McCown Chiropractic and Massage
755 Vandercook Way, Suite 101-A
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.
We use or share your health information in the following ways:
- To treat you: we can use your health information and share it with other professionals who are treating you.
- To run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- To bill for your services: We can use and share your health information to bill and get payment for health plans or other entities.
- To help with public health and safety issues:
Such as: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.
- To do research
- To comply with the law
- To respond to organ/tissue donation requests
- To work with a medical examiner or funeral director
- To address workers’ compensation, law enforcement, and other government requests
- To respond to lawsuits and legal actions
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We much follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/
I authorize McCown Chiropractic and Massage to communicate with, send updated billings, reports, and release all medical records to insurance companies and other health care providers.
Authorization to communicate with a family member or friend
In order for our office to communicate with a family member, spouse, friend or significant other, you need to authorize the communication. This authorization may be revoked by you at any time in writing.
I authorize the doctor/staff to communicate with the following person (s):
When it comes to your health information, you have certain rights and choices.
- To share information with your family, friends or others involved in your care We never share your information for marketing purposes or sell your information.
- To get an electronic or paper copy of your medical record
- To ask us to correct your medical record
- To request confidential communication
- Ask us to limit what we share
- Get a list of those with whom we’ve shared information.
- Get a copy of this privacy notice and a more detailed official version.
- Choose someone to act for you
- File a complaint if you feel your rights are violated. www.hhs.gov/ocr/privacy/hipaa/complaints/