NOTICE OF HIPAA PRIVACY PRACTICES

Your Privacy Rights

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.

Revolution Chiropractic Murfreesboro is required by law to keep your health information private and secure. This information may include:

• Notes from your doctor, teacher, or other healthcare providers
• Medical history
• Test results
• Treatment notes
• Insurance information

A government rule, known as the Health Insurance Portability and Accountability Act (HIPAA), requires that you receive a copy of this privacy notice. We will ask you to sign a form acknowledging that you have received it.

You can review this notice at any time to understand how your health information may be used and who may see it.

How Your Health Information May Be Used or Shared

We may use or share your health information with or without your written permission, depending on the situation.

When Your Permission Is Not Needed

We may use or share your health information without your permission for the following reasons:

• Treatment: To coordinate your care with other healthcare providers.
  Example: If your doctor refers you for physical therapy, we may share treatment results with them.
• Payment: To process insurance claims for services rendered.
  This may include:
  • Obtaining prior authorization
  • Requesting additional treatment approvals
  • Billing your insurance for services
• Healthcare Operations: To monitor and improve the quality of our care and services.
  This may include:
  • Evaluating staff performance
  • Comparing outcomes with other clinics
  • Enhancing care quality
• Abuse and Neglect: To report suspected abuse, neglect, or domestic violence to appropriate authorities.
• Appointment Reminders: To remind you of upcoming appointments via phone, voicemail, text message, or email. Notify our front desk if you prefer not to receive reminders.
• As Required by Law: To comply with federal, state, or local legal obligations, including police or court orders.
• Government Functions: For national security, military service, or veterans’ affairs.
• Deceased Individuals: To communicate with coroners, medical examiners, or funeral directors.
• Marketing: To inform you about services that may be of interest. You may opt out of receiving such communications.
• Public Health Risks: To report issues such as disease outbreaks or medication safety to public health agencies, including the FDA.
• Regulatory Oversight: To participate in audits, inspections, and licensure requirements by oversight agencies.
• Research: To contribute to research studies that have passed appropriate privacy reviews and include safeguards for your data.
• Health and Safety Threats: To prevent serious threats to your health or others’ safety.
• Workers’ Compensation: To comply with requirements for work-related injuries or illness claims.

When Your Permission Is Required

For uses not listed above, we must obtain your written authorization. You may revoke this authorization at any time in writing. However, we cannot take back information already shared with your consent.

Your Privacy Rights

You have the right to:

• Request restrictions: Ask us not to share certain information for treatment, payment, or healthcare operations. We are not required to agree, but will comply whenever possible.
• Request confidential communication: Ask us to contact you in a specific way or at a specific location (e.g., call only at work). We will honor reasonable requests.
• Access your medical records: You may view and obtain copies of your medical, billing, and treatment records, except in limited legal situations.
• Request amendments: Ask for corrections or additions to your records if you believe information is incorrect or incomplete. All requests must be in writing and include a reason.
• Request an accounting of disclosures: Ask for a list of instances when we shared your information (excluding certain internal uses).
  Rules:
  • Requests must be in writing.
  • You can ask for records going back six years (from April 14, 2003, onward).
  • Specify whether you want a paper or electronic copy.
• Receive a copy of this notice: You may request a paper copy at any time, even if you received it electronically.
• File a complaint:
  • If you believe your rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services.
  • Filing a complaint will not affect your care or rights in any way.

Who Must Follow This Notice

This notice applies to:

• All employees of Revolution Chiropractic Murfreesboro
• Students, interns, and staff authorized to enter medical records
• Any volunteers assisting within the clinic

Changes to This Notice

We may update this notice at any time. Changes will apply to all health information we maintain, past and present. The most current version will be available at the clinic and will include the effective date on the first page.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with the U.S. Department of Health and Human Services:
www.hhs.gov/ocr/privacy/hipaa/complaints

All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact Information

For questions or concerns about this notice or your rights, contact:

Dr. Oscar Noriega D.C.
Phone: (615) 867-7693
Email: info@rhcboro.com