Notice of Privacy Practices
Your health information is personal. This notice explains how medical information about you may be used and disclosed and describes your rights regarding that information.
Privacy Officer
Donald L. Aivalotis II, D.C.
Adjustments Chiropractic & Wellness
7900 Steubenville Pike, Suite 40
Imperial, PA 15126
dr.aivalotis@adjustmentschiropractic.com
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others.
We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.
How We May Use or Disclose Your Health Information
This medical practice collects health information about you and stores it in a chart and on a computer. The law permits us to use or disclose your health information for the following purposes:
1. Treatment
We use medical information about you to provide your medical care. We may disclose medical information to employees and others involved in providing the care you need, including other physicians, health care providers, pharmacists, laboratories, family members, or others who may assist with your care when permitted by law.
2. Payment
We may use and disclose medical information about you to obtain payment for services we provide and may disclose information to other health care providers to assist them in obtaining payment for services they have provided.
3. Health Care Operations
We may use and disclose medical information to operate this practice, including activities related to quality assessment, professional qualifications, legal services, audits, compliance, business planning and management, and other health care operations. Information may also be shared with business associates that perform services for us and are required to appropriately protect protected health information.
4. Appointment Reminders
We may use and disclose medical information to contact and remind you about appointments. When appropriate, appointment information may be left in a telephone or electronic message.
5. Sign-In & Office Communications
We may use a sign-in sheet when you arrive at our office and may call your name when we are ready to see you.
6. Family & Others Involved in Your Care
When permitted by law, we may disclose relevant health information to a family member, personal representative, or another person involved in your care or payment for your care. When possible, you will be provided an opportunity to agree or object to these disclosures.
7. Marketing
We may communicate with you regarding treatment-related products, services, care coordination, alternative treatments, providers, health programs, or services offered by this practice as permitted by law. We will not otherwise use or disclose your medical information for marketing purposes or accept payment for marketing communications requiring authorization without first obtaining your written authorization.
8. Sale of Health Information
We will not sell your health information without your prior written authorization when such authorization is required by law.
9. Required by Law & Public Health
We may use or disclose health information when required or permitted by law, including for public health activities such as preventing or controlling disease, reporting certain forms of abuse or neglect, reporting certain product or medication problems, and other legally authorized public health purposes.
10. Health Oversight Activities
We may disclose health information to health oversight agencies for legally authorized activities such as audits, investigations, inspections, licensure proceedings, and other oversight activities.
11. Judicial & Administrative Proceedings
We may disclose health information in connection with judicial or administrative proceedings when authorized or required by applicable law, court order, subpoena, discovery request, or other lawful process.
12. Law Enforcement
We may disclose health information to law enforcement officials when permitted or required by law, including in response to certain warrants, court orders, subpoenas, or other lawful requests.
13. Coroners
We may disclose health information to coroners or other authorized officials in connection with investigations of deaths as permitted or required by law.
14. Organ or Tissue Donation
We may disclose health information to organizations involved in procuring, banking, or transplanting organs and tissues when applicable.
15. Public Safety
We may disclose health information when permitted by law to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
16. Proof of Immunization
We may disclose proof of immunization to a school required to have such information when you have agreed to the disclosure on behalf of yourself or your dependent.
17. Specialized Government Functions
We may disclose health information for certain authorized military, national security, correctional institution, or other specialized government functions.
18. Workers’ Compensation
We may disclose health information as necessary to comply with applicable workers’ compensation laws and related legal requirements.
19. Change of Ownership
If this medical practice is sold or merged with another organization, health information and medical records may become the property of the successor organization, subject to applicable law and your continuing rights regarding your health information.
20. Breach Notification
In the event of a breach of unsecured protected health information, we will provide notification as required by law. Notification may be provided by us or, in appropriate circumstances, by one of our business associates.
When We May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information that identifies you without your written authorization.
If you authorize this medical practice to use or disclose your health information for another purpose, you may revoke that authorization in writing at any time, subject to applicable law.
Your Health Information Rights
You have important rights regarding your protected health information.
1. Right to Request Special Privacy Protections
You may request restrictions on certain uses and disclosures of your health information. Requests should be made in writing and describe the information and limitations you are requesting.
2. Right to Request Confidential Communications
You may request that we communicate with you about health information in a specific way or at a specific location. We will comply with reasonable written requests as required by law.
3. Right to Inspect & Copy
You generally have the right to inspect and obtain a copy of your health information, subject to limited exceptions and applicable legal requirements. Requests should identify the information you wish to access and your preferred form or format.
4. Right to Amend or Supplement
You may request an amendment to health information you believe is incorrect or incomplete. Requests must be made in writing and explain why you believe the information should be amended.
5. Right to an Accounting of Disclosures
You may request an accounting of certain disclosures of your health information made by this practice, subject to exceptions established by law.
6. Right to a Paper or Electronic Copy of This Notice
You have the right to receive a copy of this Notice of Privacy Practices, including a paper copy even if you previously agreed to receive the notice electronically.
Changes to This Notice
We reserve the right to amend this Notice of Privacy Practices in the future. Until an amendment is made, we are required to comply with the terms of the Notice currently in effect.
After an amendment is made, the revised Notice may apply to all protected health information we maintain, regardless of when it was created or received. The current Notice will be made available through our office and posted on our website.
Questions or Complaints
Questions or complaints regarding this Notice of Privacy Practices or the way this practice handles your health information should be directed to our Privacy Officer.
Donald L. Aivalotis II, D.C.
Adjustments Chiropractic & Wellness
7900 Steubenville Pike, Suite 40
Imperial, PA 15126
dr.aivalotis@adjustmentschiropractic.com
If you are not satisfied with the manner in which this office handles a complaint, you may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.
You will not be penalized or retaliated against for filing a complaint.
