HIPAA Privacy Policy: Protecting Your Health Information at Maryville Spine & Laser

Maryville Spine & Laser Chiropractic Clinic

1131 E Lamar Alexander Pkwy, Maryville TN 37804

Douglas Sanford D.C. - (865) 466-6500

Effective Date: August 8, 2013

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.

We understand the critical importance of privacy and are deeply committed to maintaining the confidentiality of your personal medical information. At Maryville Spine & Laser, we diligently record the medical care we provide and may receive relevant records from other healthcare providers. We utilize these records to deliver quality medical care, process payments through your health plan, and ensure we meet our professional and legal obligations to operate our chiropractic clinic properly.

As required by law, we maintain the privacy of your protected health information (PHI), provide you with clear notice of our legal duties and privacy practices, and will notify you following any breach of unsecured protected health information. This notice outlines how we may use and disclose your medical information, your rights regarding this information, and our legal obligations. If you have any questions, please contact our Privacy Officer (details above).

Table of Contents

• How Maryville Spine & Laser May Use or Disclose Your Health Information
• When Your Authorization is Required for Disclosure
• Your Health Information Rights
• Changes to This Notice of Privacy Practices
• Filing a Complaint

How Maryville Spine & Laser May Use or Disclose Your Health Information

Your health information, collected and stored in your medical record, is the property of this medical practice, though the information within it belongs to you. The law permits us to use or disclose your health information for the following specific purposes:

Treatment

We use your medical information to provide your direct care and disclose it to our employees and others involved in your treatment. For example, we may share information with other physicians, healthcare providers, pharmacists, or laboratories involved in your care. We may also share information with family members or others assisting in your care when you are sick or injured, or after you pass away.

Payment

We use and disclose your medical information to secure payment for the services we provide. This includes providing your health plan with necessary information for billing purposes and assisting other healthcare providers in obtaining payment for services they’ve rendered to you.

Health Care Operations

We may use and disclose your medical information to ensure the proper operation of Maryville Spine & Laser Chiropractic Clinic. This includes activities like:

• Reviewing and improving the quality of care.
• Assessing the competence and qualifications of our professional staff.
• Obtaining authorization for services or referrals from your health plan.
• Conducting medical reviews, legal services, audits (including fraud detection), business planning, and management.
• Sharing information with "business associates" (e.g., billing services) who perform administrative tasks under strict confidentiality contracts.
• Sharing information with other healthcare providers, clearinghouses, or health plans for their quality assessment, patient safety, population health improvement, case management, training, accreditation, or fraud detection efforts.
• Sharing information within "organized health care arrangements" (OHCAs) for their healthcare operations (a list of OHCAs we participate in is available from our Privacy Officer).

Appointment Reminders

We may use and disclose your medical information to contact you about appointments. If you are not home, we may leave this information on your answering machine or with a person answering the phone.

Sign-In Sheet

For efficient office operations, we may use and disclose your medical information by having you sign in upon arrival and by calling out your name when we are ready to see you.

Notification and Communication With Family

We may disclose your health information to notify or assist in notifying a family member, your personal representative, or another person responsible for your care about your location, general condition, or in the event of your death (unless you instruct us otherwise). In a disaster, we may share information with relief organizations for notification efforts. We may also disclose information to someone involved with your care or who helps pay for your care. We will offer you an opportunity to object before making these disclosures if you are able.

Marketing (Non-Payment-Based)

Provided we receive no payment for these communications, we may contact you with information about products or services related to your treatment, case management, or to recommend other treatments, providers, or care settings. We may also describe our practice's products/services, indicate participating health plans, encourage healthy lifestyles, or provide small gifts. We may receive compensation for reminding you to take/refill prescriptions. We will not otherwise use or disclose your medical information for marketing purposes or accept payment for other marketing communications without your prior written authorization. You may revoke any such authorization in writing.

Sale of Health Information

We will not sell your health information without your prior written authorization. Any authorization will disclose if we receive compensation for such a sale, and you may revoke it at any time.

Required by Law

As required by law, we will use and disclose your health information, but we will limit such use or disclosure to the relevant legal requirements. This includes reporting abuse, neglect, or domestic violence, or responding to judicial, administrative, or law enforcement proceedings.

Public Health

We may, and are sometimes required by law, to disclose your health information to public health authorities for purposes such as: preventing/controlling disease, injury, or disability; reporting child, elder, or dependent adult abuse/neglect; reporting domestic violence; reporting to the Food and Drug Administration (FDA) about product problems/medication reactions; and reporting disease/infection exposure. We will inform you promptly if we report abuse unless it puts you at risk.

Health Oversight Activities

We may, and are sometimes required by law, to disclose your health information to health oversight agencies during audits, investigations, inspections, licensure, and other proceedings, subject to legal limitations.

Judicial and Administrative Proceedings

We may, and are sometimes required by law, to disclose your health information in administrative or judicial proceedings as expressly authorized by a court or administrative order. We may also disclose information in response to a subpoena or discovery request with reasonable efforts to notify you, or if objections are resolved by a court order.

Law Enforcement

We may, and are sometimes required by law, to disclose your health information to law enforcement officials for purposes like identifying/locating a suspect, fugitive, material witness, or missing person, or complying with court orders/warrants.

Coroners

We may, and are often required by law, to disclose your health information to coroners in connection with death investigations.

Organ or Tissue Donation

We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Public Safety

We may, and are sometimes required by law, to disclose your health information to appropriate persons to prevent or lessen a serious and imminent threat to the health or safety of an individual or the general public.

Proof of Immunization

We will disclose proof of immunization to a school that requires it for student admission, where you have agreed to the disclosure for yourself or your dependent.

Specialized Government Functions

We may disclose your health information for military or national security purposes, or to correctional institutions or law enforcement officers who have you in their lawful custody.

Workers’ Compensation

We may disclose your health information as necessary to comply with workers’ compensation laws, including periodic reports to your employer about your condition if your care is covered, and reporting occupational injury or illness.

Change of Ownership

If Maryville Spine & Laser Chiropractic Clinic is sold or merged, your health information/record will become the property of the new owner. However, you will retain the right to request copies of your health information be transferred to another physician or medical group.

Breach Notification

In the event of a breach of unsecured protected health information, we will notify you as required by law. We may use email or other appropriate methods for notification. In some circumstances, our business associate may provide this notification.

When Your Authorization is Required for Disclosure

Except as described in this Notice, Maryville Spine & Laser Chiropractic Clinic will not use or disclose health information that identifies you without your specific written authorization. If you do authorize a disclosure for another purpose, you may revoke your authorization in writing at any time.

Your Health Information Rights

You have important rights regarding your protected health information at Maryville Spine & Laser:

Right to Request Special Privacy Protections

You have the right to request restrictions on certain uses and disclosures of your health information. This must be a written request specifying the information you want to limit and the desired limitations on use or disclosure. If you instruct us not to disclose information to your commercial health plan about healthcare items or services you paid for in full out-of-pocket, we will honor your request (unless disclosure is needed for treatment or legal reasons). We reserve the right to accept or reject other requests and will notify you of our decision.

Right to Request Confidential Communications

You have the right to request that you receive your health information in a specific way or at a specific location (e.g., to a particular email or work address). We will comply with all reasonable written requests specifying how or where you wish to receive these communications.

Right to Inspect and Copy

You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want, whether you wish to inspect it or get a copy, and your preferred form and format. We will provide copies in your requested format if readily producible, or an acceptable alternative. We will also send a copy to any person you designate in writing. We may charge a reasonable fee for labor, supplies, postage, and a summary/explanation if requested. We may deny your request under limited circumstances, with a right to appeal for certain denials.

Right to Amend or Supplement

You have the right to request that we amend your health information that you believe is incorrect or incomplete. This request must be in writing and include your reasons. We are not required to change your information if we don't have it, didn't create it (unless the creator is unavailable), you wouldn't be permitted to inspect it, or if it is already accurate and complete. If we deny your request, we will inform you of our decision and how you can disagree; you may submit a written statement of disagreement, and we may prepare a rebuttal.

Right to an Accounting of Disclosures

You have a right to receive an accounting of certain disclosures of your health information made by our practice. This does not include disclosures made to you, with your authorization, or for purposes like treatment, payment, healthcare operations, notification to family, research (without direct identifiers), public health (without direct identifiers), incidental disclosures, or disclosures to health oversight/law enforcement agencies when such accounting would impede their activities.

Right to a Paper or Electronic Copy of this Notice

You have a right to receive a copy of this Notice of Privacy Practices, including a paper copy, even if you previously agreed to receive it electronically.

For a more detailed explanation or to exercise any of these rights, please contact our Privacy Officer listed at the top of this Notice.

Changes to This Notice of Privacy Practices

We reserve the right to amend this Notice of Privacy Practices at any time in the future. Until an amendment is made, we are legally required to comply with the terms currently in effect. Once amended, the revised Notice will apply to all protected health information we maintain, regardless of when it was created or received. A copy of the current notice will be posted in our reception area, available at each appointment, and on our website.

Filing a Complaint

Complaints about this Notice of Privacy Practices or how Maryville Spine & Laser Chiropractic Clinic handles your health information should be directed to our Privacy Officer, whose contact information is at the top of this Notice.

If you are not satisfied with how this office handles a complaint, you may also submit a formal complaint to the U.S. Department of Health and Human Services, Office for Civil Rights.

Email: OCRMail@hhs.gov

Complaint Form: https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html

You will not be penalized in any way for filing a complaint.