Health Insurance Portability & Accountability Act of 1996 (“HIPPA”)
is a federal program that requires that all medical records and other
individually identifiable health information used or disclosed by us
in any form, whether electronically, on paper, or orally, are kept
the course of your care as a patient at Fimreite Chiropractic, we may
need to use or disclose personal and health related information about
you in the following ways:
Your personal health information, including your clinical
records, may be disclosed to another health care provider or hospital
if it is necessary to refer you for further diagnosis, assessment or
Your health care records as well as your billing records may be
disclosed to another party, such as an insurance carrier, an HMO, a
PPO or your employer (if they are, or may be, responsible for the
payment of your services).
Your name, address, email, phone number, and your health care
records may be used to contact you regarding appointment reminders or
other appointment related issues, to provide information about
alternatives to your present care or other health related information
that may be of interest to you.
Periodically, thank you letters, referral cards, newsletters,
birthday cards, postcards, paper clippings or email messages may be
you are not at home to receive an appointment reminder, a message may
be left on your answering machine or with another member of the
Further, you have the right to inspect or obtain a copy of the
information we will use for these purposes.
You also have the right to refuse to provide authorization for
this office to contact you regarding these matters.
If you do not provide us with this authorization it will not
affect the care provided to you or the reimbursement avenues
associated with your care.
federal law, we are also permitted or required to use or disclose your
health insurance without your consent or authorization in the
If we are providing health care services to you based on the
orders of another health care provider.
If we provide health care services to you in an emergency.
If we are required by law to provide care to you and we are
unable to obtain your consent after attempting to do so.
If there are substantial barriers to communicating with you,
but in our professional judgment we believe that you intend for us to
If we are ordered by the courts or another appropriate agency.
use or disclosure of your protected health information, other than as
described in the examples outlined above, will only be made upon your
normally provide information about your health care to you in person
at the time you receive chiropractic care from us.
We may also mail information to you regarding your health care,
insurance forms or about the status of your account.
If you would like to receive this information at an address
other than your home or, if you would like the information in a
different form, please advise us in writing as to your preferences.
have the right to inspect and/or copy your health information for
seven years from the date that the record was created or for as long
as the information remains in our files.
In addition, you have the right to request an amendment to your
Requests to inspect, copy or amend your health related
information should be provided to us in writing.
are required by state and federal law to maintain the privacy of your
patient file and to protect the health information therein.
We are also required to provide you with this notice of our
privacy practices with respect to your health information.
are further required by law to abide by the terms of this notice while
it is in effect.
We reserve the right to alter or amend the terms of this
If changes are made to your privacy notice, we will notify you
in writing as soon as possible following the changes.
Any change in our privacy notice will apply for all of your
health information in our files.
that we use or disclose based on this privacy notice may be subject to
re-disclosure by the person or persons to whom we provide the
information and may no longer be protected be the federal privacy
Open adjusting rooms:
we keep an open environment in the office to create a sense of
warmth, family, healing and education.
During adjustments, we do not go over private information;
however, you will be in an open area where others may see you and/or
If there is a need to discuss something of a personal or
private nature, you should request an appointment in one of our closed
private exam rooms.
A doctor or trained staff member will speak with you about your
condition or other matters in the closed private exam room.
To Family and close friends involved in your care:
Our office has an open, family-centered approach to wellness
and we believe it is in all our patient’s best interests to have the
support and cooperation of their families.
Therefore, our office requires that the spouse or significant
other be present when the doctor goes over the patient’s report and
recommendations for treatment and wellness.
If you object to the presence of your spouse or significant
other at your report, please let us know immediately and we can refer
you to another chiropractor.
addition, we may disclose your Personal Health Information (PHI) to a
family or a close friend if those persons accompany you while you are
receiving health care services; or if we determine that it is in your
best interest so we can provide you with the best health care
We may also disclose your PHI to a family member or someone
else who helps pay for your health care treatment.
You have the right to request a restriction in how we use of
disclose you PHI.
However, we are not required to agree to your request.
For instance, if you request that your spouse or significant
other not be present when the doctor presents your report to you, we
will not agree to such request.
Right to inspect and copy:
You have the right to inspect and copy PHI that may be used to
make decisions about your care.
Usually, PHI includes medical and billing records.
To inspect and copy PHI, you must submit your request in
writing on the form provided by our Practice.
We will usually respond to your request within sixty (60) days.
If you request a copy of your PHI, we may charge a fee for the
costs of copying, mailing or other supplies associated with your
we charge a fee, we will let you know the fee in writing, prior to
making the copies, so that you can withdraw or modify your request
before incurring a charge.
In addition, we may charge to make copies of your record to
send to another health care provider; if so, we will notify you in
writing prior to making the copies.
may deny your request to inspect and copy your PHI in certain
If you are denied access to your PHI, you may request that the
denial be reviewed in certain circumstances.
Another licensed health care professional chosen by the
Practice will review your request and our denial.
The person conducting the review will not be the person who
denied your request.
We will comply with the outcome of the review.
you have a complaint regarding our privacy notice and/or our privacy
practices, or would like further information about our privacy
policies and practices please contact:
K. Fimreite, D.C.
Willow Springs Road