Legal

HIPAA 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.

Effective date: [DATE PLACEHOLDER]

Snohomish Chiropractic & Nutrition is required by law to protect the privacy of your health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. This notice applies to our practice because we electronically transmit health information in connection with insurance claims and related transactions, which makes us a covered entity under the Health Insurance Portability and Accountability Act (HIPAA).

How we may use and disclose your health information

We may use and share your protected health information for the following purposes without your separate written authorization:

• Treatment. We use your health information to provide and coordinate your care — for example, evaluating your condition, planning care, and consulting with or referring you to other providers involved in your treatment.
• Payment. We use and disclose your health information to bill and receive payment for the care we provide — for example, submitting claims to your health plan, auto-injury (PIP), or workers’ compensation carrier, and verifying coverage.
• Health care operations. We use your health information to run our practice — for example, quality review, staff training, scheduling, and general administration.

Other uses and disclosures permitted or required by law

In certain situations we may use or disclose your health information as permitted or required by law — for example, for public health activities, to report suspected abuse or neglect, for health oversight activities, in response to a court order or lawful legal process, to avert a serious threat to health or safety, for workers’ compensation as authorized by law, or for law enforcement purposes. We may also remind you of appointments or tell you about treatment options and health-related services.

Uses and disclosures that require your authorization

Most uses and disclosures not described in this notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes (if any), uses and disclosures for marketing, and any sale of your health information. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

You have the following rights regarding your health information:

• Access. You may inspect and request a copy of your health and billing records, in a paper or electronic format where readily producible.
• Amendment. You may ask us to correct information you believe is incorrect or incomplete.
• Accounting of disclosures. You may request a list of certain disclosures we have made of your health information.
• Restrictions. You may ask us to limit how we use or disclose your health information. We will consider your request but are not required to agree, except for a disclosure to a health plan for a service you paid for in full out of pocket.
• Confidential communications. You may ask us to contact you a certain way or at a certain location.
• Paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Breach notification. You have the right to be notified if a breach of your unsecured health information occurs.

To exercise any of these rights, please submit your request to our office in writing using the contact information below.

Our responsibilities

We are required by law to maintain the privacy and security of your protected health information, to notify you following a breach of unsecured protected health information, and to follow the terms of the notice currently in effect. We reserve the right to change this notice and to make the revised notice effective for information we already have as well as information we receive in the future. A current copy will be posted in our office and, where applicable, on this website.

How to file a complaint

If you believe your privacy rights have been violated, you may file a complaint with our office using the contact information below, or with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

U.S. Department of Health and Human Services, Office for Civil Rights (OCR)
200 Independence Avenue, SW, Washington, D.C. 20201
Toll-free: 1-877-696-6775
Online: www.hhs.gov/ocr

Contact us

For questions about this notice or to exercise any of your rights, please contact our Privacy Officer:

Snohomish Chiropractic & Nutrition
Dr. Andy Marrone, D.C.
1405 Avenue D, Snohomish, WA 98290
Phone: (360) 863-3949