Notice of Privacy Practices
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.
This Notice of Privacy Practices describes how we may use and disclose
your health information to carry out treatment, payment or healthcare
operations and for other purposes that are permitted or required by
law. It also describes your rights to access and control your health
information. Health information is information about you, including
demographic information that may identify you and that relates to your
past, present and future physical or mental health or condition and
related healthcare services.
Each time you have an adjustment, a record is made. This record may
contain your symptoms, examination, test results, diagnoses, and a plan
for future care and treatment. This information, often referred to as
your health record, serves as a:
• Basis for planning your care and treatment
• Means of communication among the many health professionals who
contribute to your care
• Legal document describing the care you receive
• Means by which you or a third party payer can verify that services
billed are actually provided
• A tool in educating healthcare professionals
• A source of information for public health officials who oversee
the delivery of health planning and marketing
• A tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve
Understanding what is in your health record and how your health information
is used helps to ensure its accuracy, to better understand who, what,
when, where and why others may access your health information and to
make more informed decisions when authorizing disclosures to others.
Our Responsibilities
Our facility is required by law to:
• Maintain the privacy of your health information
• Provide you with a notice as to our legal duties and privacy
practices with respect to information we collect and maintain about
you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health
information by alternative means or at alternative locations
We reserve the right to change our practices and to make new provisions
effective for all protected health information we maintain. Should or
practices change, we will give or send you a revised notice.
We will not use or disclose your health information without your written
authorization, except as described in this notice.
How We Will Use or Disclose Your Health Information
1. Treatment: We will use your health information for treatment.
For example, information obtained by a chiropractor or other member
of your healthcare team will be recorded in your record and used to
determine the course of treatment that should work best for you. Your
doctor will document in your record his or her expectations and course
of treatment. If necessary, we will also provide a subsequent healthcare
provider with copies of various reports that should assist him or her
in treating you.
2. Payment: We will use your health information for payment.
For example, a bill may be sent to you or a third-party payer, including
Medicare and/or Medicaid. The information on or accompanying the bill
may include information that identifies you, as well as your diagnosis,
procedures, adjustments, therapies and supplies used.
3. Healthcare Operations: We will use your health information
for regular healthcare operations. For example, members of the staff
may use your information in your health record to assess the care and
outcomes in your case and others like it. The information will then
be used in an effort to continually improve the quality and effectiveness
of the healthcare and service we provide.
4. Business Associates: There are some services provided in our
organization through contracts with business associates. Examples include
accountants, consultants and attorneys. When these services are contracted,
we may disclose your health information to our business associate so
they can perform the job we have asked them to do. To protect your health
information, however, we require the business associate to appropriately
safeguard your information.
5. Communication with Family: Health professionals, using their
best judgment, may disclose to a family member, other relative, close
personal friend or other person you identify, health information relevant
to that person’s involvement in your care or payment related to
your care.
6. Marketing: We may contact you to provide appointment reminders
or information about treatment alternative or other health-related benefits
and services that may be of interest to you.
7. Fundraising: We may contact you as part of a fundraising effort.
8. Food and Drug Administration – FDA: We may disclose to
the FDA health information relative to adverse effects with respect
to food, supplements, products and product defects, or post marketing
surveillance information to enable product recalls, repairs or replacement.
Charles Street Family Chiropractic
9. Worker’s Compensation: We may disclose health information
to the extent authorized by, and to the extent necessary to comply with,
laws relating to Worker’s Compensation or similar programs established
by law.
10. Public Health: As required by law, we may disclose your health
information to public health or legal authorities charged with preventing
or controlling diseases, injury or disability.
11. Law Enforcement: We may disclose health information for law
enforcement purposes as required by law or in response to a subpoena.
12. As Required By Law: When required to do so and only to the
extent required by law, including but not limited to, reporting suspected
abuse or neglect of an incapacitated adult or a minor.
13. Health Oversight Activities: To a health oversight agency
for activities authorized by law, including audits, investigations and
licensure.
14. Public Safety/Duty to Warn: To warn of a serious threat to
a clearly identified or reasonably identifiable person, or a serious
threat of substantial damage to real property but only to the threatened
person or law enforcement to help prevent the threat.
15. National Security: To authorized federal officials for specialized
government functions such as national security and intelligence.
Your Health Information Rights
Although your health record, including your x-rays, is the physical
property of the facility, the information in your health record belongs
to you. You have the following rights:
1. You may request that we not use or disclose your health information
for a particular reason related to treatment, payment, the facility’s
general healthcare operations, and/or to a particular family member
or other relative or close personal friend. We ask that such requests
be made in writing. Although we will consider your request with regard
to the use of your health information, please be aware that we are under
no obligation to accept it or abide by it. We will abide by your request
with regard to the disclosure of your clinical and personal records
to anyone outside the facility, except in an emergency or the disclosure
is required by law.
2. If you wish to change the manner in which or the location where you
are receiving communications from us regarding your health information,
you may request we provide you with such information by alternative
means or at an alternative location. Such requests must be submitted
in writing. We will accommodate all reasonable requests.
3. You may request to inspect and/or obtain copies of health information
about you, which will be provided to you in the time frame established
by law. You may make such requests orally or in writing. If you request
to have copies made, we may charge you a reasonable fee.
Charles Street Family Chiropractic
4. If you believe any health information in your record is incorrect
or if you believe that important information is missing, you may request
that we correct the existing information or add the missing information.
Such requests must be made in writing and must provide a reason to support
the amendment. You can obtain a Request for Amendment of a Record
Form from the facility.
5. You may request that we provide you with a written accounting of
disclosures made by use during the time period for which you request,
not to exceed six (6) years and not before April 14, 2003. We ask that
such requests be submitted in writing. Please note that an accounting
will not include any disclosures made: (a) For reasons of treatment,
payment or healthcare operations; (b) To you, or your legal representative
or any other individual involved with you care; or (c) For the protection
of national security. You will not be charged for your first accounting
request in any twelve (12) month period. However, for any request you
make thereafter, you may be charged a reasonable fee.
6. You have the right to obtain a copy of our Notice of Privacy Practices
upon request.
7. You may revoke an authorization to use or disclose health information,
except to the extent that action has already been taken. Such a request
must be in writing.
For More Information or To Report a Problem
If you have questions or would like additional information please contact
our office and/or the Privacy Officer. Questions may also be directed
to:
Charles Street Family Chiropractic
Attn: Privacy Oficer
83 Charles Street
Boston, MA 02114
(617) 720-1992
If you believe your rights have been violated you may file a complaint
with us. The complaint must be filed in writing. You may also file a
complaint with the Secretary of the United States Department of Health
and Human Services. There will be no retaliation for filing a complaint.
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