Our office goal is: "better health... NATURALLY."
We seek to accomplish this through:
Chiropractic adjustments to gently remove
spinal nerve interference.
therapies, as indicated.
exercises to supplement the chiropractic adjustments
and help maintain spinal correction.
Patients come to our office who suffer from various conditions which include:
patients come for Wellness Care. Though without symptoms, they
seek to maintain their health and well-being through regular
- Car accident injuries
- Back pain
- Shoulder pain
- Carpal Tunnel
- Work-related injuries
- Neck pain
- Knee pain
- Sports-related injuries
- Hip pain
- Arm or leg pain
- Pregnancy discomforts
All patients receive:
Consultation to hear their
Examination to find the cause of
X-rays taken on premises,
Notice of Privacy Practices
April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO
THAT INFORMATION. PLEASE
REVIEW THIS NOTICE CAREFULLY.
Offices (the "Practice"), in accordance with the federal
Privacy Rule, 45 CFR parts 160 and 164 (the "Privacy Rule")
and applicable state law, is committed to maintaining the
privacy of your protected health information ("PHI").
PHI includes information about your health condition and
the care and treatment you receive from the Practice and is
often referred to as your health care or medical record.
This Notice explains how your PHI may be used and
disclosed to third parties. This Notice also details
your rights regarding your PHI.
HOW THE PRACTICE MAY
DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The Practice, in accordance with this Notice and
without asking for your express consent or authorization, may
use and disclose your PHI for the purposes of:
Treatment - To provide you with the health care you require,
the Practice may use and disclose your PHI to those health
care professionals, whether on the Practice's staff or not, so
that it may provide, coordinate, plan and manage your health
care. For example, a chiropractor treating you for lower
back pain may need to know and obtain the results of your
latest physician examination or last treatment plan.
Payment - To get paid for services provided to you, the
Practice may provide your PHI, directly or through a billing
service, to a third party who may be responsible for your
care, including insurance companies and health plans. If
necessary, the Practice may use your PHI in other collection
efforts with respect to all persons who may be liable to the
Practice for bills related to your care. For example,
the Practice may need to provide the Medicare program with
information about health care services that you received from
the Practice so that the Practice can be reimbursed. The
Practice may also need to tell your insurance plan about
treatment you are going to receive so that it can determine
whether or not it will cover the treatment expense.
Health Care Operations - To operate in accordance with
applicable law and insurance requirements, and to provide
quality and efficient care, the Practice may need to compile,
use and disclose your PHI. For example, the Practice may
use your PHI to evaluate the performance of the Practice's
personnel in providing care to you.
OTHER EXAMPLES OF
HOW THE PRACTICE MAY USE YOUR
PROTECTED HEALTH INFORMATION
(a) Advice of Appointment and Services - The Practice may,
from time to time, contact you to provide appointment
reminders or information about treatment alternatives or other
health-related benefits and services that may be of interest
to you. The following appointment reminders may be used
by the Practice: a) a postcard mailed to you at the address
provided by you; and b) telephoning your home, office, or cell
phone and leaving a message on your answering machine or with
the individual answering the phone.
Log - The Practice maintains a sign-in log at its reception
desk for individuals seeking care and treatment in the office.
The sign-in log is located in a position where staff can
readily see who is seeking care in the office. This
information may be seen by, and is accessible to, others who
are seeking care or services in the Practice's offices.
(c) Family/Friends - The Practice may disclose to a family
member, other relative, a close personal friend, or any other
person identified by you, your PHI directly relevant to such
person's involvement with your care or the payment for your
care. The Practice may also use or disclose your PHI to
notify or assist in the notification (including identifying or
locating) a family member, a personal representative, or
another person responsible for your care, of your location,
general condition or death. However, in both cases, the
following conditions will apply:
(i) If you are present at
or prior to the use or disclosure of your PHI, the Practice
may use or disclose your PHI if you agree, or if the Practice
can reasonably infer from the circumstances, based on the
exercise of its professional judgment, that you do not object
to the use or disclosure. (ii) If you are not present, the
Practice will, in the exercise of professional judgment,
determine whether the use or disclosure is in your best
interests and, if so, disclose only the PHI that is directly
relevant to the person's involvement with your care.
USE & DISCLOSURES WHICH MAY
BE PERMITTED OR REQUIRED
The Practice may also use and disclose your PHI
without your consent or authorization in the following
(a) De-identified Information - The
Practice may use and disclose health information that may be
related to your care but does not identify you and cannot be
used to identify you.
(b) Business Associate - The
Practice may use and disclose PHI to one or more of its
business associates if the Practice obtains satisfactory
written assurance, in accordance with applicable law, that the
business associate will appropriately safeguard your PHI.
A business associate is an entity that assists the
Practice in undertaking some essential function, such as a
billing company that assists the office in submitting claims
for payment to insurance companies.
Representative - The Practice may use and disclose PHI to a
person who, under applicable law, has the authority to
represent you in making decisions related to your health care.
(d) Emergency Situations - The Practice may use and
disclose PHI for the purpose of obtaining or rendering
emergency treatment to you provided that the Practice attempts
to obtain your Consent as soon as possible: The Practice
may also use and disclose PHI to a public or private entity
authorized by law or by its charter to assist in disaster
relief efforts, for the purpose of coordinating your care with
such entities in an emergency situation.
(e) Public Health
Activities - The Practice may use and disclose PHI when
required by law to provide information to a public health
authority to prevent or control disease.
Neglect or Domestic Violence - The Practice may use and
disclose PHI when authorized by law to provide information if
it believes that the disclosure is necessary to prevent
(g) Health Oversight Activities - The
Practice may use and disclose PHI when required by law to
provide information in criminal investigations, disciplinary
actions, or other activities relating to the community's
health care system.
(h) Judicial and Administrative
Proceeding - The Practice may use and disclose PHI in response
to a court order or a lawfully issued subpoena.
Law Enforcement Purposes - The Practice may use and disclose
PHI, when authorized, to a law enforcement official. For
example, your PHI may be the subject of a grand jury subpoena,
or if the Practice believes that your death was the result of
(j) Coroner or Medical Examiner -
The Practice may use and disclose PHI to a coroner or medical
examiner for the purpose of identifying you or determining
your cause of death.
(k) Organ, Eye or Tissue
Donation - The Practice may use and disclose PHI if you are an
organ donor to the entity to whom you have agreed to donate
(l) Research - The Practice may use and
disclose PHI subject to applicable legal requirements if the
Practice is involved in research activities.
Avert a Threat to Health or Safety - The Practice may use and
disclose PHI if it believes that such disclosure is necessary
to prevent or lessen a serious and imminent threat to the
health or safety of a person or the public and the disclosure
is to an individual who is reasonably able to prevent or
lessen the threat.
(n) Specialized Government Functions -
The Practice may use and disclose PHI when authorized by law
with regard to certain military and veteran activity.
Workers' Compensation - The Practice may use and disclose PHI
if you are involved in a Workers' Compensation claim to an
individual or entity that is part of the Workers' Compensation
(p) National Security and Intelligence Activities
- The Practice may use and disclose PHI to authorized
governmental officials with necessary intelligence information
for national security activities.
(q) Military and
Veterans - The Practice may use and disclose PHI if you are a
member of the armed forces, as required by the military
disclosures, other than those described above, will be made
only with your written Authorization.
You have the right to:
(a) Revoke any
Authorization or consent you have given to the Practice, at
any time. To request a revocation, you must submit a
written request to Dr. Kalb, the Practice's Privacy Officer.
(b) Request special restrictions on certain uses and
disclosures of your PHI as authorized by law. In
general, this relates to your right to request special
restrictions concerning disclosures of your PHI regarding uses
for treatment, payment and operational purposes under Privacy
Rule, Section 164.522(a) and restrictions related to
disclosures to your family and other individuals involved in
your care under Privacy Rule, Section 164.510(b). Except
in certain instances, the Practice may not be obligated to
agree to any requested restrictions. To request
restrictions, you must submit a written request to the
Practice's Privacy Officer. In your written request, you
must inform the Practice of what information you want to
limit, whether you want to limit the Practice's use or
disclosure, or both, and to whom you want the limits to apply.
If the Practice agrees to your request, the Practice
will comply with your request unless the information is needed
in order to provide you with emergency treatment.
Receive confidential communications or PHI by alternative
means or at alternative locations as provided by Privacy Rule
Section 164.522(b). For instance, you may request all
written communications to you marked "Confidential Protected
Health Information." You must make your request in
writing to the Practice's Privacy Officer. The Practice
will accommodate all reasonable requests.
(d) Inspect and
copy your PHI as provided by federal law (including Privacy
Rule, Section 164.524) and state law. To inspect and
copy your PHI, you must submit a written request to the
Practice's Privacy Officer. The Practice will charge you
a fee for the cost of copying, mailing or other supplies
associated with your request. In certain situations that
are defined by law, the Practice may deny your request, but
you will have the right to have the denial reviewed as set
forth more fully in the written denial notice.
your PHI as provided by federal law (including Privacy Rule,
Section 164.526) and state law. To request an amendment,
you must submit a written request to the Practice's Privacy
Officer. You must provide a reason that supports your
request. The Practice may deny your request if it is not
in writing, if you do not provide a reason in support of your
request, if the information to be amended was not created by
the Practice (unless the individual or entity that created the
information is no longer available), if the information is not
part of your PHI maintained by the Practice, if the
information is not part of the information you would be
permitted to inspect and copy, and/or if the information is
accurate and complete. If you disagree with the
Practice's denial, you will have the right to submit a written
statement of disagreement.
(f) Receive an accounting of
disclosures of your PHI as provided by federal law (including
Privacy Rule Section 164.528) and state law. To request
an accounting, you must submit a written request to the
Practice's Privacy Officer. The request must state a
time period, which may not be longer than six (6) years and
may not include dates before April 14, 2003. The request
should indicate in what form you want the list (such as a
paper or electronic copy). The first list you request
within a twelve (12) month period will be free, but the
Practice may charge you for the cost of providing additional
lists. The Practice will notify you of the costs
involved and you can decide to withdraw or modify your request
before any costs are incurred.
(g) Receive a paper copy of
this Privacy Notice from the Practice (as provided by Privacy
Rule Section 164.520(b)(1)(iv)(F)) upon request to the
Practice's Privacy Officer.
(h) Complain to the Practice
or to the Secretary of HHS (as provided by Privacy Rule
Section 164.520(b)(1)(vi)) if you believe your privacy rights
have been violated. To file a complaint with the
Practice, you must contact the Practice's Privacy Officer.
All complaints must be in writing.
To obtain more
information about your privacy rights or if you have questions
you want answered about your privacy rights (as provided by
Privacy Rule Section 164.520(b)(2)(vii)), you may ask the
Practice's Privacy Officer.
(a) Is required by federal law to
maintain the privacy of your PHI and to provide you with this
Privacy Notice detailing the Practice's legal duties and
privacy practices with respect to your PHI. (b)
Under the Privacy Rule, may be required by State law to grant
greater access or maintain greater restrictions on the use or
release of your PHI than that which is provided for under
(c) Is required to abide by the terms
of this Privacy Notice.
(d) Reserves the right to change
the terms of this Privacy Notice and to make the new Privacy
Notice provisions effective for all of your PHI that it
(e) Will inform you of any revised Privacy
Notice when you come into our office.
(f) Will not
retaliate against you for filing a complaint.
This Notice is in effect as of 04/14/2003.