HIPAA |
Poulin
Chiropractic - Notice of Patient Privacy Practices |
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Our Patient information
is private information that we do not disclose
to anyone - unless directed to do so by you,
the patient. In addition to this policy, we have
added the new Poulin Chiropractic HIPAA Policy,
as of April 1, 2003. For more information, please
read the following: |
POULIN INC.
d.b.a. Poulin Chiropractic
NOTICE OF PATIENT 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
or comments about this Notice please contact: |
Poulin Chiropractic
2465 Centreville Road, Suite J-18
Herndon, VA 20171 |
Our Privacy Officer is: Tina
Pritchard, (703) 561-0600
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Who Does this Notice
Apply to?
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Poulin
Chiropractic has published this Notice. It applies
to everyone who works for Poulin Chiropractic,
including our employees, contractors, and volunteers. |
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Why
Do We Publish this Notice?
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As
medical professionals,
we understand that information
about you and your health
is sensitive and personal.
We are also required
by law to maintain the
privacy of our patient’s
information we gather
and use about our patients,
and provide them with
notices of our legal
duties and privacy practices
with respect to their
information. |
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While
we are committed to the
privacy of our patients’
information, in order
to serve them we need
to gather, keep and use
records of this information.
We sometimes also need
to share information
with other parties. This
Notice is intended to
let you know how we use
and disclose your information. |
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This
Notice is also to let
you know about certain
legal rights you have
with respect to the information
we hold about you. You
have certain rights to
review and copy our records
of information about
you. You may also request
that we amend these records,
and may ask us to account
for certain disclosures
we may have made of information
about you. |
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to the top
When
Is
This
Notice
Effective?
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We
are required to comply
with the terms of this
Notice while it is in effect.
We reserve the right to
change the terms of this
Notice, and make the new
terms effective for all
information to which this
Notice applies. This Notice
will be in effect from
April 10, 2003 until the
date we publish an amended
Notice. If we do publish
an amended Notice, we will
notify you at your next
visit. We will also publish the
amended Notice in our offices,
and will publish it on
our web site if we maintain
one. |
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the
top
What
Information
Does
this
Notice
Cover?
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This
Notice covers all information
in our written or electronic
records which concerns
you, your health care,
and payments for your health
care. It also covers information
we may have shared with
other organizations to
help us provide your care,
get paid for providing
you care, or manage some
of our administrative operations. |
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What
Can
We
Use
or
Disclose
Information
About
You?
• |
Treatment.
We may use or disclose
information about you for
treatment purposes to doctors,
nurses, technicians, medical
students or other individuals
who work in our practice
who are involved in providing
you with health care. We
may also disclose information
about you to organizations
and individuals involved
in your care who are outside
of our practice, such as
consulting physicians,
laboratories, social workers,
and so on. |
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For
example, if we refer you
to another physician or a
hospital for special services,
we will provide that physician
or hospital with all clinical
information, which might
be necessary or helpful to
help them provide you with
the right care. Or, if we
need to send a sample of
your blood to a laboratory
for analysis, we will provide
the laboratory with the information
they need to process your
blood correctly. |
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These
are only examples, and
we may use or disclose
information about you to
provide you proper treatment
in many other ways. |
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Payment.
We may use or disclose information
about you for payment purposes
to our clerks and officers
involved in billing and claims
payment. We may also disclose
such information to your health
plan or other party financially
responsible for your care,
or to claims and billing services
if necessary. |
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For
example, if you are covered
by a health plan, we cannot
get paid for the services
we provide you unless we
submit information in a
claim. This might include
detailed clinical information,
depending on the kind of
plan and claim. This is
only an example, and there
may be many other ways
in which we may use or
disclose information about
you in connection with
payment for your care. |
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Health
care operations.
We may use or disclose
information about you
for operational in
connection with our
practice. These activities
might include practice
quality improvement,
training of medical
students, insurance
underwriting, medical
or legal review, and
business planning or
administration of our
practice. |
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For
example, we may wish to
review the quality of care
you receive, in order to
help us deliver the best
care we can. Or we may
audit our management practices
so we can become more efficient.
These are only examples,
and we may use or disclose
information about you for
health care operations
in many other ways. |
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To
a public health agency,
for purposes such as controlling
disease. |
• |
In
case of suspected child
abuse, to the appropriate
governmental authority. |
• |
In
other cases of suspected
abuse, neglect or domestic
violence, to the appropriate
governmental authority,
with your agreement or
if required by law, or
if you are incapacitated
or it appears necessary
to prevent serious harm
to you or others. |
• |
To
health oversight authorities,
for regulatory, licensing
and other legal purposes. |
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In
litigation, subject to
certain requirements controlling
the terms of the disclosure. |
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To
law enforcement agencies,
subject to applicable legal
requirements and limitations. |
• |
Worker’s
Compensation: In such cases
that your treatment is a
result of an injury on the
job, we may release your
information to the appropriate
carrier/employer. |
• |
To
Funeral Directors/Medical
Examiners/Coroners in the
event of your death. |
• |
When
required by Federal, State
or Local law. |
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For
medical research purposes,
subject to your authorization
or approval by an institutional
review board. |
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If
you are in the United States
military, national security
or intelligence, Foreign
Service, to your authorized
superiors or other authorized
federal officials. |
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We
may contact you for information
to support your health
care, including appointment
reminders, information
about alternative treatments,
and health-related services,
which may be of interest
to you. We will routinely
contact patients via telephone
at home and/or work and,
unless otherwise requested,
may leave messages on the
appropriate voice mail
or answering service regarding
appointments. Please advise
us if you do not wish to
receive such communications, and
we will not use or disclose
your information for such
purposes. If you wish not
to receive this kind of
communication, you must
advise us in writing at
our Contact address given
above. |
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We
may not use or disclose
information about you for
any other purpose without
your written authorization. |
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What
Legal
Rights
Do
You
Have
In
Connection
With
Your
Information?
The
Law
entitles
you
to:
• |
Ask
us to further restrict
our use and disclosure
of information about you.
We are not required to
grant such a request, but
if we do we must make sure
the restrictions are implemented. |
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Receive
confidential communication
from us, at an alternative
address you provide to us. |
• |
Review
our records of your information. |
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Obtain
a copy of all or any part of
our records of your information.
We may charge you a copying
charge of a $10.00 base fee,
$0.50 per page for pages 1-50,
then $0.25 for any pages over
50. |
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Ask
us to amend your records,
if you believe that they
are incorrect or incomplete.
We are not required to
make such as amendment.
If you request an amendment
and we determine we will
not make it, you are entitled
to have a statement of
your disagreement included
in your records. If you
do include a statement
of disagreement in your
records, we may include
a statement of explanation
or response in your records
as well. |
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Obtain
an accounting of all persons
to which we have disclosed
information about you, for
any purpose except your treatment,
payment for your treatment,
or our health care operations. |
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If
you believe we have violated
your privacy rights, you
may forward us a written
complaint to our Contact
address given above. You
may also file a complaint
with the Secretary of the
United States Department
of Health and Human Services.
If you do file a complaint
we are legally prohibited
from retaliating against
you. |
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