HAMADANCHI CHIROPRACTIC CLINIC and HOLISTIC HEALTH
Patient privacy and health information protection notice
HAMADANCHI CHIROPRACTIC CLINIC
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.
If you have any questions about this Notice please contact: our Privacy Contact
who is CAROL MORGAN
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" 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 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 by accessing our website
www.chiromi.com/hamadanchi.htm
, 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.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based Upon Your Written
Consent
You will be asked by your physician 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, your
physician will use or disclose your protected health information as described in
this Section 1. Your protected health information may be used and disclosed by
your physician, our office staff and others outside of our office 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 pay your health care bills and to support the operation of the
physician's practice.
Following are examples of the types of uses and disclosures of your
protected health care information that the physician's office is permitted to
make once you have signed our consent form. These examples are not meant to be
exhaustive, but to describe the types of uses and disclosures that may be made
by our office once you have provided consent.
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
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 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,
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. For example, obtaining approval for a hospital
stay may require that your relevant protected health information be disclosed to
the health plan to obtain approval for the hospital admission.
Healthcare 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 medical
students, licensing, marketing and fundraising activities, and conducting or
arranging for other business activities.
For example, we may disclose your protected health information to medical
school students that see patients at our office. In addition, we may use a
sign-in sheet at the registration desk where you will be asked to sign your name
and indicate your physician. We may also call you by name in the waiting room
when your 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
appointment.
We will share your protected health information with third party "business
associates" that perform various activities (e.g., billing, transcription
services) for the 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.
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 protected health information for other marketing
activities. For example, your name and address may be used to send you a
newsletter about our practice and the services we offer. We may also send you
information about products or services that we believe may be beneficial to you.
You may contact our Privacy Contact 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 Contact and request that
these fundraising materials not be sent 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, at any
time, in writing, except to the extent that your physician or the physician's
practice has taken an action in reliance on the use or disclosure indicated in
the authorization.
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 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. In this case, only
the protected health information that is relevant to your health care will be
disclosed.
Facility Directories: Unless you object, we will use and
disclose in our facility directory your name, the location at which you are
receiving care, your condition (in general terms), and your religious
affiliation. All of this information, except religious affiliation, will be
disclosed to people that ask for you by name. Members of the clergy will be told
your religious affiliation.
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 a disclosure, we may disclose 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.
Emergencies: We may use or disclose your protected health information in an
emergency treatment situation. If this happens, your physician shall try to
obtain your consent as soon as reasonably practicable after the delivery of
treatment. If your physician or another physician in the practice is required by
law to treat you and the physician has attempted to obtain your consent but is
unable to obtain your consent, he or she may still use or disclose your
protected health information to treat you.
Communication Barriers: We may use and disclose your protected health
information if your physician or another physician in the practice attempts to
obtain consent from you but is 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.
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 protected health information in the
following situations without your consent or authorization. These situations
include:
Required By Law: We may use or 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, as required by law, of any such
uses or disclosures.
Public Health: We may disclose your protected health information for public
health 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
protected health information, if directed by the public health authority, to a
foreign government agency that is collaborating with the public health
authority.
Communicable Diseases: 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 information
to a health oversight agency for activities authorized 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 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
protected health information to a person or company required by the Food and
Drug Administration to report adverse events, product defects 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 protected health
information 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 protected health
information, 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 the premises of the practice, and (6) medical
emergency (not on the Practice's premises) and it is likely that a crime has
occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose
protected health information 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 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 researchers 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 information 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: Your protected health information
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 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.
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 or determine our compliance with the requirements of
Section 164.500 et. seq.
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 that is contained in a designated record set for as long as we maintain the
protected health information. A "designated record set" contains medical and
billing records and any other records that your physician and the practice uses
for making decisions about you.
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 protected
health information that is subject to law that prohibits access to protected
health information. Depending on the circumstances, a decision to deny access
may be reviewed. In some circumstances, you may have a right to have this
decision reviewed. Please contact our Privacy Contact 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
healthcare 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 physician believes it is in your best interest to permit use and disclosure
of your protected health information, your protected health information will not
be restricted. 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 writing to our compliance officer, and
instructing your wishes.
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 Contact.
You may have the right to have your physician amend your protected health
information. This means you may request an amendment of protected health
information 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. Please contact our Privacy Contact
to determine 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. 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 have the right to
receive specific information regarding these disclosures that occurred after
April 14, 2003. You may request a shorter timeframe. 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 electronically. your
privacy rights have been violated by us. You may file a complaint with us by
notifying our privacy contact of your complaint. We will not retaliate against
you for filing a complaint.
You may contact our Privacy Contact, CAROL MORGA at (269)-983-2221 or
hamchiro2@aol.com for further
information about the complaint process.
3. Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your rights have been violated by us.
You may file a complaint with us by notifying our privacy contact of your complaint.
We will not retaliate against you for filing a complaint ,you may contact our privacy contact officer CAROL MORGA at (269)-983-2221.
This notice was published and becomes effective on JANUARY 31TH,2003
Hamadanchi Chiropractic Clinic
2914 Division 
St. Joseph, Michigan 49085
(269) 983-2221 Fax (269)
983-2245
E-mail:
hamchiro@sbcglobal.net
Last updated: June 25, 2008
S
ite created by Sue Quinn Palin