Andrea A. Flores DC, LLC

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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. PLEASE REVIEW IT CAREFULLY.

 

YOU WILL BE ASKED TO SIGN A STATEMENT ON YOUR FIRST VISIT ACKNOWLEDGING THAT YOU HAVE READ THIS NOTICE. YOU MAY REQUEST A COPY OF THIS NOTICE FROM A STAFF MEMBER OR THE PHYSICIAN AT ANY TIME.

 

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. “Protected Health Information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change or revise the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices when you call the office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.

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1. Uses and disclosures of Protected Health Information Based upon your Written Consent

You will be asked to sign a consent form. Once you have consented to use and disclosure of your Protected Health Information for treatment, payment and health care operations by signing the consent form, the clinic will use or disclose your Protected Health Information as described in Section 1 of this document. Your Protected Health Information may be used and disclosed by the employees and others that are involved in your care and treatment for the purpose of providing health care services to you. Your Protected Health Information may also be used and disclosed to seek payment of your health care bills.

Following are examples of the types of uses and disclosures of your protected health information that the clinic is permitted to make once you have signed the consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by the clinic once you have provided consent.

 

Treatment: We will use and disclose your Protected Health Information to provide, coordinate, or management of your health care with a third party that has already obtained your permission to have access to your Protected Health Information. For example, we would disclose your Protected Health Information, as necessary, to a home health agency that provides care to you. We will also disclose Protected Health Information to other physicians who may be treating you when we have the necessary permission from you to disclose your Protected Health Information. For example, your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your Protected Health Information from time-to-time to another physician or health care provider (e.g.: a specialist or laboratory) who, at the request of this physician, is involved in your care.

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Payment: Your Protected Health Information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

 

Healthcare Operations: We may use or disclose, as needed, your Protected Health Information in order to support the business activities of this Clinic. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, marketing, and fundraising activities, and conducting of arranging for other business activities. For Example, we may disclose the sign-in sheet at the front desk where you will be asked to sign your name. We may also call you by name in the waiting room when the physician is ready to see you. We may use or disclose your Protected Health Information, as necessary, to contact you to remind you of your future appointments. We may use or disclose your Protected Health Information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI for other marketing activities (e.g.: address will be used to mail newsletters about the clinic and services we offer). You may contact the Front Desk Manager to request that these materials not be sent to you.

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Uses and Disclosures of Protected Health Information Based upon your Written Authorization:

Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization at any time, in writing.

 

Other Permitted and Required Uses and disclosures that may be made with your consent, authorization or Opportunity to object: We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then the physician, using professional judgment, determines whether the disclosure is in your best interest. In this case, only the Protected Health Information that is relevant to your health care will be disclosed.

 

Others involved in your healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We use or disclose your Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.  Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

 

Research:  Under certain circumstances, we may use and disclose Health Information for research.  For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition.  Before we use or disclose Health Information for research, the project will go through a special approval process.  Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information

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Emergencies:  We may use or disclose your Protected Health Information in an emergency treatment situation. If this happens the physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If we have attempted to obtain your consent but are unable to obtain your consent, we may still use or disclose your PHI to treat you.

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Communication Barriers: We may use and disclose your PHI if we attempt to obtain consent from you are unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.

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Other permitted and Required uses and disclosures that may be made without your consent, authorization or opportunity to object: We may use or disclose your PHI in the following situations without your consent or authorization. 

These situations include:

• Required by law: We may use or disclose your PHI Information to the extent that the use or disclosures is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses and disclosures.

• Public Health: We may disclose your PHI for public activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, or a foreign government agency that is collaborating with the public health authority.

• Communicable Disease: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

• Health Oversight: we may disclose Protected Health Information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government’s agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

• Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your Protected Health Information if we believe that your have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

• Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defect or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

• Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

• Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on clinic premises, and (6) medical emergency.

• Coroners, Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties.

• Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces Personnel (1) for activities deemed necessary nu appropriate military command authorities; (2) for the purpose of a determination by the Departments of Veterans affairs of your eligibility for benefits, or (3) to a foreign military if you are a member of a foreign military service. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the present or others legally authorized.

• Workers Compensations: Your PHI may be disclosed by us as authorized to comply with workers compensation laws and other similar legally established programs

• Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and the physician received your PHI in the course of providing care to you.

• Required uses and disclosures: Under the law, we must make disclosures to you and when required by the secretary of the Department of Health and Human Services to investigate our compliance with the requirements.

 

1. Your Rights

The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights. You have the right to inspect and copy your Protected Health Information. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that the clinic and its physicians use for making decisions about you.

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Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our office manager if you have questions about access to your medical record.

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You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for requested and to whom you want the restriction to apply.

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This clinic is not required to agree to a restriction that you may request. If the physician believes it is in your best interest to permit use and disclosure of your Protected Health Information, your PHI will not be restricted. If the Physician does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind please discuss any restriction you wish to request with the physician. You may request by asking for a form.

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You have the right to request to receive confidential communications from us by alternative means or at any alternative location. We will accommodate reasonable requests.

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You have the right to have the physician amend your Protected Health Information. This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. 

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You have the right to receive an accounting of certain disclosures we have made, if any of your Protected Health Information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations, as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice by reading it where it is posted or by receiving it electronically.

 

Effective Date

This Notice is in Effect as of 10/12/2013.

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