NOTICE OF PRIVACY PRACTICES

Compass Family Chiropractic - 4425 US Hwy 1 S Suite 109, St. Augustine, Florida 32086

Leroy William Dickman, D.C. - (904) 797-5100

Effective Date: 01/01/2024

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.

At Compass Family Chiropractic, we are committed to protecting the privacy of your medical information. We understand that medical information about you and your health is personal, and we are committed to protecting this information. We create a record of the care and services you receive at our practice to provide you with quality care and to comply with certain legal requirements. This Notice applies to all the records of your care generated by Compass Family Chiropractic, whether made by your personal doctor or others working at our offices.

A. Our Responsibilities:

We are required by law to:

- Maintain the privacy of your protected health information.

- Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.

- Abide by the terms of this Notice.

- Notify you if we are unable to agree to a requested restriction.

- Accommodate reasonable requests you may have to communicate health information.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised Notice to the address you’ve supplied us with.

How We May Use and Disclose Medical Information About You:

The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

1. Treatment: We utilize your health information to provide tailored chiropractic care, coordinating with our team and external providers as necessary for optimal treatment.

2. Payment: Your health information is essential for billing purposes, facilitating payment from insurance plans and assisting in the financial aspects of your care.

3. Health Care Operations: We employ your health information for managing and enhancing the operations of our practice, ensuring quality care and efficient administrative processes.

4. Appointment Reminders: We'll use your information to remind you of upcoming appointments, employing various methods to reach you if you're unavailable.

5. Sign-In Sheet: For organizational purposes, we use a sign-in process at our office and may announce your name when it's time for your session.

6. Notification and Communication With Family: In specific scenarios, especially emergencies, we may communicate your health status to family or responsible parties.

7. Marketing: We engage in health-related marketing without financial benefit and require your explicit consent for any marketing activities that involve compensation.

8. Sale of Health Information: Selling your health information is not our practice and would only occur with your clear consent, which you can withdraw at any time.

9. Required by Law: We are obliged to disclose your health information when required by law, including for legal and regulatory purposes.

10. Public Health: In certain instances, we may disclose your health information for public health initiatives or as required by health authorities.

11. Health Oversight Activities: Your health information may be disclosed during audits, investigations, or inspections by health oversight agencies.

12. Judicial and Administrative Proceedings: In the context of legal proceedings, we may disclose necessary health information as authorized by courts or administrative orders.

13. Law Enforcement: For specific law enforcement purposes, such as identifying a suspect or complying with legal orders, we may disclose relevant health information.

14. Coroners: In cases involving deaths, we may provide health information to coroners as part of their investigations.

15. Organ or Tissue Donation: We may disclose health information to facilitate organ or tissue donation and transplantation processes.

16. Public Safety: To prevent or reduce threats to public health or safety, we may disclose necessary health information.

17. Proof of Immunization: We will provide immunization records to schools or other entities as required and with your agreement.

18. Specialized Government Functions: In cases involving military or national security activities, we may disclose health information as required.

19. Workers’ Compensation: For workers' compensation claims, we may disclose health information in accordance with relevant laws.

20. Change of Ownership and Breach Notification: If our practice changes ownership, your health records will be transferred, and we will notify you promptly in case of any breach of unsecured health information.

B. Limitations on the Use or Disclosure of Your Health Information

Outside of the scenarios outlined in this Privacy Notice, Compass Family Chiropractic will not use or disclose your identifiable health information without your explicit authorization, in line with our legal obligations. You have the right to withdraw your authorization for any specific use or disclosure of your health information at any time, provided it is in writing.

C. Your Rights Regarding Health Information

1. Right to Request Privacy Restrictions: You can ask us to place additional restrictions on our use or disclosure of your health information. Your written request should specify what information you want to limit. We will accommodate your requests regarding payments out-of-pocket in full, and we reserve the right to accept or reject other requests, notifying you of our decision.

2. Right to Confidential Communication: You have the right to ask for the receipt of your health information in a certain manner or at a specific location, provided the request is reasonable and in writing.

3. Right to Access and Copy: You can request access to and obtain a copy of your health information. Written requests should specify the information you want and your desired format. We'll comply where feasible, and charge a nominal fee for costs incurred.

4. Right to Amend or Supplement: If you believe your health information is incorrect or incomplete, you can request an amendment in writing. We may deny your request under certain conditions but will provide reasons for our decision and allow you to submit a disagreement statement.

5. Right to an Accounting of Disclosures: You're entitled to a record of certain disclosures of your health information made by our practice, except for disclosures for treatment, payment, healthcare operations, and certain other situations.

6. Right to a Copy of this Notice: You can request a paper or electronic copy of this Privacy Notice at any time.

For detailed explanations or to exercise these rights, please contact our Privacy Officer.

D. Changes to this Notice

Compass Family Chiropractic reserves the right to amend this Privacy Notice. We're obligated to adhere to the current Notice until an amendment is made. Following any changes, the revised Notice will apply to all health information we maintain. Current notices will be posted in our reception area and on our website.

E. Complaints

If you have concerns about this Privacy Notice or our handling of your health information, please contact our Privacy Officer. For unresolved issues, you may file a formal complaint with the Office for Civil Rights (OCR) at OCRMail@hhs.gov.

Contact info.

Email - Office@realignyourhealth.com

Phone - (904) 797-5100