Greater Portland Chiropractic - Notice of Privacy Practices

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.

Greater Portland Chiropractic is required by law to maintain the privacy of your health information (PHI) and to provide 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 the privacy practices at Greater Portland Chiropractic please contact:

Effective Date of This Notice: 04/14/2003

I. How Greater Portland Chiropractic may Use or Disclose Your Health Information

Greater Portland Chiropractic (GPC) collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of GPC but the information in the medical record belongs to you. GPC protects the privacy of your health information. The law permits GPC to use or disclose your health information for the following purposes:

2. Payment: In order to get paid for services provided to you, GPC will provide the necessary PHI, directly or through a billing service, to appropriate third party payors (insurance companies, etc.), as outlined in their billing and payment requirements. Your contact information is also used to bill for any balance on your account. For example, GPC may need to provide the Medicare program with information about health care services that you received from GPC so that we can be properly reimbursed. GPC may also need to tell your insurance plan about treatment you are going to receive so that it can determine whether or not it will cover the treatment expense.

3. Regular Health Care Operations: In order for GPC to operate in accordance with applicable law and insurance requirements and in order for GPC to continue to provide quality and efficient care, it may be necessary for GPC to compile, use and/or disclose your PHI. For example, GPC may use your PHI in order to evaluate the performance of the GPC’s personnel in providing care to you
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4. Information Provided to You: In order to keep you informed of your care, GPC may discuss with you or provide written statements regarding your care and PHI.

5. Directory: Your name is listed in a database with all patient names, phone numbers, addresses and file numbers. This list is used to store contact information in one central location and for use with special mailings.

6. Notification and Communication with Family: GPC may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to that person’s involvement with your care or the payment for your care. GPC may also use or disclose your PHI to assist in the notification or to notify (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, GPC may use or disclose your PHI if you agree, or if GPC 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 Practice 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.

7. Other Instances:

(a) De-identified Information — Information that does not identify you and, even without your name, cannot be used to identify you.

(b) Business Associate — To a business associate if GPC obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists GPC in undertaking some essential function, such as a billing company that assists the office in submitting claims for payment to insurance companies or other payers.

(c) Personal Representative — To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.

(d) Emergency Situations —

(i) for the purpose of obtaining or rendering emergency treatment to you provided that GPC attempts to obtain your acknowledgement of our Privacy Notice as soon as possible; or

(ii) to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.

(e) Communication Barriers — If, due to substantial communication barriers or inability to communicate, GPC has been unable to obtain your acknowledgement of our Privacy Notice and GPC determines, in the exercise of its professional judgment, that your consent to receive treatment is clearly inferred from the circumstances.

(f) Public Health Activities - 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 to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

(g) Abuse, Neglect or Domestic Violence - If GPC is authorized or required by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm. For example, GPC may disclose PHI in the case of child abuse and/or neglect.

(h) Health Oversight Activities - We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community’s health care system.

(i) Judicial and Administrative Proceeding - For example GPC may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.

(j) Law Enforcement Purposes - In certain instances, your PHI may have to be disclosed to a law enforcement official. We may disclose your PHI for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes. For example, GPC may disclose your PHI if we believe that your death was the result of criminal conduct.

(k) Coroner or Medical Examiner - GPC may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.

(I) Organ, Eye or Tissue Donation - If you are an organ donor, GPC may disclose your PHI to whom you have agreed to donate your organs.

(m) Research - If GPC is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI.

(n) Avert a Threat to Health or Safety - GPC may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

(o) Specialized Government Functions - This refers to disclosures of PHI that relate primarily to military and veteran activity.

(p) Workers’ Compensation - If you are involved in a Workers’ Compensation claim, GPC may be required to disclose your PHI to an individual or entity that is part of the Workers’ Compensation system.

(q) National Security and Intelligence Activities — GPC may disclose your PHI in order to provide authorized governmental officials with necessary intelligence information for national security activities and purposes authorized by law.

(r) Military and Veterans — If you are a member of the armed forces, GPC may disclose your PHI as required by the military command authorities.

(s) Public safety - We may 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 the general public.

(t) As required by law - GPC may use and disclose your health information as state and federal law dictates. For example, the Maine Mandate requires that we submit a report to your primary Care Physician within 3 days of your first visit if you subscribe to a fully funded HMO plan.

8. Appointment Reminders: GPC may, from time to time, contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. The following appointment reminders may be used by GPC: a) a postcard mailed to you at the address provided by you; b) telephoning your home and leaving a message on your answering machine or with the individual answering the phone; c) telephoning your place of business if we have urgent need to contact you and the above has failed or is not an option; d) other mailings, e) email, or f) fax. We may also send birthday and other special occasion cards to your home.

9. Marketing: Should GPC wish to use your name, likeness, or other PHI for marketing purposes, we must first obtain a release to do so. This includes referral boards, Thank You letters, other bulletin boards, etc.

10. Health plan: We may disclose your health information to the sponsor of your health plan.

11. Facsimile Transmissions: GPC may from time to time transmit information about you to insures, other health care professionals and providers, and appropriate governmental agencies utilizing facsimile transmissions.

12. Sign In Sheets: GPC utilizes sign-in sheets for individuals seeking care and treatment in this office. Although GPC makes great efforts to protect your PHI, this information may be seen by others who are seeking care or services in the GPC office. For example, if one patient is signing in while one is checking out at the front desk.

13. Change of Ownership: In the event that GPC is sold or merged with another organization, your health information/record will become the property of the new owner.

II. When GPC May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, GPC will not use or disclose your health information without your written authorization. If you do authorize GPC to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

III. Your Health Information Rights

You have the right to:

(b) Request restrictions on certain use and/or disclosure of your PHI as provided by law. However, GPC is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to GPC’s Privacy Officer. In your written request, you must inform GPC of what information you want to limit, whether you want to limit the GPC’s use or disclosure, or both, and to whom you want the limits to apply. If the Practice agrees to your request, the Practice will comply with your request unless the information is needed in order to provide you with emergency treatment.

(c) Receive confidential communications or PHI by alternative means or at alternative locations. You must make your request in writing to GPC’s Privacy Officer. GPC will accommodate all reasonable requests.

(d) Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to the GPC’s Privacy Officer. GPC may charge you a fee of $1.00 per page (amount will not exceed $10.00) for the cost of copying, and we may charge for mailing or other supplies associated with your request.

(e) Amend your PHI as provided by law. To request an amendment, you must submit a written request to the GPC’s Privacy Officer. You must provide a reason that supports your request. GPC 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 GPC (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by GPC, 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 GPC’s denial, you will have the right to submit a written statement of disagreement.

(f) Receive an accounting of disclosures of your PHI as provided by law. To request an accounting, you must submit a written request to the GPC’s Privacy Officer. The request must state a time period which may not be longer than six (6) years and may not include dates before April 14, 2003. The request should indicate in what form you want the list (such as a paper or electronic copy). The first list you request within a twelve (12) month period will be free, but GPC may charge you for the cost of providing additional lists. GPC will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred.

(g) Receive a paper copy of this Privacy Notice from GPC upon request to the GPC’s Privacy Officer.

(h) Complain to GPC or to the Secretary of HHS if you believe your privacy rights have been violated. To file a complaint with GPC, you must contact the GPC’s Privacy Officer. All complaints must be in writing.

IV. GPC Requirements

(b) GPC is required by State law to maintain a higher level of confidentiality with respect to certain portions of your medical information that is provided for under federal law.

(c) GPC is required to abide by the terms of this Privacy Notice.

(d) GPC reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for your entire PHI that it maintains.

(e) GPC will distribute any revised Privacy Notice to you prior to implementation if possible and no later than during your first visit after the implementation.

(f) There will be no recourse against you for filing a complaint.

V. Complaints

Complaints about this Notice of Privacy Practices or how GPC handles your health information should be directed to:

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.