Terms of Use, Privacy and Copyright notices

DUBNER FAMILY CHIROPRACTIC CENTER
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.

Dubner Family Chiropractic 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 to your protected health information. Dubner Family Chiropractic Center will make every effort possible to protect the privacy and confidentiality of all health information of its patients against inappropriate or unauthorized use and disclosures as required by law.

Disclosure of Your Health Care Information

Treatment
We may disclose your health care information to other healthcare professionals for the purpose of referral, consultation, coordination of health care, 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 Dubner Family Chiropractic Center.”

“It is our policy to provide a substitute health care provider, authorized by Dubner Family Chiropractic Center to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”

Payment
We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (example)

“As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Dubner Family Chiropractic Center for health care services rendered. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.”

Other Third Party Disclosures
Third party uses and disclosures other then for purposes of treatment, payment, or health care operations will be made only with the patients written authorization and may be revoked by the patient as provided by law.

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.

Government Agencies
We may disclose your health information if we are ordered by the courts or another appropriate agency.

Ongoing Treatment.
Patient histories, examinations and reports of findings are always done in a private room behind a closed door.

This office provides ongoing treatment in an “open-door” and/or “open adjusting” environment. An “open-door” approach involves the doctor moving from patient care area to patient care area leaving the doors between care areas open. An “open-adjusting” environment involves several patients being seen in the same adjusting room at the same time. Patients are within sight of each other and some ongoing routine details of care are discussed within earshot of other patients and staff. The use of this format is intended to make your experience with our office more efficient and productive as well as to enhance your access to quality health care and health information. These environments are used for ongoing care and are NOT the environments used for taking patient histories, performing examinations or presenting reports of findings. These procedures are completed in a private, confidential setting.

Phone and/or Mail Contact
We may contact you at times by phone, mail, or e-mail as described below:
“As a courtesy to our patients, at times we may call you on the evening prior to your scheduled appointment to remind you of your appointment time or as a follow up to missed appointments.. If we can’t reach you in person, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.”

“As a benefit to our patients, we may also periodically be sending you written information via mail such as newsletters, birthday and seasonal greetings, recall notices, and other correspondence.”

Change of Ownership.
In the event that Dubner Family Chiropractic 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, however, that Dubner Family Chiropractic 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 alternative 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 Dubner Family Chiropractic Center amend your protected health information. Please be advised, however, that Dubner Family Chiropractic 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 Dubner Family Chiropractic 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
Dubner Family Chiropractic 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, Dubner Family Chiropractic Center is required by law to comply with this Notice.

Dubner Family Chiropractic 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. Allen Dubner, DC by calling this office at 408-996-1042. If Dr. Allen Dubner, DC 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 Dubner Family Chiropractic Center has handled your health information should be directed to Dr. Allen Dubner, DC by calling this office at 408-996-1042 If Dr. Allen Dubner, DC 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

 

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