Form Cms-R-131 - Application For Peripheral Neuropathy Treatment (Page 4 of 10) in pdf

Welcome to Prax Chiropractic And Massage: A Functional

Neurology Center!

Notice of Privacy Practices

HIPAA (Health Insurance Portability and Accountability Act)

Protecting Your Confidential Health Information is Important to Us!

This notice describes how health information about you may be used

laboratories, pharmacies or other health care personnel providing you

and disclosed and how you can get access to this information. It was

treatment.

updated 9/23/13 in accordance with HIPAA Policy. Please review it

carefully.

To Obtain Payment

We may include your health information with an invoice used to collect

Dear Patient:

payment for treatment you receive in our office. We may do this with

insurance forms filed for you in the mail or sent electronically. We will

This is not meant to alarm you! Quite the opposite! It is our desire to

be sure to only work with companies with a similar commitment to the

communicate to you that we are taking the new Federal (HIPAA –

security of your health information.

Health Portability and Accountability Act) laws written to protect the

confidentiality of your health information seriously. We do not ever

To Conduct Health Care Operations

want you to delay treatment because you are afraid your personal

Your health information may be used during performance evaluations

health history might be unnecessarily made available to others outside

of our staff. Some of our best teaching opportunities use clinical

of our office. The term PHI means protected health information.

situations experienced by patients receiving care at our office. As a

result, health information may be included in training programs for

The most significant variable that has motivated the Federal

students, interns, associates, and business and clinical employees. It is

government to legally enforce the importance of the privacy of health

also possible that health information will be disclosed during audits by

information is the rapid evolution of computer technology and its use

insurance companies or government appointed agencies as part of their

in health care. The government has appropriately sought to standardize

quality assurance and compliance reviews. Your health information

and protect the privacy of the electronic exchange of your health

may be reviewed during the routine processes of certification, licensing

information. This has challenged us to review not only how your

or credentialing activities.

health information is used within our computers but also with the

internet, phone, faxes, copy machines, and charts. We believe this has

In Patient Reminders

been an important exercise for us because it has disciplined us to put in

Because we believe regular care is very important to your general

writing the policies and procedures we use to ensure the protection of

health, we will remind you of a scheduled appointment or that it is

your health information everywhere it is used.

time for you to contact us and make an appointment. Additionally, we

may contact you to follow up on your care and inform you of

We want you to know about these policies and procedures which we

treatment option or services that may be of interest to you or your

developed to make sure your health information will not be shared

family.

with anyone who does not require it. Our office is subject to State and

Federal law regarding the confidentiality of your health information

Abuse or Neglect

and in keeping with these laws; we want you to understand our

procedures and your rights as our valuable patient.

We will notify government authorities if we believe a patient is the

victim of abuse, neglect or domestic violence. We will make this

We will use and communicate your HEALTH INFORMATION only for

disclosure only when we are compelled by our ethical judgment, when

the purposes of providing your treatment, obtaining payment and

we believe we are specifically required or authorized by law or with the

conducting health care operations. Your health information will not be

patient’s agreement.

used for other purposes unless we have asked for and been voluntarily

given your written permission.

Public Health and National Security

We may be required to disclose to Federal officials or military

The 9/23/2013 HIPAA update to this notice includes changes related to

authorities health information necessary to complete an investigation

disclosures to health plans, marketing, copies of ePHI, breach

related to public health or to national security. Health information

notification, and the sale of your PHI further described below.

could be important when the government believes that the public safety

could benefit when the information could lead to the control or

How your HEALTH INFORMATION may be used

prevention of an epidemic or the understanding of new side effects of a

drug treatment or medical device.

To Provide Treatment

For Law Enforcement

We will use your HEALTH INFORMATION within our office to

provide you with the best health care possible. This may include

As permitted or required by State or Federal law, we may disclose your

administrative and clinical office procedures designed to optimize

health information to a law enforcement official for certain law

scheduling and coordination of care between physician assistant, nurse,

enforcement purposes, including, under certain limited circumstances, if

physician and business office staff. In addition, we may share your

you are a victim of a crime or in order to report a crime.

health information with referring physicians, clinical and pathology

Form Cms-R-131 - Application For Peripheral Neuropathy Treatment Page 4

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