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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.
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Medical information including health history,
is collected from the patient upon initiation and subsequent
visits, and is then stored in the patient's medical file.
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Medical information will be used in the
assessment of the patient's condition and the need for health
care or referral purposes.
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Some of the medical information will be
transferred to a computer program for the purposes of retrieval,
storage, billing and payment purposes.
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Medical information will be disclosed to
health and disability insurers for the purpose of payment or
reimbursement of services.
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The medical information contained in the
medical record will be stored by Pazdel Chiropractic, Inc. for
a period of no less the six (6) years.
To whom health care information will be disclosed:
- Other health care providers for the purpose of referral, consultation
or coordination of health care,
- Health care insurers,
- Disability insurers,
- Business Associates,
- Persons responsible for health care, such as a parent or nurse,
- Billing organizations,
- Collection agencies,
- Law enforcement officials or agencies,
- Correctional institution,
- Public Health authorities,
- Family members,
- Workers' compensation insurers or state agency, if applicable.
For what purposes health care information will be used and disclosed,
such as:
- For the purpose of diagnosis, assessment, referral, and/or
treatment,
- For the purpose of payment by a third party, such as a health
insurer,
- For the purpose of day to day health care operations,
- We may disclose your health information to the appropriate
authorities if we reasonably believe that you are a possible
victim of abuse, neglect, or domestic violence or the possible
victim of other crimes. We may disclose your health information
to the extent necessary to avert a serious threat to your health
or safety or the health or safety of others.
- Appointment reminder notices or messages.
Examples of the likely uses and disclosures of health information
routinely performed by Pazdel Chiropractic, Inc.:
- As a courtesy to our patients it is our policy to call your
home when you are late for, or miss an appointment. If you are
not at home we will leave a reminder message on your answering
machine or with the person answering the telephone. No personal
information is disclosed in our message nor will be disclosed
to any other person during this call.
- As a courtesy to our patients, we will submit an itemized
billing statement to your insurance carrier for the purpose
of payment to Pazdel Chiropractic, Inc. for health care services
rendered. If you pay for your health care services personally,
we will, as a courtesy, provide an itemized billing to your
insurance carrier for the purpose of reimbursement to you. The
billing statement contains medical information, including diagnosis,
date of injury or condition, and codes which describe the health
care services received.
The patient's rights:
- The right to inspect and copy his/her protected health information,
- The patient's right to place restrictions on certain uses
and disclosures of his/her health information,
- A notice that Pazdel Chiropractic, Inc. is not required to
agree to the requested restriction of protected health information,
- The right to amend his/her protected health information,
- The right to receive confidential communication of protected
health information by an alternative method other then the stated
means of communication,
- The right to a copy of patient's Notice of Privacy Practices
at any time,
- The right to an accounting of all uses and disclosures of
his/her protected health information.
A statement that third party uses and disclosures other than
for the purposes of treatment, payment of health care operations,
will be made only with the patient's written authorization,
and the patient may revoke such authorization as provided
by law.
A statement of promise that Pazdel Chiropractic, Inc. will make
every effort possible to protect the privacy and confidentiality
of all health information of its patients against inappropriate
or unauthorized use and disclosure, as required by law.
A statement explaining Pazdel Chiropractic, Inc.'s procedure to
inform the patient on future changes and revisions to the Notice
of Privacy Practices, within 60 days of a material revision to
notice requirements.
The patient's right as well as the process of filing a complaint
against Pazdel Chiropractic, Inc. for the inappropriate or illegal
way in which they handled the patient's health information.
Pazdel Chiropractic, Inc. may not use or disclose protected health
information of its patients in a manner inconsistent with the
Notice of Privacy Practices.
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Providing
Gentle Chiropractic Care
for All Ages and Life Styles
258
Sunset Avenue Suisun City,
California (707) 429-4861
5030 Business Center Drive Fairfield, California (707) 863-9001
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