HIPAA Notice of Privacy Practices

Who follows this notice

This Notice of Privacy Practices ("Notice") applies to Complete Wellness Chiropractic, its chiropractic physician, employees, staff and anyone else involved in your care at our office at 14358 N Frank Lloyd Wright Blvd, Suite B-15, Scottsdale, AZ 85260. We all follow this Notice when we use or share your protected health information: information that identifies you and relates to your past, present or future physical or mental health, the care you receive, or payment for that care.

Our duties

We are required by law to:

• Keep your protected health information private.
• Give you this Notice of our legal duties and privacy practices.
• Follow the terms of the Notice currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your information.

How we may use and share your health information

The categories below describe the ways we may use and disclose your information. Not every use in a category is listed, but every way we are allowed to use or share information falls into one of them.

Treatment

We use your information to examine, diagnose and treat you, and we may share it with other health care providers involved in your care. For example, we may send X-ray findings to your physician or to another provider you are referred to.

Payment

We use and share your information to bill and get paid for the care you receive. For example, we may give information to a health plan to check out-of-network benefits, to Medicare, or to an auto or personal injury insurer when your care relates to an accident.

Health care operations

We use your information to run our practice and improve care, for example to review the quality of our services, train staff, and handle compliance, legal and administrative work.

Appointment reminders and services

We may contact you by phone, text, email or mail to remind you of appointments or to tell you about treatment options and health-related services we offer. You can ask us to contact you in a different way (see "Your rights" below).

Business associates

We may share information with companies that perform services for us, such as scheduling, billing, records and IT providers. They must sign an agreement to protect your information.

Family, friends and others involved in your care

Unless you object, we may share information with a family member, friend or other person you identify who is involved in your care or helps pay for it. If you are not present or able to agree, we will use our professional judgment about what is in your best interest.

Other uses allowed or required by law

We may also use or share your information without your written authorization when the law allows or requires it, including:

• As required by lawWhen federal, state or local law requires it.
• Public health and safetyTo prevent or control disease, injury or disability, report abuse or neglect, report problems with products, or prevent a serious threat to someone’s health or safety.
• Health oversightTo agencies authorized by law to audit, inspect or license health care providers.
• Lawsuits and disputesIn response to a court or administrative order, subpoena or other lawful process.
• Law enforcementFor law enforcement purposes allowed by law, such as identifying a suspect or reporting a crime on our premises.
• Workers’ compensationFor workers’ compensation or similar programs, as allowed by law.
• Coroners and funeral directorsTo a coroner, medical examiner or funeral director when needed.
• Disaster reliefTo organizations assisting in a disaster so your family can be told about your condition and location.
• Government functionsFor military, national security, or correctional institution purposes, as allowed by law.
• ResearchFor research approved under privacy protections required by law.

Where Arizona or other law gives your information more protection than federal law, we follow the more protective law.

Uses that need your written permission

We will not use or share your information for marketing, sell your information, or share psychotherapy notes (if any exist) without your written authorization. Any other use or disclosure not described in this Notice also requires your written authorization. You may revoke an authorization in writing at any time. Revoking it stops future uses, but cannot undo a disclosure already made with your permission.

Your rights

To use any of these rights, contact our Privacy Officer using the details at the end of this Notice. We may ask you to make the request in writing.

• Get a copy of your recordsYou can ask to see or get a paper or electronic copy of your medical and billing records. We will usually respond within 30 days and may charge a reasonable, cost-based fee.
• Ask us to correct your recordsIf you believe information is incorrect or incomplete, you can ask us to amend it. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communicationsYou can ask us to contact you in a certain way (for example, only on your cell phone) or at a certain address. We will agree to all reasonable requests.
• Ask us to limit what we use or shareYou can ask us not to use or share certain information for treatment, payment or operations. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share it with your health plan and we will agree unless the law requires us to share it.
• Get a list of disclosuresYou can ask for a list of the times we shared your information in the six years before your request, with whom and why. Treatment, payment, operations and disclosures you authorized are not included. The first list in any 12-month period is free.
• Get a copy of this NoticeYou can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for youIf you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights. We will confirm their authority first.

Changes to this Notice

We may change the terms of this Notice, and the changes will apply to all information we hold about you. The current Notice is posted in our office and on this website, and the effective date appears at the top. You may ask for a copy of the current Notice at any visit.

Questions and complaints

If you have questions or believe your privacy rights have been violated, contact our Privacy Officer:

• Privacy OfficerDr. David Pope, DC
• MailComplete Wellness Chiropractic, Attn: Dr. David Pope, Privacy Officer, 14358 N Frank Lloyd Wright Blvd, Suite B-15, Scottsdale, AZ 85260
• Phone480-520-7000
• Emaildrpope@cwchiroaz.com

You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/complaints.

We will not penalize you or retaliate against you in any way for filing a complaint.