Privacy Statement
Uses and Disclosures
Our Privacy Pledge
We have and always will respect your privacy. Other than the uses and disclosures we describe below, we will not sell or provide any of your health information to any outside marketing organization.
Here are some examples of how we might have to use or disclose your health care information:
- Your chiropractor or a staff member may have to disclose your health information including all of your clinical records to another healthcare provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.
- Our insurance and billing staff may have to disclose your examination and treatment records and your billing records to another party, such as an insurance carrier, an HMO, a PPO, or your employer, if they are potentially responsible for the payment of your services.
- Your chiropractor and members of the staff may need to use your health information, examination and treatment records, and your billing records for quality control purposes or for other administrative purposes to efficiently and effectively run our practice.
- Your chiropractor and members of the practice staff may need to use your name, address, phone number, and your clinical records to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information that may be of interest to you. 164.520 (b)(1)(iii)(A). If you are not at home to receive an appointment reminder, a message will be left on your answering machine.
You have the right to refuse to give us authorization to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information at any time.
Permitted uses and disclosures without your consent or authorization
Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:
- We are permitted to use or disclose your health information if we are providing healthcare services to you based on the orders of another healthcare provider.
- We are permitted to use or disclose your health information if we provide healthcare services to you as an inmate.
- We are permitted to use or disclose your health information if we provide healthcare services to you in an emergency.
- We are permitted to use or disclose your health information if we are required by law to treat you and we are unable to obtain your consent after attempting to do so.
- We are permitted to use or disclose your health information if there are substantial barriers to communicating with you, but in our professional judgment we believe that you intend for us to provide care.
Other than the circumstances described in the preceding examples, any other use or disclosure of your health information will be made only with your written authorization.
Your right to revoke your authorization
You may revoke your authorization to us at any time; however, your revocation must be in writing. There are two circumstances under which we will not be able to honor your revocation request:
- If we have already released your health information before we receive your request to revoke your authorization. 164.508(b)(5)(i)
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If you were required to give your authorization as a condition of obtaining insurance, the insurance
company may have a right to your health information if they decide to contest any of your claims. If you
wish to revoke your authorization, please write to us at:
Slidell Chiropractic Clinic
2769 Third Street
Slidell, LA 70458
Your right to limit uses or disclosures
If there are healthcare providers, hospitals, employers, insurers, or other individuals or organizations to whom you do not want us to disclose your health information, please let us know, in writing, what individuals or organizations to whom you do not want us to disclose your healthcare information. We are not required to agree to your restrictions. However, if we agree with your restrictions, the restriction is binding on us. If we do not agree to your restrictions, you may drop your request or you are free to seek care from another healthcare provider.
Your right to receive confidential communication regarding your health information
We normally provide information about your health to you in person at the time you receive chiropractic services from us. We may also mail you information regarding your health or about the status of your account. We will do our best to accommodate any reasonable request if you would like to receive information about your health or the services that we provide at a place other than your home or if you would like the information in a different form. To help us respond to your needs, please make any request in writing.
Your right to inspect and copy your health information
You have the right to inspect and/or copy your health information for six years from the date that the record was created or as long as the information remains in our files.
Your right to amend your health information
You have the right to request that we amend your health information for six years from the date that the record was created or as long as the information remains in our files. We require your request to amend your records to be in writing and for you to give us a reason to support the change you are requesting us to make.
Your right to receive an accounting of the disclosures we have made of your records
Louisiana law requires that we furnish you, upon your request, a copy of any information related in any way to you which we have transmitted to any company, or any public or private agency, or any person.
We may charge reasonable copying charges for this service which are set forth in the statutes as well as a handling charge and actual postage.
We may deny access to a record if we reasonably conclude that knowledge of the information contained in the record would be injurious to the health or welfare of the patient or could reasonably be expected to endanger the life or safety of any other person.
Your right to obtain a paper copy of this notice
If you have agreed to receive privacy notices by e-mail, you may request a paper copy of this notice at any time.
Our duties
We are required by law to maintain the privacy of your health information. We are also required to provide you with this notice of our legal duties and our privacy practices with respect to your health information.
We must abide by the terms of this notice while it is in effect. However, we reserve the right to change the terms of our privacy notices. If we make a change to the terms of our privacy agreement we will notify you in writing when you come in for treatment or by mail. If we make a change in our privacy terms the change will apply for all of your health information in our files.
Re-disclosure
Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by the federal privacy rules.
Marketing Authorization
We will not market your information to outside sources without your written consent.
CHIROPRACTIC ASSOCIATION OF LOUISIANA AUTHORIZATION
Your chiropractor and members of the practice staff may need to disclose your name, address, phone number, billing information, and your clinical records to the Chiropractic Association of Louisiana (CAL). This disclosure will be made if we need the CAL's assistance to receive reimbursement for your services or we need the CAL's assistance because the party responsible for reimbursing your services has improperly processed your claim.
By signing this form you are giving us authorization to send the CAL this information. You are also giving the CAL authorization to re-disclose your information to the party responsible for the payment of your services, the CAL's legal counsel, and state or federal agencies that may be asked to intercede on your behalf.
Appointment Reminders and Healthcare Information Authorization
Your chiropractor and members of the practice staff may need to use your name, address, phone number, and your clinical records to contact you with appointment reminders, information about treatment alternatives, or other health-related information that may be of interest to you. If this contact is made by phone and you are not at home, a message will be left on your answering machine. By signing this form, you are giving us authorization to contact you with these reminders and information.
You may restrict the individuals or organizations to which your healthcare information is released or you may revoke your authorization to us at any time; however, your revocation must be in writing and mailed to us at our office address. We will not be able to honor your revocation request if we have already released your health information before we receive your request to revoke your authorization. In addition, if you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information if they decide to contest any of your claims.
Information that we use or disclose based on the authorization you are giving us may be subject to re-disclosure by anyone who has access to the reminder or other information and may no longer be protected by the federal privacy rules.
You have the right to refuse to give us this authorization. If you do not give us authorization, it will not affect the treatment we provide to you or the methods we use to obtain reimbursement for your care.
You may inspect or copy the information that we use to contact you to provide appointment reminders, information about treatment alternatives, or other health-related information at any time. 164.524
Your right to complain
You may complain to us or to the Secretary for Health and Human Services if you feel that we have violated your privacy rights. We respect your right to file a complaint and will not take any action against you if you file a complaint. While you may make an oral complaint at any time, written comments should be addressed to the above agency.
