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.
Griffin Chiropractic, Inc is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.
We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example)
“on occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Griffin Family Wellness.”
“It is our policy to provide a substitute health care provider, authorized by Griffin Family wellness to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”
We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (example)
“As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Griffin Family wellness 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 rendered.”
We may disclose your health information as necessary to comply with State Workers’ Compensation Laws.
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.
JUDICIAL AND ADMINISTRATIVE PROCEEDINGS
We may disclose your health information in the course of any administrative or judicial proceeding.
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.
We may disclose your health information to coroners or medical examiners.
We may disclose your health information to organizations involved in procuring, banking, or transplanting organs or tissues.
We may disclose your health information to researchers conducting research that has been approved by and Institutional Review Board.
It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.
SPECIALIZED GOVERNMENT AGENCIES
We may disclose your health information for military, national security, prisoner and government benefits purposes.
We may contact your for marketing purposes or fund-raising purposes, as described below: (Example)
“As a courtesy to our patients, it is our policy to call/text/email you prior to your scheduled appointment to remind you of your appointment time. If you are not available, we leave a reminder message on your answering maching or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.”
CHANGE OF OWNERSHIP
In the event that Griffin Family Wellness is sold or merged with another organization, your health information/record will become the property of the new owner
YOUR HEALTH INFORMATION RIGHTS
- You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Griffin Family Wellness is not required to agree to the restriction you requested.
- You have the right to have your health information received or communicated through and alternative method or sent to an alternative location other than the usual method of communication or deliver, upon your request.
- You have the right to inspect and copy your health information
- You have a right to request that Griffin Family Wellness amend your protected health information. Please be advised, however, that Griffin Family Wellness is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
- You have a right to receive an accounting of disclosures of your protected health information made by Griffin Family Wellness
- You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
Griffin Family Wellness reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Griffin Family Wellness is required by law to comply with this notice.
Griffin Family Wellness is required by law to maintain the privacy of your health information and to privide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact Griffin Family Wellness by calling this office at 661-505-6303. If Dan Griffin, DC is not available you may make an appointment for a personal conference in person or by telephone within 2 working days.
Complaints about your privacy rights, or how Griffin Family Wellness has handled your health information should be directed to Dan Griffin, DC by calling this office at 661-505-6303. If Dan Griffin, DC is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.
If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
I have read the privacy notice and understand my rights contained in this notice.
By way of my signature, I provide Griffin Family Wellness with my authorization and consent to use and disclose my protected health care information for the purposes of treatment, payment and health care operations as described in the Privacy Notice.