Notice of Privacy Practices
Protected Health Information (PHI)
As our patient a Kerkhoff Chiropractic we would like to take this opportunity to describe our privacy practices in regard to your patient information. It is a requirement by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices. Our goal is to take appropriate steps to attempt to safe guard any medical or other personal information that is provided to us.
Information Collected About You
Name, address, and phone number
Medical History
Insurance information and coverage
How We May Use and Disclose Information About You
For Treatment
For Payment
For Health Care Operations
Public Policy Uses and Disclosures
The Following Are Your Patients' Rights
Right to adequate notice of privacy practices
Right to access health information; inspect and copy medical records about you, except under certain circumstances
Right to request amendment of health information; if you believe that information in your records is incorrect or incomplete
Right to an accounting of disclosures, right to request that you receive communications containing PHI from us by alternative means, for example, you may ask that we only contact you at home or by mail for invoice or other purposes or appointment reminders
Right to request restriction of use and disclosures; in the ways in which your PHI is used beyond those imposed by law, your request will be considered but we are not required to accept it
Right to a copy of this Notice in paper form at any time.
The following are our uses and disclosures of your protected health information:
You the patient for treatment, payment, and health care operations authorize Policy and Patient Data uses and disclosures. An Authorization for Release of Medical Information form will be signed by you the patient before any PHI is released.
Other uses and disclosures will only be made with written authorization from you the patient. The patient may revoke the authorization.
Other purposes where Kerkhoff Chiropractic is permitted or required to use or disclose PHI without patients' written consent or authorization:
In the event of contacting authorities regarding a suspended abuse, neglect, or domestic violence.
To report births or deaths
Prevent or control disease, injury or disability
Report reactions to medications or problems with products
Notification to any persons who may have been exposed to an infectious disease for contracting or spreading disease or condition.
We may also use protected health information if law or other legal regulations is required:
Audits, investigations, and inspections
Legal proceedings in response to court order or administrative tribunal
Law enforcement requests for identification or location
Circumstances pertaining to victims of a crime
Deaths suspected from criminal conduct
Coroners, funeral directors, and organ donations
Research
Criminal activity
Workers' compensation injuries
Inmates of correctional facility; for the institution to provide you with health care
Members of Armed Forces; release PHI required by military command authorities
Parental access if patient is a minor
Other purposes may include this offices' practices of referrals and/or welcome policies. This office sends correspondence to new patients to welcome them to our practice. We also send correspondence to the referral source to thank them for their confidence in our practice.
Our office reserves the right to change this notice and will provide each patient with the revised notice upon request.
Complaints/Comments
If you have any complaints or comments concerning our Privacy Policy, you may contact the Secretary of the Department of Health and Human Services, at 200 Independence Avenue S.W. Room 509F, HHH building, Washington, D.C. 20201.
You may also contact us directly to speak to our Privacy Officer at 515-987-4747
If you have any questions at all about our PHI Policy please contact us at (515)
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