Our Uses and Disclosures


How do we typically use or share your health   information? We typically use or   share your health information in the following ways.
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.
Run our organization • We can use and share   your health information to run our practice, improve your care, and contact   you when necessary. Example: We use health information about you to manage your treatment and   services.
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 health 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: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health   and safety issues • We can share health   information about you for certain situations such as:• Preventing disease• Helping with product   recalls• Reporting adverse   reactions to medications• Reporting suspected   abuse, neglect, or domestic violence• Preventing or   reducing a serious threat to anyone’s health or safety
Do research • We can use or share   your information 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 and Human Services if it wants to see that we’re   complying with federal privacy law.
Respond to organ and   tissue donation requests • We can share health   information about you with organ procurement organizations.
Work with a medical   examiner or funeral director • We can share health   information with a coroner, medical examiner, or funeral director when an   individual dies.
Address workers’   compensation, law enforcement, and other government requests • We can use or share   health information about you:• For workers’   compensation claims• For law enforcement   purposes or with a law enforcement official• With health oversight   agencies for activities authorized by law• For special   government functions such as military, national security, and 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: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

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.

Cole Chiropractic Clinic

Jacquelyn F. Cole, DC