NOTICE OF DOCTORS PRIVACY PRACTICE

The LeBaron Chiropractic office, located at 55 S. Stapley Dr. Mesa, AZ 85204, is required by the Health Insurance Portability and Accountability Act (HIPPA) to inform all patients about the recent Federal/State standards that have been adopted to protect the privacy and confidentiality of all patients' identifiable and protected health information (PHI). Our office has certain responsibilities to the patient that are outlined in this notice. This notice describes the various rights that patients have regarding PHI. If the patient desires a copy of this notice, the receptionist will provide one, upon request (45CFR sect 164).

PATIENT RIGHTS REGARDING HEALTH-MEDICAL RECORDS

All medical records including those that the patient, doctor(s), nurses, therapist, laboratory technicians, and staff generate, including intake forms, history, examination, diagnosis, treatment, progress notes, therapy, testing, etc., as well as any records received from other sources become the property of this facility.  The patient has the right to inspect and copy his/her health records, amend or change her/his records, and request restrictions on certain aspects of his/her medical records for a period of seven years or as long as the patient's records are maintained by this facility.  If the patient has any sensitive PHI information he/she wants "restricted," the patient may request that the PHI be "restricted" unless specifically authorised by the patient or when mandated by a legal or court order. If the patient provides sensitive information (such as psychotherapy, domestic violence, AIDS/HIV, communicable disease, elder abuse, drug-alcohol abuse, mental impairment, and etc) these require special authorisation for release of records to other parties.  The patient may ask for accounting of every disclosure and use of his/her PHI to another party at any time.  The patient may ask that disclosure of his/her PHI be communicated in a different manner, such as by fax instead of postal service.  Our office will not disclose any PHI without the patient's signed and dated authorisation, unless mandated by law (such as a court order), in an emergency situation, when providing treatment to the patient based on prescribed orders from another health care provider, or when compelled to do so in cases of potential harm/injury to a person, abuse, or crime as dictated by law.  The patient may revoke any authorisation, except in situations where actions or reliance upon have already been taken.  All requests for amendments, viewing or copying records, restrictions, revocation of authorisations, or request for summary of disclosures or uses of patient records must be submitted in writing to the privacy officer.  Please give our office enough time to process any requests.  If requesting records, HIPPA laws allow for 30 days if records are maintained on-site and 60 days if stored off-site.

WHAT ARE OUR RESPONSIBILITIES TO THE PATIENT?

Our office is required to maintain reasonable and appropriate administrative, technical, and physical safeguards to insure the integrity and confidentiality of patient's PHI and protect against unauthorised uses or disclosures of PHI.  Our office is required to allow the patient to indicate alternative means of communication from our office, including preferred address locations for mail or alternative telephone numbers for receiving calls or for leaving messages.  Any person/business who has access to, or needs disclosure of a patient's PHI in order to perform necessary tasks, (examples include computer, technical, billing, janitorial, physician, diagnostic, laboratory, or radiology services) will be required to sign a "Business Associate" agreement that require appropriate safeguarding of PHI.  Our office reserves the right to change our practices and make new provisions or disclosures.  Our office will make every reasonable effort to comply with protecting the patient's PHI and if the health information practices of our office change, the patient will be mailed a copy of such changes to the most recent address given by the patient.

HOW WILL OUR OFFICE USE YOUR PROTECTED HEALTH INFORMATION?

This office has several doctors, therapists, nurses, assistants, and other personnel that work as a team to provide the patient with the best care in a coordinated effort.  Your medical-health records that are generated each visit provide the basis for our office to determine your diagnosis, what treatment needs to be prescribed or modified, how you have responded to treatment, weather consulation/referral is needed, and provides the means for the doctors/staff to communicate relevant PHI with each other.  Unless restricted by the patient, our office will use the patients PHI to coordinate care and to obtain information to verify and process insurance billing, provide "minimum necessity" records to those third-party payers who are responsible to pay for services given, and to obtain authorisation for treatment, services, procedures, testing, and for supplies provided.  The patient's PHI will be used to help determine the condition, diagnosis, treatment, and the need for consultation, referral, testing, or coordination with other health care providers.  The patients PHI may be used to respond to questons from insurance companies regarding the necessity of a service, test, or supplies or to verify services.  Our office will use the patient's PHI to return telephone calls, make appointments reminders, mail billing statements or updates,and for sending other office related materials. For cases in which the patient has an attorney, our office needs to be able to communicate about various aspects of the patient's case and submit reports outlining the patient's response to treatment, diagnosis, and other relevant issues.  If the patient has a friend, family member, or other person in attendance at our office,  the patient must provide signed consent for any discussions that involve any PHI.  If the patient's doctor is out of the office and has another doctor covering his/her practice, the patience's PHI is necessary for the doctor to provide treatment.

NOTE: Patients are encouraged to mail written recommendations or file complaints directly to the office address above with ATTN: Privacy Officer on envelope.  If the patient believes that the health care provider has violated his/her privacy rights he/she may file complaints with the U.S. Department of Health and Human Services at 200 Independence Ave, SW, Room 509F, HHH Bldg, Washington, DC 20201.  Our office will not retaliate in any manner if any complaints are made. Thank you.