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.
Life Chiropractic College West is committed to maintaining the privacy of your protected health information (“PHI”), which includes information about your health condition and the care and treatment you receive from the Health Center. The creation of a record detailing the care and services you receive helps this office to provide you with quality health care. This Notice details how your PHI may be used and disclosed to third parties. This Notice also details your rights regarding your PHI. The privacy of PHI in patient files will be protected when the files are taken to and from the Health Center by placing the files in a box or brief case and kept within the custody of a doctor or employee of the Health Center authorized to remove the files from the Health Center’s office.
The Health Center may use and/or disclose your PHI for the purposes of:
The Health Center may use and/or disclose your PHI, without a written Consent from you, in the following additional instances:
Appointment Reminders
Family/Friends
The Health Center may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person’s involvement with your care or the payment for your care unless you direct the Health Center to the contrary. The Health Center may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply:
(a) If you are present at or prior to the use or disclosure of your PHI, the Health Center may use or dis-close your PHI if you agree, or if the Health Center can reasonably infer from the circumstances, based on the exercise of its professional judgment that you do not object to the use or disclosure.
(b) If you are not present, the Health Center will, in the exercise of professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person’s involvement with your care.
Uses and/or disclosures, other than those described above, will be made only with your written Authorization.
Your Right to Revoke Your Authorization
You may revoke your authorization to us at any time; however, your revocation must be in writing.
Restrictions
You may request restrictions on certain use and/or disclosure of your PHI as provided by law. However, the Health Center is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to the Health Center’s Privacy Officer. In your written request, you must inform the Health Center of what information you want to limit, whether you want to limit the Health Center’s use or disclosure, or both, and to whom you want the limits to apply. If the Health Center agrees to your request, the Health Center will comply with your request unless the information is needed in order to provide you with emergency treatment.
You Have a Right to
Inspect and obtain a copy your PHI as provided by 45 CFR 164.524. To inspect and copy your PHI, you are requested to submit a written request to the Health Center’s Privacy Officer. The Health Center can charge you a fee for the cost of copying, mailing or other supplies associated with your request.
Receive confidential communications or PHI by alternative means or at alternative locations. You must make your request in writing to the Health Center’s Privacy Officer. The Health Center will accommodate all reasonable requests.
Prohibit report of any test, examination or treatment to your health plan or anyone else for which you pay in cash or by credit card.
Receive an accounting of disclosures of your PHI as provided by 45 CFR 164.528. The request should indicate in what form you want the list (such as a paper or electronic copy)
Receive a paper copy of this Privacy Notice from the Health Center upon request to the Health Center’s Privacy Officer.
Request copies of your PHI in electronic format if this office maintains your records in that format.
Amend your PHI as provided by 45 CFR 164.528. To request an amendment, you must submit a written request to the Health Center’s Privacy Officer. You must provide a reason that supports your request. The Health Center may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by the Health Center (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by the Health Center, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with the Health Center’s denial, you will have the right to submit a written statement of disagreement.
Receive notice of any breach of confidentiality of your PHI by the Health Center
For more information see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
If you have any further questions or comments, please feel free to contact our Compliance Officer via phone: 510-780-4500, ext 2570, or email: rodell@lifewest.edu. Effective date of this notice is January 24, 2020.
Life Chiropractic College West adheres to section 1557 of the Patient Protection Affordable Care Act. Please follow the link below for further details. If you believe you have been discriminated against on one of the bases protected by Section 1557, please contact the Section 1557 Compliance Coordinator at rodell@lifewest.edu or by calling (510) 780-4500.
hhs.gov/civil-rights/for-individuals/section-1557/index.html
If you feel that you have been subject to discrimination in health care or health coverage, you may file a complaint of discrimination under Section 1557. Please visit OCR’s website at hhs.go/ocr to file a complaint or to request a complaint package, or call OCR’s toll free number at (800) 368-1019 or (800) 537-7697 (TDD) to speak with someone who can answer your questions and guide you through the process. OCR’s complaint forms are available in a
variety of languages. Individuals can also file lawsuits under Section 1557.
© 2024 Life Chiropractic College West • Privacy Policy