TOZER CHIROPRACTIC, P.A. 

NOTICE OF PRIVACY PRACTICES

March 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE READ THIS NOTICE CAREFULLY.

THE PRIVACY OF YOUR PROTECTED HEALTH INFORMATION IS IMPORTANT TO US.

This Notice describes how Tozer Chiropractic, P.A. may collect, use and disclose your protected health information and your rights concerning your protected health information.

We are required to maintain the privacy of your protected health information and to provide you this Notice about our legal duties and privacy practices.

This Notice takes effect April 14, 2003.

We reserve the right to change our privacy practices and the terms of this Notice.

These changes apply to all protected health information we have, including protected health information created or received before we change the Notice.

Your Protected Health Information

Protected health information includes:

• Medical Information

Individually identifiable information, such as your: 

• Name
• Address
• Telephone Number
• Member Identification Number

We understand the sensitivity of privacy issues.  We also recognize that protecting the privacy and security of the protected health information we obtain about you is an important responsibility. 

How We Safeguard Your Protected Health Information

Tozer Chiropractic, P.A. is committed to maintaining the security and confidentiality of the information we receive from our patients.  We maintain physical, electronic, and procedural safeguards that comply with Federal and State laws to protect information against unauthorized access and use.  Our Privacy Official has the overall responsibility of implementing and enforcing policies and procedures to safeguard your protected health information against inappropriate access, use and disclosure.

Permitted Uses and Disclosures of Protected Health Information

We use and disclose protected health information in a number of different ways.  The following are only a few examples of the types of uses and disclosures of your protected health information that we are permitted by law to make without your authorization:

Treatment- We may disclose your protected health information to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment.

We may also disclose your protected health information to health care providers in connection with preventive health, early detection and disease and case management programs.

Payment- We may use and disclose your protected health information to administer your health benefits policy or contract, which may involve the determination of:

• Eligibility;
• Claims;
• Utilization review management;
• Medical necessity review;
• Coordination of care benefits and other services; or
• Responding to complaints, appeals and external review requests.

We may also disclose your protected health information with affiliates and third party “business associates” that perform payment or health care operation activities for us on your behalf.

In addition, the law permits us to use or disclose your protected health information in the following situations without your authorization:

Required by Law- We may use or disclose your protected health information to the extent that we are required to do so by State or Federal Law.

Public Health- We may disclose your protected health information to an authorized public health authority for purposes of public health activities.  The information may be disclosed for such reasons as controlling disease, injury or disability.

Abuse or Neglect- We may make disclosures to government authorities concerning abuse, neglect or domestic violence.

Health Oversight- We may disclose your protected health information to a government agency authorized to oversee the healthcare system or government programs, including audits, examinations, investigations, inspections and licensure activity.

Legal Proceedings- We may disclose your protected health information in the course of any legal proceedings, in response to an order of a court or administrative judge and, in certain cases, in response to a subpoena, discovery request or other lawful process.

Law Enforcement- We may disclose your protected health information under limited circumstances to law enforcement officials.  For example, disclosures may be made in response to a warrant or subpoena or for the purpose of identifying or locating a suspect, witness or missing persons or to provide information concerning victims of crimes.

Coroners and Medical Examiners- We may disclose your protected health information in certain instances to coroners and Medical Examiners.

Research- We may disclose your protected health information to researchers, provided that certain established measures are taken to protect your privacy. 

Threat to Health or Safety- We may disclose your protected health information to the extent necessary to avert a serious and imminent threat to your health or safety or to the health or safety of others.

Military Activity and National Security- We may disclose your protected health information to Armed Forces personnel under certain circumstances and to authorized federal officials for the conduct of national security and intelligence activities.

Correctional Institutions- If you are an inmate in a correctional facility, we may disclose your protected health information to the correctional facility for certain purposes, including the provision of health care to you or the health and safety of you or others.

Workers’ Compensation- We may disclose your protected health information to the extent required by workers’ compensation laws.

**Any uses and disclosures not described in this notice will require your written authorization.  If you give us an authorization, you may cancel it in writing at any time. **

Your Rights Concerning Your Protected Health Information

We would like you to know that you have additional rights with respect to your protected health information:

Right To Request Restrictions- You have the right to ask us to place restrictions on the way we use or disclose your protected health information for treatment, payment or health care operations or as described in this Notice above.

However, the law does not require us to agree to these restrictions.  If we do agree to a restriction, we may not use or disclose protected health information in violation of that restriction, unless it is needed or for an emergency.

Confidential Communications- We will accommodate reasonable requests to communicate with you about your health information to an alternative location.

You must make your request in writing, and you must state that the information could endanger you if it is not communicated in confidence to the alternative location you want. 

Access to Protected Health Information- You have the right to receive a copy of protected health information about you.  You must make your request in writing to access copies of your records, and provide us with the specific information we need to fulfill your request.

We may share protected health information about you with a family member or another in two ways:

1. You are present, either in person or on the telephone, and give us permission to talk to the other person; or
2. You sign an authorization form.

Amendment of Protected Health Information- You have the right to ask us to amend any protected health information about you.  All requests for amendment must be in writing.  We will not amend records in the following situations:

• We do not have the records you are requesting be amended.
• We did not create the records that you are requesting be amended.
• We have determined that the records are accurate and complete. 
• The records have been compiled in anticipation of a civil, criminal or administrative action or proceeding.
• The records are covered by the Clinical Laboratory Improvement Act.

You will be notified of all denials is writing.  You may respond by filing a written statement of disagreement with us, and we will have the right to rebut that statement.  We will respond to your request to amend within 30 days of receipt of a request using the appropriate form.

Accounting of Certain Disclosures- You have the right to have us provide you an accounting of time when we have disclosed your protected health information for any purpose other than the following:

• Treatment, payment, or health care operations as described in this Notice on page 1;
• Disclosures that you or your personal representative have authorized; or
• Certain other disclosures, such as disclosures for national security purposes.

**This accounting requirement applies for six years from the date of the disclosure, beginning with disclosure occurring after April 14, 2003. **

All requests for an accounting must be in writing.  We will require you to provide us the specific information we need to fulfill your request.

Privacy Violation

If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, you may either:

1. File a written complaint with our Privacy Official at Tozer Chiropractic, P.A.; or
2. Notify the Secretary of the U.S. Department of Health and Human Services (HHS).  Send your complaint to:

We will not take retaliatory action against you if you file a complaint about our privacy practices either with us or HHS.