The Chelmsford Chiropractor to see - Chiropractor Chelmsford

NOTICE TO PATIENTS REGARDING YOUR PRIVACY RIGHTS

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.

It is our Policy to conform to the New Federal Privacy Law, known as the Health Insurance Portability and Accountability Act. This law affords our patient’s very real rights. It is the intent of this Notice to advise the patients of those rights and to encourage dialogue if you have questions after reviewing this Notice.

The laws require that our office maintain the privacy and confidentiality of your health information.   Furthermore, the law requires us to provide this Notice to you outlining our privacy practices and legal duties.  The law requires that we abide by the terms of this Notice.

1. The Provider may, from time to time contact you, via the telephone to remind you of an appointment, or to inform you of treatment alternatives, or other healthcare benefits and services that might be of interest to you.   If you are not home, it is likely that the office staff will leave a message, if you have an answering machine, or voice mail.

2. The new Federal Privacy Law permits our office to forward medical record information on your treatment to other entities, without your express permission for routine matters such as further treatment outside of this office, to secure payment for services provided to you, and for other health care operations.   The law requires us to provide some examples of what could be disclosed without your express authorization.

a) If this office received a request from another medical provider treating, this office would likely remit particular information to assist with your ongoing treatment.

b) In order to secure payment, this office might remit copies of notes generated by the provider during your treatment, this information could include diagnostic and treatment information that will be “codified” and forwarded to an insurance company for payment.

c) Sometimes, an insurance company denies payment for treatment and requests that the provider give the insurer a detailed summary as to why the treatment was necessary.  In order to secure payment, this office could complete such a report and disclose information about your treatment.

d) As part of our quality assessment and compliance programs, this office periodically reviews its treatment and bills to ensure that it is complying with other laws that govern health care.  At times, this practice might engage an attorney, or other external consultant to compare records and bills to ensure that our billing is accurate.

e) The Department of Health and Human Services, Department of Public Health, or other health oversight agency with the express authority under law investigates completes a compliance review of the office and requests to review patients’ records.

3. Except for the above types of routine disclosures, other uses or disclosures of your protected health information will be made only with your written authorization.  If you ever complete such an authorization, this Notice advises you that you may decide to revoke the authorization at any time, so long as action has not already been taken in reliance upon the authorization, or if authorization was obtained as a condition of obtaining insurance coverage.

4.  You have a right to request that restrictions be placed on the information routinely forwarded to other entities.  To do so, you would need to forward a letter to this office, expressly stating what

Information you did not want release, and any type of information you wanted not to be disclosed and to whom you do not want information disclosed to.  Please understand that the law states that the practice does not need to agree to such a restriction.  Please understand that in the event of a medical emergency, even if this office has a restriction prohibiting further release of health information, the practice reserves its right to forward necessary medical information to the treating facility.  In the event that this release occurs, we will make a good faith effort to convey to the facility not to further disclose this information.

In fairness, we reserve the right to discuss payment with you at the time that you make such a request if you decide to restrict information flow to your insurance company. If you request that information not be sent to your insurer, the practice reserves its right to obtain payment directly through you.                                      

5. You have the right to request that we forward information to you at a different place, or at a different telephone, or by another means of communication.  If you submit a request in writing yo this office, asking that we contact you at a location different than your residence, or if you ask that we forward copies of medical records to a different location, our practice will make a good faith effort to accommodate your request.

6. Pursuant to Massachusetts law and the Federal Privacy law, you have the right to request a copy of your medical record.  Upon receipt of a signed request from you, (or your legal guardian if you are a minor) we will consider the request and if proper, permit the access to the information that our practice has determined to be the content of your “designated records set” ( a term that includes many of the forms, notes and reports in your medical record folder.)

7. The Federal Privacy law grants you the right to find out if your health information has been released to anyone outside of those depicted in this Notice, or to someone else, without your authorization.  In order to obtain such a report, you are asked to submit a request in writing to the practice.  The request should ask for no more than six years of information.  The provider is not mandated to release any information before April 14, 2003, the date the law went into effect.  Furthermore, the provider reserves the right to charge a cost-based fee for the second request for such information within any 12 month period.

8. We intend to post this Notice in the Waiting Room and also to provide a copy to each patient at the very first appointment.  If at any time, you desire an additional copy of this Notice, all you need to do is ask the receptionist to provide you with a copy at your next visit, or call the office and ask that a copy of the Notice be mailed to you.

9. If you believe that your privacy rights have been violated you have a right to file a complaint with this office. To do so, you need to forward a written letter to the Privacy Office, at the address and telephone number above.  Additionally, you may file a complaint with the Secretary of the Department of Health and Human Services. If you file a complaint, either with our office of the DHHS, you will not be retaliated against by this practice, its employees, owners, or agents.

We Reserve the Right to change this Notice or Privacy Policy and to make any new Notice effective for all health information retained by this office.  If the Notice is revised, the revised Notice will be posted in a prominent location in the Patient’s Waiting Room. 

The Effective Date of this Notice is: 12/06/2006