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.
Kenny Chiropractic Health Center is required, by law, to maintain the privacy
and confidentiality of your protected health information and to provide our patients
with notice of our legal duties and
privacy practices with respect
Disclosure of Your Health Care Information
Treatment
We may disclose your health care
information to other healthcare professionals within our practice for the
purpose of treatment, payment or healthcare operations. (example)
“On occasion, it may be
necessary to seek consultation regarding your condition from other health care
providers associated with
Kenny Chiropractic Health Center.”
“It is our policy to provide a
substitute health care provider, authorized by Kenny Chiropractic Health Center
to provide assessment
and/or treatment to our patients, without advanced notice, in the event of our primary health care
provider’s
Payment
We may disclose your health
information to your insurance provider for the purpose of payment or health
Workers’ Compensation
We may disclose your health
information as necessary to comply with State Workers’ Compensation Laws.
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.
Change of Ownership.
In the event that Kenny Chiropractic Health Center 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, how ever, that Kenny
Chiropractic Health Center 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 alter native 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
Kenny Chiropractic Health Center amend your protected health information.
Please be advised, however, that Kenny Chiropractic Health Center 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
Kenny Chiropractic Health Center.
· 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
Kenny Chiropractic Health Center
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, Kenny Chiropractic Health
Center is required by law to comply with
this Notice.
Kenny Chiropractic Health Center 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:
Dr. D. G. Kenny by calling this
office at 920.487.3832.
If Dr. D. G. Kenny 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 Kenny Chiropractic Health Center has handled your health
information
should be directed to Dr. D. G. Kenny, by
calling this office at 920.487.3832 If Dr. D. G. Kenny 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
(920)487-3832