Downtown Chiropractic is committed to maintaining the privacy of your personal and medical information. We create a record of the care and services you receive at Downtown Chiropractic. We need this information to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share your protected health information (PHI), and also describes your rights regarding your PHI.

Law requires us to: 1. Keep your medical information private, 2. Give you this notice describing our legal duties and privacy practices along with your rights regarding your medical information, and 3. Follow the terms of the notice that is now in effect.

We have the right to: 1. Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law, 2. Make the changes in our privacy practices and the new terms of our notice effective for all medical information, including any information previously created or received before the changes.

Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

Use and Disclosure of Medical Information

The following section describes different ways that we use and disclose medical information. For each kind of disclosure we explain what we mean and give an example. Not every use or disclosure is listed; however, we have listed all of the different ways we are permitted to use and disclose medical information. We will not disclose your medical information for any purpose not listed below without your specific written authorization. Any written authorization you provide may be revoked at any time by writing to us.

FOR TREATMENT:

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical/chiropractic students, or other people who are working in this facility and/or are taking care of you in any other facility to assist them in treating you.

Example: If you were referred to this facility by your Primary Care Physician updates about your care in this facility will be sent to your Primary Care Physician on a regular basis.

FOR PAYMENT:

We may use and disclose your medical information for payment purposes.

Example: We may need to give your health insurance company information about the treatment you received in this facility so that your health plan will pay for any treatment you have received.

Example: We may tell your health insurance company about any treatment you are going to receive to get approval or to determine if your plan will pay for the treatment.

FOR HEALTHCARE OPERATIONS:

We may use and disclose your medical information for healthcare operations. This may include measuring and improving quality of care, evaluation of performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.

FACILITY DIRECTORY:

Unless you notify us that you object, medical information about you will be placed in our facilities directory and sign-in logs where staff can readily see who is seeking care. This information may be seen by others seeking care as well.

NOTIFICATION:

In case of an emergency and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interests about allowing someone to pick up medical supplies, x-ray, or medical information for you.

COURT ORDERS AND JUDICIAL ADMINISTRATIVE PROCEEDINGS:

We may disclose medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning the medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share the medical information of an inmate or other person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

 PUBLIC HEALTH ACTIVITIES:

As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including child abuse or neglect, if we believe that you are a victim of abuse, domestic violence or the possible victim of other crimes. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition. We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.

WORKER'S COMPENSATION:

We may disclose medical information when authorized and necessary to comply with laws relating to worker’s compensation or other similar programs.

HEALTH OVERSIGHT ACTIVITIES:

We may disclose medical information to an agency providing health oversight activities authorized by law, including audits, civil, administrative, criminal investigations or proceedings, inspections, licensure, disciplinary actions, or other authorized activities.

Your Have the right to:

• Look at or get copies of your medical information. You must make your request in writing. You may get the form to request access by using the contact information listed at the end of this notice. You may also request access by sending a letter to the contact person listed at the end of this notice. If you request copies, we may charge you up to $2.00 for each page, and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
• Request that we place additional restrictions on the use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (expect in the case of an emergency.)
• Revoke any authorization or consent in writing at any time. To do so, you must submit a written request to the contact below.
• Amend you PHI as provided by law. Do this by submitting a written request to the name below along with the reason that supports the request. We may deny your request if it is not in writing, if you do not have a reason supporting your request, if the information was not created by this practice, if the information is not part of your PHI, or if it is not information you may inspect.
• Receive an accounting of disclosures of your PHI as provided by law. To request this, you must submit a written request to this practice. The request must state a time period no greater than 6 years and not be before December 1, 2004. The request should indicate what form you want the list (paper or electronic.) The practice may charge you for this list.
• Receive a paper copy of this Notice or review the copy at the front desk.

If you have any questions or complaints about this notice or to submit a request, contact:

Dr. Travis Oller - 117 SW Seventh St. - Topeka, KS 66603 - (785) 233-2300