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The Busch Chiropractic
Center Chiropractic Notice of Privacy Practices
5005 Riviera Court, Fort Wayne, IN
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.
The
Busch Chiropractic Center 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 The Busch
Chiropractic Center.”
“It is our policy to provide a substitute health care provider,
authorized by The Busch Chiropractic Center 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 The Busch Chiropractic Center 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 The Busch Chiropractic Center 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 The Busch Chiropractic Center amend
your protected health information. Please be advised, however, that
The Busch Chiropractic Center 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 The Busch Chiropractic Center.
-
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
Busch 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, The Busch Chiropractic Center is required by law to comply with this
Notice.
Busch 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: J.E. Busch by
calling this office at 260-471-4090. If J.E. Busch is not available, you
may make an appointment for a personal conference in person or by
telephone within 5 working days.
Complaints
Complaints about your Privacy rights, or how The Busch Chiropractic Center
has handled your health information should be directed to J. E. Busch,
by calling this office at 260.471-4090 If J. E. Busch is not available,
you may make an appointment for a personal conference in person or by
telephone within 5 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 |
