Privacy Policy

HIPAA/Patient Health Information Consent

We want you to know how your Patient Health Information (PHI) is going to be used in this office and your rights concerning those records. Before we will begin any health care operations we must require you to read and sign this consent form stating that you understand and agree with how your records will be used.

  1.  The patient understands and agrees to allow the chiropractic office to use their Patient Health Information (PHI) for the purpose of treatment, payment, healthcare operations, and coordination of care. As an example, the patient agrees to allow this chiropractic office to submit requested PHI to the Health Insurance Company (or companies) provided to us by the patient for purpose of
    payment. Be assured that this office will limit the release of all PHI to the minimum needed for
    what the insurance company requires for payment.
  2. The patient has the right to examine and obtain a copy of his or her health records at any time and request corrections. The patient may request to know what disclosures have been made and submit in writing any further restrictions on the use of their PHI. Our office is not obligated to agree to those restrictions.
  3. A patient’s written consent need only be obtained one time for all subsequent care given to the patient in this office.
  4. The patient may provide a written request to revoke consent at any time during care. This would no effect the use of those records for the care given prior to the written request to revoke consent but would apply to any care after the request has been presented.
  5. For your security and right to privacy, all staff has been trained in the area of patient record privacy and a privacy official has been designated to enforce those procedures in our office. We have taken all precautions that are known by this office to assure that your records are not readily available to those that do not need them.
  6. Patients have the right to file a formal complaint with our privacy official about any possible violations of these policies and procedures.
  7. If the patient refuses to sign this consent for the purpose of treatment, payment, and health care operations, the chiropractic physician has the right to refuse to give care.
  8. We have an open front desk and all of our financial arrangements are discussed at the front counter. If you feel that you need a more private place to discuss your financial arrangements we can always move to a private room. Please notify the office staff if any arrangements need to be made.