Privacy Policy

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.

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR PRIVACY OFFICER.

This Notice of Privacy Practices describes how

Willis ChiroMed

Herein after referred to as the Clinic, 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” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

The Clinic and all clinic personnel are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of our notice, at any time.  The new notice will be effective for all protected health information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy Practices.  You may request a revised version by accessing our website, or calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

The Clinic is required by law to maintain the privacy and security of your protected health information.  We will let you know promptly if a reportable breach occurs that may have compromised the privacy or security of your information.  A breach will be considered reportable unless, after analyzing the situation, it is determined that there is a low probability of protected health information compromise.  We must follow the duties and privacy practices  described in this notice and give you a copy of it if you request it.  We will not use or share your information other than as described herein unless you tell us we can in writing.  If you tell us that we can disclose your information, you can change your mind, but must inform us in writing.  For more information, go to:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office who 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 pay your health care bills and to support the operation of your physician’s practice.

Following are examples of the types of used and disclosures or your protected health information that the Clinic is permitted to make.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment:  We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with another provider.  For example, we would disclose your protected health information, as necessary, to the primary care physician that provides care to you.  We will also disclose protected health information to other physicians who may be treating you.  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 your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

Payment:  Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider.  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.  For example, obtaining approval for a diagnostic test, such as a MRI, may require that your relevant protected health information be disclosed to the health plan to obtain approval for the MRI to be performed.

Health Care Operations:  We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of chiropractic students, licensing, and conducting or arranging for other business activities.

We will share your protected health information with third party “business associates” that perform various activities (for example, billing or transcription services) for our practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Should you die, we may make relevant disclosures to your family and friends, provided these individuals were involved in providing care or payment for care and we were not aware of any expressed preference to the contrary (i.e. you had not put a restriction on these individuals prior to your death).

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.  You may contact our Privacy Officer to request that these materials not be sent to you.

We may use or disclose your demographic information and the dates that you received treatment from your physician, as necessary, in order to contact you for fundraising activities supported by our office.  If you do not want to receive these materials, please contact our Privacy Officer and request that these fundraising materials not be sent to you.

We will never share your information for marketing purposes or sell your information, unless you give us written permission to do so.

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Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Agree or Object

We may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object.  These situations include:

REQUIRED BY LAW:  WE MAY USE OF DISCLOSE YOUR PROTECTED HEALTH INFORMATION TO THE EXTENT THAT THE USE OR DISCLOSURE 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, IF REQUIRED BY LAW, OF ANY SUCH USES OR DISCLOSURES.

PUBLIC HEALTH:  WE MAY DISCLOSE YOUR PROTECTED HEALTH INFORAMTION FOR PUBLIC HEALTH ACTIVITES AND PURPOSES TO A PUBLIC HEALTH AUTHORITY THAT IS PERMITTED BY LAW TO COLLECT OR RECEIVE THE INFORMATION.  FOR EXAMPLE, A DISCLOSURE MAY BE MADE FOR THE PURPOSE OF PREVENTING OR CONTROLLING DISEASE, INJURY OR DISABILITY.

COMMUNICABLE DISEASE:  WE MAY DISCLOSE YOUR PROTECTED HEALTH INFORMATION, 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 INFORAMTION TO A HEALTH OVERSIGHT AGENCY FOR ACTIVITIES AUTHORIZES BY LAW, SUCH AS AUDITS, INVESTIGATIONS, AND INSPECTIONS.  OVERSIGHT AGENCIES SEEKING THIS INFORMATION INCLUDE GOVERNMENT 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 PROTECTED HEALTH INFORMATION 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 YOU HAVE BEEN A VICTIM OF ABUSE, NEGLECT OR DOMESTIV VIIOLENCE 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 PROTECTED HEALTH INFORAMTION TO A PERSON OR COMPANY REQUIRED BY THE FOOD AND DRUG ADMINISTRATION FOR THE PURPOSE OF QUALITY, SAFETY, OR EFFECTIVENESS OF FDA-DEFECTS OR PROBLEMS, BIOLOGIC PRODUCT DEVIATIONS, TO TRACK PRODUCTS; TO ENABLE PRODUCT RECALLS; TO MAKE REPAIRS OR REPLACEMENTS, OR TO CONDUCT POST MARKETING SURVEILLANCE, AS REQUIRED.

LEGAL PROCEEDINGS:  WE MAY DISCLOSE PROTECTED HEALTH INFORAMTION 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), OR IN CERTAIN CONDITIONS IN RESPONSE TO A SUBPOENA, DISCOVERY REQUEST OR LAWFUL PROCESS.

LAW ENFORCEMENT:  WE MAY ALSO DISCLSOE PROTECTED HEALTH INFORMATION, SO LONG AS APPLICABLE LEGAL REQUIREMTNS ARE MET, FOR LAW ENFORCEMENT PURPOSES.  THE LAW ENFORCEMENT PURPOSES INCLUDE (1) ELGAL PROCESSES AND OTHERWISE REQUIRED BY LAW, (2) LIMITED INFORMATION REQUEST FOR IDENTIFICATION AND LOCATION PURPOSES, (3) PERTAINIG TO VICTIMES OF A CRIME, (4) SUSPICION THAT DEATH HAS OCCURRED AS A RESULT OF CRIMINAL CONDUCT, (5) IN THE EVENT THAT A CRIME OCCURS ON THE PREMISES OF OUR PRACTICE, AND (6) MEDICAL EMERGENCY (NOT ON OUR PRACTICE’S PREMISES) AND IT IS LIKELY THAT CRIME HAS OCCURRED.

CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATION:  WE MAY DISCLOSE PROTECTED HEATLH INFORMATION TO A CORONER OR MEDICAL EXAMINER FOR IDENTIFICATION PURPOSES, DETERMING CAUSE OF DEATH OR FOR THE CORONER OR MEDICAL EXAMINER TO PERFORM OTHER DUTIES AUTHORIZED BY LAW.  WE MAY ALSO DISCLOSE PROTECTED HEALTH INFORMATION TO A FUNERAL DIRECTOR, AS AUTHORIZED BY LAW, IN ORDER TO PERMIT THE FUNERAL DIRECTOR TO CARRY OUT THEIR DUTIES.  WE MAY DISCLOSE SUCH INFORMATION IN REASONABLE ANTICIPATION OF DEATH.  PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED FOR CADAVERIC ORGAN, EYE OR TISSUE DONATION PURPOSES.

RESEARCH:  WE MAY DISCLOSE YOUR PROTECTED HEALTH INFORMATION TO TRESEARCHERS WHEN THEIR RESEARCH HAS BEEN APPROVED BY AN INSTITUTIONAL REVIEW BOARD THAT HAS REVIEWED THE RESEARCH PROPOSAL AND ESTABLISHED PROTOCOLS TO ENSURE THE PRIVACY OF YOUR PROTECTED HEALTH INFORMATION.

CRIMINAL ACTIVITY:  CONSISTENT WITH APPLICABLE FEDERAL AND STATE LAWS, WE MAY DISCLOSE YOUR PROTECTED HEALTH INFORMATION, IF WE BELIEVE THAT THE USE OR DISCLOSURE IS NECESSARY TO PREVENT OR LESSEN A SERIOUS AND IMMINENT THREAT TO THE HEALTH OR SAFETY OF A PERSON OR THE PUBLIC.  WE MAY ALSO DISCLOSE PROTECTED HEALTH INFORAMTION IF IT IS NECESSARY FOR LAW ENFORCEMENT AUTHORITIES TO IDENTIFY OR APPREHEND AN INDIVIDUAL.

MILITARY ACTIVITY AND NATIONAL SECURITY:  WHEN THE APPROPRIATE CONDITIONS APPLY, WE MAY USE OR DISCLOSE PROTECTED HEALTH INFORMATION OF INDIVIDUALS WHO ARE ARMED FORCES PERSONNEL (1) FOR ACTIVITIES DEEMED NECESSARY BY APPROPRIATE  MILITARY COMMAND AUTHORITIES; (2) FOR THE PURPOSE OF A DETERMINATION BY THE DEPARTMENT OF VETERANS AFFAIRS OF YOUR ELIGIBILITY FOR BENEFITS, OR (3) TO FOREIGN MILITARY AUTHORITY IF YOU ARE A MEMBER OF THAT FOREIGN MILITARY SERVICES.  WE MAY ALSO DISCLOSE YOUR PROTECTED HEALTH INFORMATION TO AUTHORIZED FEDERAL OFFICIALS FOR CONDUCTING NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES, INCLUDING FOR THE PROVISION OF PROTECTIVE SERVICES TO THE PRESIDENT OR OTHERS LEGALLY AUTHORIZED.

WORKERS’ COMPENSATION:  WE MAY DISCLOSE YOUR PROTECTED HEALTH INFORAMTION AS AUTHORIZED TO COMPLY WITH WORKERS’ COMPENSATION LAWS AND OTHER SIMILAR LEGALLY-ESTABLISHED PROGRAMS.

INMATES:  WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION IF YOU ARE AN INMATE OF A CORRECTIONAL FACILITY AND YOUR PHYSICIAN CREATED OR RECEIVED YOUR PROTECTED HEALTH INFORMATION IN THE COURSE OF PROVIDING CARE TO YOU.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made ONLY with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke this authorization in writing at any time.  If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures already made with your authorization. This would include disclosing information to family and friends.

Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object

We may use and disclose your protected health information in the following instances.  You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest.

OTHERS INVOLVED IN YOUR HEALTH CARE OR PAYMENT FOR YOUR CARE:  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 INVOLOVEMENT IN YOUR HEALTH CARE.  IF YOU ARE UNABLE TO AGREE OR OBJECT TO SUCH A DISCLOSURE, WE MAY DISLCOSE SUCH INFORMATION AS NECESSARY IF WE DETERMINE THAT IT IS IN YOUR BEST INTEREST BASED ON OUR PROFESSIONAL JUDGMENT.  WE MAY USE OR DISCLOSE 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 PROTECTED HEALTH INFORMATION 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.

Uses and Disclosures of Protected Health Information Relative to Reproductive Healthcare

As per the updated Privacy Rule as given by the OCR, medical records potentially related to reproductive health care will NOT be disclosed when it is sought to investigate or impose liability on individuals, providers, or others who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which such health care is provide, or to identify persons for such activities.

When we receive a request for protected health information (PHI) potentially related to reproductive health care, we must obtain a signed attestation that clearly states the requested use or disclosure is not for the prohibited purposes described below, where the request is for PHI for any of the following purposes: Health oversight activities, Judicial or administrative proceedings, Law enforcement, and Regarding decedents, disclosures to coroners and medical examiners.

Prohibited Purposes: We may not use or disclose PHI for the following purposes:

(1) To conduct a criminal, civil, or administrative investigation into any person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care.

(2) To impose criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care.

(3) To identify any person for any purpose described in (1) or (2).

The prohibition applies when the reproductive health care at issue (1) is lawful under the law of the state in which such health care is provided under the circumstances in which it is provided, (2) is protected, required, or authorized by Federal law, including the United States Constitution, under the circumstances in which such health care is provided, regardless of the state in which it is provided, or (3) is provided by another person and presumed lawful.

We will not rely on the attestation to disclose the requested PHI if any of the following is true:

• It is missing any required element or statement or contains other content that is not required
• It is combined with other documents, except for documents provided to support the attestation.
• We know that material information in the attestation is false.
• A reasonable covered entity or business associate in the same position would not believe the requestor’s statement that the use or disclosure is not for a prohibited purpose as described above.

If we later discover information that reasonably shows that any representation made in the attestation is materially false, leading to a use or disclosure for a prohibited purpose as described above, we will stop making the requested use or disclosure. We will not make a disclosure if the reproductive health care was provided by a person other than ourselves and the requestor indicates that the PHI requested is for a prohibited purpose as described above, unless the requestor supplies information that demonstrates a substantial factual basis that the reproductive health care was not lawful under the specific circumstances in which it was provided.

Once the clinic’s attestation form has been completed in its entirety and has been reviewed by the office manager or clinic director, the form will be scanned into the patient’s record.  New attestations will be required for each specific use or disclosure request.

2. YOUR RIGHTS

Following is a statement of your rights with respect to your protected health information 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 protected health information about you for so long as we maintain the protected health information.  We will provide this usually within 30 days of your request.  You may obtain your medical record that contains medical and billing records and any other records that your physician and the practice uses for making decisions about you.  You may receive these records in electronic format or hard copies.  Should you request your records to be emailed to you, it will not be sent unencrypted unless you are made aware of such and still request that form of transmission.  As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records.

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 laboratory results that are subject to law that prohibits access to protected health information.  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 Privacy Officer if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or health care operations.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request.  If your physician does agree to the requested restriction, we may not use or disclose your protected health information 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 your physician.  You may request a restriction by completing the Patient Request for Special Confidential Communication Procedures Form.

ONLY if you pay for a service or health care item out-of-pocket, in full, at the time of service, can we comply with your request not to share that information for the purpose of payment or our operations with your health insurer (i.e. – comply with your request not to file your claims to your insurance company). Otherwise, we will comply with your request, unless a law requires us to  share that information.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  We will accommodate reasonable requests.  We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.  We will not request an explanation from you as to the basis for the request.  Please make this request in writing to our Privacy Officer.

You may have the right to have your physician amend your protected health information.  This means you request an amendment of protected health information about you in a designated record set for so long as we maintain this information.  In certain cases, we may deny your request for an amendment.  If we deny your request for amendment, we will tell you why in writing within 60 days.  If this occurs, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and we will provide you with a copy of any such rebuttal.  Please contact our Privacy Officer if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.  You can ask for a list of times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.  This right applies to disclosures for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices.  It excludes disclosures we may have made to you if you authorized us to make the disclosure, for a facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure.  You have the right to receive specific information regarding these disclosures that occur after April 14, 2003.  The right to receive this information is subject to certain exceptions, restrictions, and limitations.  We’ll provide one accounting a year for free but we will charge a reasonable fee is you ask for another within 12 months.

You have the right to choose someone to act for you.  If you have given someone medial power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.  We will make sure the person that has this authority and can act for you before we take action.

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 electronically.

3. Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You can do so by sending a letter to the US Department of Health and Human Services Office for Civil Rights at 200 Independence Ave.S. W., Washington, D.C.; 20201, or calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.  You may file a complaint with us by notifying our Privacy Officer of your complaint.  We will not retaliate against you for filing a complaint.

You may contact our Privacy officer, at the office phone number found on this website for further information about the complaint process.

This notice was published and becomes effective on this date: 12/20/2024.