“On occasion, it may be necessary to seek consultation
regarding your condition from other health care providers associated
with Alden Chiropractic, Inc. or to disclose information for the
purpose of treatment such as for X-rays or laboratory work.”
“Whenever possible, and with your approval, we will
provide a substitute health care provider, authorized by Alden
Chiropractic, Inc. to provide assessment and/or treatment to our
patients in the event of your primary health care provider’s
absence due to vacation, sickness, or other emergency situation
This provider will have access to your health care information.”
Payment
We may disclose your health information to your insurance provider
for the purpose of payment or health care operations. (example)
“As a courtesy to our patients with Personal Injury
claims, we will submit an itemized billing statement to your Medpay
insurance carrier for the purpose of payment to Alden Chiropractic,
Inc. for health care services rendered. The billing statement
contains medical information, including diagnosis, date of injury
or condition, and codes which describe the health care services
received.”
Workers’ Compensation
We may disclose your health information as necessary to comply with
State Workers’ Compensation Laws and to receive payment for
treating a workers compensation injury.
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.
Marketing
We may contact you for marketing purposes or fundraising purposes,
as described below: (example)
“As a courtesy to our patients, we may call to remind
you of your appointment time. If you are not at home, we may leave
a reminder message on your answering machine or with the person
answering the phone. No personal health information will be disclosed
during this recording or message other than the date and time
of your scheduled appointment along with a request to call our
office if you need to cancel or reschedule your appointment.”
“From time to time, we may send out a newsletter or
mailing with information about our practice or health or legal
information that might be of interest to many of our patients.
It will not contain any personal health information."
Change of Ownership
In the event that Alden Chiropractic, Inc. 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 Alden Chiropractic, Inc. 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 Alden Chiropractic, Inc. amend
your protected health information. Please be advised, however,
that Alden Chiropractic, Inc. 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 Alden Chiropractic,
Inc.
- 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
Alden Chiropractic, Inc. 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, Alden Chiropractic, Inc. is required
by law to comply with this Notice.
Alden Chiropractic, Inc. 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: Robin
Barnett by calling this office at 510-286-8103. If Robin Barnett
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 Alden Chiropractic,
Inc. has handled your health information should be directed to Robin
Barnett by calling this office at 510-286-8103 If Robin Barnett
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
