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Ortega Chiropractic Notice of Privacy
Practices
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.
Ortega Chiropractic is required, by law,
to maintain the privacy and confidentiality of your protected
health information and to provide our patients with notice
of our legal duties and privacy practices with respect to
your protected health information.
Disclosure of Your Health Care Information
Treatment
We may disclose your health care information to other healthcare
professionals within our practice for the purpose of treatment,
payment or healthcare operations. (example)
“On occasion, it may be necessary
to seek consultation regarding your condition from other
health care providers associated with Ortega Chiropractic.”
“It is our policy to provide a substitute
health care provider, authorized by Ortega Chiropractic
to provide assessment and/or treatment to our patients,
without advanced notice, in the event of your primary health
care provider’s absence due to vacation, sickness,
or other emergency situation.”
Payment
We may disclose your health information to your insurance
provider for the purpose of payment or health care operations.
Workers’ Compensation
We may disclose your health information as necessary to comply
with State Workers’ Compensation Laws.
Emergencies
We may disclose your health information to notify or assist
in notifying a family member, or another person responsible
for your care about your medical condition or in the event
of an emergency or of your death.
Public Health
As required by law, we may disclose your health information
to public health authorities for purposes related to: preventing
or controlling disease, injury or disability, reporting child
abuse or neglect, reporting domestic violence, reporting to
the Food and Drug Administration problems with products and
reactions to medications, and reporting disease or infection
exposure.
Judicial and Administrative Proceedings.
We may disclose your health information in the course of any
administrative or judicial proceeding.
Law Enforcement.
We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a suspect,
fugitive, material witness or missing person, complying with
a court order or subpoena, and other law enforcement purposes.
Deceased Persons.
We may disclose your health information to coroners or medical
examiners.
Organ Donation.
We may disclose your health information to organizations involved
in procuring, banking, or transplanting organs and tissues.
Research.
We may disclose your health information to researchers conducting
research that has been approved by an Institutional Review
Board.
Public Safety.
It may be necessary to disclose your health information to
appropriate persons in order to prevent or lessen a serious
and imminent threat to the health or safety of a particular
person or to the general public.
Specialized Government Agencies.
We may disclose your health information for military, national
security, prisoner and government benefits purposes.
Change of Ownership.
In the event that Ortega Chiropractic is sold or merged with
another organization, your health information/record will
become the property of the new owner.
Your Health Information Rights
- You have the right to request restrictions
on certain uses and disclosures of your health information.
Please be advised, however, that Ortega Chiropractic is
not required to agree to the restriction that you requested.
- You have the right to have your health
information received or communicated through an alternative
method or sent to an alternative location other than the
usual method of communication or delivery, upon your request.
- You have the right to inspect and copy
your health information.
- You have a right to request that Ortega
Chiropractic amend your protected health information. Please
be advised, however, that Ortega Chiropractic is not required
to agree to amend your protected health information. If
your request to amend your health information has been denied,
you will be provided with an explanation of our denial reason(s)and
information about how you can disagree with the denial.
- You have a right to receive an accounting
of disclosures of your protected health information made
by Ortega Chiropractic.
- You have a right to a paper copy of this
Notice of Privacy Practices at any time upon request.
Changes to this Notice of Privacy Practices
Ortega Chiropractic reserves the right to amend this Notice
of Privacy Practices at any time in the future, and will make
the new provisions effective for all information that it maintains.
Until such amendment is made, Ortega Chiropractic is required
by law to comply with this Notice.
Ortega Chiropractic is required by law to
maintain the privacy of your health information and to provide
you with notice of its legal duties and privacy practices
with respect to your health information. If you have questions
about any part of this notice or if you want more information
about your privacy rights, please contact: Dr. Steven Read
by calling this office at 904.425.4545. If Dr. Steven Read
is not available, you may make an appointment for a personal
conference in person or by telephone within 2 working days.
Complaints
Complaints about your Privacy rights, or how Ortega Chiropractic
has handled your health information should be directed to
Dr. Steven Read, by calling this office at 904.425.4545 If
Dr. Steven Read is not available, you may make an appointment
for a personal conference in person or by telephone within
2 working days.
If you are not satisfied with the manner
in which this office handles your complaint, you may submit
a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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