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Ferguson Chiropractic Solutions
Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
The Practice (the "Practice”), in accordance with the Federal Privacy Rule, 45 CFR parts 160 and 164 (the “Privacy Rule”) and applicable state law, is committed to maintaining the privacy of your protected health information (“PHI”). PHI includes information about your health condition and the care and treatment you receive from the Practice and is often referred to as your health care or medical record. This notice explains how your PHI may be used and disclosed to third parties. This notice also details your rights regarding your PHI.
HOW THE PRACTICE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The Practice, in accordance with this Notice and without asking for your expressed consent or authorization, may use and disclose your PHI for the purpose of:
(A) Treatment - To provide you with the health care you require, the Practice may use and disclose your PHI to those health care professionals, whether on the Practice's staff or not, so that it may provide, coordinate, plan or manage your health care. For example, a chiropractor treating you for lower back pain may need to know and obtain the results of your latest physical examination or last treatment plan. Please note – This practice provides therapy in a semi-open area. This means that statements made by you or staff during therapy may be overheard by others. If you have comments you wish to make privately when you are in therapy, please inform the doctor or staff so they can accommodate your request.
(B) Payment -- To get paid for the services provided by you, the Practice may provide your PHI, directly or through a billing service, to a third party who may be responsible for your care, including insurance companies and health plans. If necessary, the Practice may use your PHI in other collection efforts with the respect to all persons who may be liable to the Practice for bills related to your care. For example, the Practice may need to provide the Medicare program with information about health care services that you receive from the Practice so that the Practice can be reimbursed. The Practice may also need to tell your insurance plan about treatment you are going to receive so that it can determine whether or not it will cover the treatment expense. (C) Health Care Operations – To operate in accordance with applicable law and insurance requirements and to provide quality and efficient care, the Practice may need to compile, use and disclose your PHI. For example, the Practice may use your PHI to evaluate the performance of the Practice"s personnel in providing care for you. (D) INSPECT -- Inspect and copy your PHI as provided by Federal Law (including Privacy Rule, Section 164.524) and state law. To inspect and copy your PHI, you must submit a written request to the Practice’s Privacy Officer. The Practice can charge you a fee for the cost of copying, mailing or other supplies associated with your request. In certain situations that are defined by law, the Practice may deny your request, but you will have the right to have the denial reviewed as set forth more fully in the written denial notice. (E) AMEND -- Amend your PHI as provided by Federal Law (including Privacy Rule, Section 164.526) and state law. To request an amendment, you must submit a written request to the practice’s Privacy Officer. You must provide a reason that supports your request. The Practice may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by the Practice (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by the Practice, if the information is not part of the information you would be permitted to inspect, and copy, and/or if the information is accurate and complete. If you disagree with the Practice’s denial, you will have the right to submit a written statement of disagreement. (F) ACCOUNTING OF DISCLOSURES – Receive an accounting of disclosures of your PHI as provided by Federal Law (including Privacy Rule Section 164.528) and state law. To request an accounting, you must submit a written request to the Practice’s Privacy Officers. The request must state a time period, which may not be longer than six (6) years and may not include dates before April 14th, 2003. The request should indicate in what form you want the list (such as paper or electronic copy). The first list you request within a twelve (12) month period will be free, but the Practice may charge you for the cost of providing additional lists. The Practice will notify you of the cost involved and you can decide to withdraw or modify your request before any costs are incurred. (G) PAPER COPY OF THIS NOTICE – Receive a paper copy of this Privacy Notice from the Practice (as provided by Privacy Rule Section 164.520(b)(1)(vi)(F)) upon request to the Practice’s Privacy Officer. (H) COMPLAINTS – Complain to the Practice or to the Secretary of HHS (as provided by Privacy Rule Section 164.520(b)(1)(vi)) if you believe your privacy rights have been violated. To file a complaint with the Practice, you must contact the Practice Privacy Officer. All complaints must be in writing.
To obtain more information about your privacy rights or if you have any questions you want answered about your privacy rights (as provided by Privacy Rule Section 164.520(b)(2)(vii)), you may contact your Practice’s Privacy Officer as follows:
Dr. Scott Ferguson and/or Sarah Cobb |
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