Privacy Policy

NOTICE OF PRIVACY PRACTICES

PERFORMANCE CHIROPRACTIC, LLC
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.

This notice takes effect on your first date of service and remains in effect until replaced or revoked in writing.

 OUR PLEDGE REGARDING MEDICAL INFORMATION
The privacy of your medical information is important to us.  We understand that your medical information is personal and we are committed to protecting it.  We create a record of the care and services you receive at PERFORMANCE CHIROPRACTIC, LLC.  We need this record 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 medical information about you.  We also describe your rights and certain duties we have regarding the use and disclosure of medical information.

OUR LEGAL DUTY


Law requires us to:

  • Keep your medical information private.
  • Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
  • F follow the terms of the notice that is now in effect         

We have the right to:

  • Change our privacy practices at any time, provided that the changes are permitted by law.
  • Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

Notice of change to Privacy Practices:

  • 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 YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information.  We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization.  Any specific 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, chiropractic interns or other people assisting in your care.  We may also share medical information about you to your other health care providers to assist them in treating you.

FOR PAYMENT:
 We may use and disclose your medical information for payment purposes. Information required by all insurance companies for payment include identifying information (name, date of birth, sex, and address, insured’s identification), date of service, Diagnosis, and Procedure codes, Treatment Plan, and Doctor’s notes. IF YOU DO NOT WANT ANY OR ALL OF THIS NFORMATION TO BE SHARED WITH YOUR INSURANCE COMPANY YOU MUST SELF-PAY AT THE TIME OF SERVICE.

YOUR INDIVIDUAL RIGHTS:

  • you may request copies of your medical records. Requests for medical records must be made in writing either by paper or email.  Please verify in writing whether you prefer photocopies or electronic copies of your records sent to you. We require 2 business days for processing of the request.
  • you may request that clarification or changes be made to this notice or your records. If we choose to deny the request you will be notified and the request as well as reasons for denial will be documented in your record.  Any requested changes or clarifications will also be documented as such in your record.
  • you may contact us with any questions or complaints regarding your privacy rights.  You may also submit a written complaint to the U.S. Department of Health and Human Services if you feel we have violated your privacy rights.

Team chiropractors for:

 

bears

blues

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