Autry Family Chiropractic
38A Fieldstone Village Drive
Rock Spring, GA 30739
(706) 952-2600
Notice of Patient Privacy Policy
MEDICAL INFORMATION
ABOUT YOU MAY BE
USED AND DISCLOSED
AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION.
Autry Family Chiropractic may use and disclose
your health information and how you can access
this information. This Notice explains how we use
and share your health information and describes
your rights and our legal duties under federal
and state privacy laws.
Who This Notice Applies To
This Notice of Privacy Practices applies to our chiropractic
practice and all related services we provide, including those
performed by our support staff and business associates who
help deliver or manage your care. We follow the requirements
of the Health Insurance Portability and Accountability Act
(HIPAA).
This Notice applies to you as a patient of our practice and to any
services we provide in connection with your care.
If you have any questions about this Notice, please contact
our Privacy Officer or any staff member in our office.
- protected health information (PHI)
- Provide you with this Notice of our
legal duties and privacy practices
- Follow the terms of the Notice
currently in effect
When we make a significant change, we will post the revised
version in our office and, if applicable, on our website. You
may obtain the current version at any time by contacting our
Privacy Officer or asking at the front desk. You may contact
our Privacy Officer in person at our office, by mail at the
address above, or by phone.
WHAT IS PROTECTED HEALTH INFORMATION (PHI)?
that may identify you and relates to your past, present, or future
physical or mental health condition, the provision of health care
to you, or payment for that care.
USES AND DISCLOSURES PERMITTED
WITHOUT AUTHORIZATION
Federal law (HIPAA) permits us to use and disclose your
protected health information for treatment, payment,
and health care operations without a separate written
authorization, as described in this Notice.
Treatment
We may use or disclose your PHI to provide, coordinate,
or manage your health care and related services. This
includes sharing information with other health care
providers involved in your care.
Payment
We may use or disclose your PHI to obtain payment for
services provided to you. This may include billing insurance
companies, determining eligibility or coverage, utilization
review, and related activities.
Health Care Operations
We may use or disclose your PHI to support the business
operations of this practice, including quality assessment,
employee training, internal audits, and administrative activities.
We may use sign-in sheets or call you by name in the waiting
area as part of our normal operations, in a manner consistent
with applicable privacy requirements.
BUSINESS ASSOCIATES
We may share your PHI with third-party “business associates”
who perform services for us (such as billing, IT support, or
transcription). These entities are required by contract to protect
the privacy and security of your PHI.
To the extent applicable, we will require, through our agreements
with that business associate, that they protect those records in
accordance with applicable Part 2 confidentiality requirements.
USES AND DISCLOSURES REQUIRING
YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your PHI will be made only
with your written authorization, unless otherwise permitted
or required by law. These include:
Disclosures of psychotherapy notes
Uses and disclosures for marketing purposes
Disclosures that constitute a sale of PHI
Other uses and disclosures not described in this Notice
Substance Use Disorder (SUD) Records – 42 C.F.R. Part 2
Certain records related to Substance Use Disorder (SUD), if
present in your record, receive additional confidentiality
protections under federal law (42 C.F.R. Part 2).
Our primary services are chiropractic care. We are not a
substance use disorder (SUD) treatment program as defined
by federal law. However, we may receive or maintain
information related to SUD treatment if you or another
provider shares that information with us.
If our office maintains such information—such as information
received from other providers, hospitals, or patient disclosures—
those records generally will not be used or disclosed without
your specific written authorization, except as otherwise permitted
or required by federal law.
A standard authorization to release medical information
may not be sufficient to permit disclosure of SUD-protected
records. When required by law, we will obtain an authorization
that specifically covers SUD information and
complies with 42 C.F.R. Part 2.
You may revoke your authorization for us to disclose
SUD‑protected records at any time by submitting a written
request to our Privacy Officer. Revocation will not affect
disclosures already made in reliance on your prior authorization.
Most patients seen in our chiropractic practice will not have
records covered by these special rules. This section applies
only if we receive or maintain information from an
SUD treatment program.
OTHER PERMITTED AND REQUIRED
USES AND DISCLOSURES
We may use or disclose your PHI without your
authorization in the following situations:
Public Health & Safety - For public health activities,
reporting communicable diseases, preventing serious
threats to health or safety, and as required by law.
Health Oversight - To health oversight agencies for
audits, investigations, inspections, and compliance activities.
Abuse, Neglect, or Domestic Violence - As required or
permitted by law to appropriate authorities.
Workers’ Compensation - As authorized to comply with
workers’ compensation laws.
Required by Law - When disclosure is required by
federal, state, or local law.
Important Note About SUD Records: Some disclosures
described in this section do not apply to records protected by
42 C.F.R. Part 2. Please see the “Substance Use Disorder (SUD)
Records – 42 C.F.R. Part 2” section of this Notice for information
about how we handle SUD-protected records.
LEGAL PROCEEDINGS & LAW ENFORCEMENT
We may disclose PHI in response to a valid court order,
subpoena, discovery request, or other lawful process as
permitted by law.
Important: Records protected under federal Substance
Use Disorder confidentiality regulations (42 C.F.R. Part 2),
if applicable, may only be disclosed pursuant to a court
order that specifically authorizes such disclosure or as
otherwise permitted by federal law. A subpoena or legal
request alone may not be sufficient for disclosure of
SUD-protected information.
If we maintain records protected by 42 C.F.R. Part 2,
those records are subject to stricter rules than other PHI.
Please refer to the “Substance Use Disorder (SUD)
Records – 42 C.F.R. Part 2” section of this Notice for details.
YOUR RIGHTS
You have the right to:
• Inspect and Copy – You may inspect and obtain a copy
of your PHI, subject to certain legal exceptions and reasonable,
cost-based fees.
• Request Restrictions – You may request limits on certain uses
or disclosures of your PHI; however, we are not required to agree
to all requests.
• Confidential Communications – You may request that we
communicate with you by alternative means or at alternative
locations.
• Amend – You may request that we amend your PHI if you
believe it is incorrect or incomplete.
• Accounting of Disclosures – You may request an accounting
of certain disclosures of your PHI as defined by law.
• Breach Notification – If there is a breach of your unsecured
PHI, we will notify you as required by applicable law.
• Paper Copy – You may request a paper copy of this Notice
at any time.
To exercise any of these rights, please submit a written request
to our Privacy Officer.
SPECIAL RIGHTS REGARDING SUD RECORDS
If our office maintains records protected under 42 C.F.R. Part 2,
you have additional rights related to those records. Disclosure of
such information generally requires your written authorization,
and you may revoke that authorization at any time. Revocation
will not apply to disclosures already made in reliance on your
authorization.
COMPLAINTS
If you believe your privacy rights have been violated, you may
file a complaint with our Privacy Officer or with the U.S.
Department of Health and Human Services by visiting
www.hhs.gov/hipaa or calling 1-800-368-1019.
To file a complaint with our office, please contact the
Privacy Officer at the address or phone number listed above.
You will not be penalized or retaliated against for
filing a complaint.