Duininck Chiropractic, P.A.
HIPAA Privacy Notice
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.
To provide you with quality care and to comply with federal HIPAA regulations, we create a record of care and services provided to you in this office. The privacy of your medical information is important to us. We understand that your medical information is personal, and it should be protected.
HIPAA law requires us to keep all of your medical information private and make available to you, the patient, information regarding your rights, your medical information and our legal duties and privacy practices.
The information below describes how medical information about you may be used and disclosed, and how you can get access to this information.
Use and Disclosure of Your Medical Information
We may use and disclose your medical records only for treatment, payment and health care operations.
- Treatment: We may use your medical information to provide you with medical treatment or services. This means we may disclose medical information about you to doctors, technicians, or other health care providers who are treating you.
(Example: Areas adjusted and possible therapies used.)
- Payment: We may disclose your medical information to obtain reimbursement for services, to confirm coverage and for billing and collection activities.
(Example: Sending a bill to your insurance company for reimbursement.)
- Health care operations: We may use and disclose your medical information for our health care operations. This may include conducting programs for training, employee evaluations, auditing functions, measuring and improving quality and getting licenses, certificates and credentials we need to serve you.
(Example: Internal quality assessment review.)
Other Office Practices
This office may contact you to provide information on treatment alternatives or other health related information or to inform you of requested information or products. The following communications are used by the practice:
- Telephoning your home, work, or contact person and leaving a message on your answering machine or with the individual answering the phone.
- Newsletters or health related articles, with health information we believe to be valuable to you, may be sent as requested.
- Ordinary practice related information may be communicated to you by any physical or electronic method that may be available and deemed reasonable and appropriate by the compliance officer.
Facsimile, E-mail, and other electronic transmissions
This office may transmit information about you to insurers, other health care professionals and providers, and appropriate governmental agencies utilizing facsimile transmissions, e-mail or other electronic means.
All other disclosures will be made only with your written authorization and you may revoke that authorization at any time.
Your Individual Rights
You have the following rights with respect to your personal information, which you can exercise by presenting our office with a written request:
- The right to request restrictions on certain uses and disclosures of your protected health information. We are not, however, required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
- The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an accounting of the disclosures of your protected health information made by this office.
Our Duties
Duininck Chiropractic, PA is required by law to maintain the privacy of your protected health information. We are also required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of the notice and to make the new notice provisions effective for all protected health information that we maintain. The most current policy will be available upon request as well as posted in our offices.
Questions & Complaints
You have recourse if you feel that your privacy protections have been violated. If you have a complaint you can contact our privacy officer, Heather Preble, at 320-235-6320 or by mail at Duininck Chiropractic, P.A., 1550 Willmar Ave. SE, Suite B, Willmar, MN 56201. You may also contact the Office of Civil Rights. The website is www.hhs.gov/ocr. The e-mail address is OCRComplaint@hhs.gov. This regions mailing address is: Celeste Davis, Acting Regional Manager, Office for Civil Rights, US Department of Health and Human Services, 233 N Michigan Ave Ste 240, Chicago, IL 60601 and the telephone number to the regional office is 312-886-2359. Complaints must be filed within 180 days of the occurrence of the violation.
Revised 11/30/11
