Privacy Notice

If you have any questions about this notice, please contact 
Lesli  - Hipaa Coordinator, 281-367-0404

This notice describes our practice and that of:

  • Any health care professional authorized to enter information into your office chart;
  • Any representative of an insurance carrier, managed care organization or clinical research organization that is participating in a review of your medical care;
  • All employees, staff and other office personnel; and,
  • All other entities and locations where the health care professionals in this office practice and follow the terms of this notice. These entities may share medical information with each other for treatment, payment or operations purposes.

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We copy or scan your driver license and medical insurance card/s. We create a record of the care and services you receive at this office in order to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the office, whether made by office personnel or your doctor.

This notice will tell you about the ways in which we may use and disclose medical information about you and also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

  • make sure that medical information that identifies you is kept private;
  • give you this notice of our legal duties and privacy practices with respect to medical information about you; and
  • follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

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, medical students, or other office personnel who are involved in your care at the office. Different departments of the office also may share medical information. We also may disclose medical information about you to people outside the office who may be involved in your medical care after you leave the office, such as family or others we use to provide services that are part of your care.

Payment - We may use and disclose medical information about you so that the treatment

    and services you receive at the office, hospital, ambulatory surgery center, or other site may be billed to and payment may be collected from you, an insurance company or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may disclose demographic and billing information to our outside collection agency if payment has not been made by you in a timely manner.

Health Care Operations - We may use and disclose medical information about you for

    office operations. These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care. We may disclose information to doctors, nurses, technicians, medical students, and other office personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

Messages/Appointment Reminders - We may use and disclose medical information to

    contact you regarding health care results, appointment reminders or billing issues. We may use e-mail, fax, or messaging on voice mail/answering machines at home or work to contact you unless specifically in writing you request this not to be done.

Health-Related Benefits and Services - We may use and disclose medical

    information to tell you about health-related benefits or services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care - We may release medical

    information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family that you are in the hospital, ambulatory surgery center or office.

As Required By Law - We will disclose medical information about you when required to

    do so by federal, state or local law. Workers' Compensation - We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Risks - We may disclose medical information about you for public health activities. These activities generally include the following:
  • To prevent or control disease, injury or disability;
  • To report deaths;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and,
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities - We may disclose medical information to a health oversight

    agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.

Lawsuits and Disputes - If you are involved in a lawsuit or a dispute, we may disclose

    medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.

Law Enforcement - We may release medical information if asked to do so by a law-enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • About criminal conduct at the office; and
  • In emergency circumstances.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

Right to Inspect and Copy - You have the right to inspect and copy medical information

    that may be used to make decisions about your care. Originals of this medical and billing information may not be allowed outside of the medical office for copying purposes. Usually, this includes medical and billing records, but does not include psychotherapy notes.
    To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Sunrise Chiropractic Group. If you request a copy of the information, we may charge a fee as permitted by state law for the costs of copying, mailing or other supplies associated with your request.
    We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.

Right to Amend - If you feel that medical information we have about you is incorrect or

    incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the office.
    To request an amendment, your request must be made in writing and submitted to Sunrise Chiropractic Group. In addition, you must provide a reason that supports your request.
    We may deny your request for an amendment if it is not in writing or does not include a supporting reason. In addition, we may deny your request if you ask us to amend information that:
  • Was not created by us,
  • Is not part of the medical information kept by or for the office;
  • Is not part of the information which you would be permitted to inspect and copy; or,
  • Is accurate and complete.

 

Right to Request Restrictions - You have the right to request a restriction or limitation on

    the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care.

    We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to . In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

    Right to Request Confidential Communications - You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to Sunrise Chiropractic Group. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice - You have the right to a paper copy of this notice.

    You may ask us to give you a copy of this notice at any time.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the office.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization.

You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.