This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services. Please review it carefully.
Core Chiropractic Center and Rehab reserves the right to change the terms of this notice at any time. If we change this notice, the new terms will apply to all protected health information we maintain, including information created or received before the change. If we make a material change to this notice, we will post the revised notice at our office and on our website.
Uses and disclosures based on your implied consent
Because our clinic engages primarily in the direct treatment and/or assessment of patients (as opposed to a clearinghouse or third-party administrative function), we have direct treatment relationships with our patients. As such, we are permitted to use and disclose your protected health information for the purposes of treatment, payment, and healthcare operations, without your written consent, based on your implied consent to treatment.
Treatment
We may use and disclose your health information to provide, coordinate, or manage your chiropractic care and related services, including consulting with other healthcare providers regarding your treatment.
Payment
We may use and disclose your health information to obtain payment for services we provide to you, including billing your insurance carrier or other third-party payer.
Healthcare operations
We may use and disclose your health information for our healthcare operations, which include quality assessment, staff training, licensing, and general administrative and business activities.
We may use a sign-in sheet at the front desk where you will be asked to sign your name. We may also call you by name in the waiting room when your chiropractor is ready to see you.
We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment, or to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
We may disclose your protected health information to business associates who perform functions on our behalf and who agree, in writing, to safeguard the information appropriately. We may also disclose information to your family, friends, or other individuals involved in your care, unless you object.
We will not use or disclose your protected health information for marketing purposes without your written authorization.
Uses that require your written authorization
We may contact you as part of a fundraising effort. You have the right to opt out of receiving these communications at any time by notifying our Privacy Officer.
We may use your photograph, testimonial, or treatment outcome in our marketing materials or on our website and social media, but only with your prior written authorization.
Other uses and disclosures of your protected health information not described above will be made only with your written authorization. You may revoke this authorization at any time, in writing, except to the extent we have already relied on it.
Uses you have the opportunity to object to
Others involved in your healthcare
Unless you object, we may disclose your protected health information to a family member, friend, or other individual involved in your care or in payment for your care. We may also disclose your information to notify (or assist in notifying) such a person of your location, general condition, or, in the event of your death, to a person authorized by law.
Uses permitted without your consent, authorization, or opportunity to object
We may use or disclose your protected health information without your consent or authorization in the following circumstances:
Required by law
When required to do so by federal, state, or local law.
Public health
For public health activities, including reporting to prevent or control disease, injury, or disability.
Communicable diseases
To a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading it.
Health oversight
To a health oversight agency for activities authorized by law, such as audits and investigations.
Abuse or neglect
To a public health authority authorized to receive reports of child abuse or neglect, or to report suspected abuse or neglect of any patient.
Food and Drug Administration
For activities related to the quality, safety, or effectiveness of FDA-regulated products.
Legal proceedings
In response to a court or administrative order, subpoena, discovery request, or other lawful process.
Law enforcement
For law enforcement purposes, including reporting certain wounds or injuries.
Coroners, funeral directors, and organ donation
To coroners, medical examiners, and funeral directors, and for cadaveric organ, eye, or tissue donation purposes.
Research
To researchers, provided certain measures have been taken to protect your privacy.
Criminal activity
To prevent or lessen a serious and imminent threat to the health or safety of any person or the public.
Military and national security
To military authorities for members of the armed forces, and for national security and intelligence purposes.
Workers' compensation
As authorized by, and to comply with, workers' compensation laws.
Inmates
To a correctional institution or law enforcement official having custody of an inmate.
Required uses and disclosures
To the Secretary of the Department of Health and Human Services to investigate compliance, or to you upon your request.
Your rights
You have the following rights regarding the protected health information we maintain about you:
Inspect and copy
You have the right to inspect and copy your protected health information, with certain exceptions.
Know when access may be limited
You have the right to know the circumstances under which your information may be disclosed without your authorization.
Request a restriction
You have the right to request a restriction on certain uses and disclosures of your information, although we are not required to agree to the restriction.
Know when a restriction may be refused
You have the right to be informed of the circumstances in which we may deny your request for a restriction.
Request confidential communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
Have your physician amend your record
You have the right to request an amendment to your protected health information for as long as we maintain it.
Receive an accounting of certain disclosures
You have the right to receive a list of certain disclosures we have made of your protected health information.
Obtain a paper copy
You have the right to obtain a paper copy of this notice from us, even if you agreed to receive it electronically.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Contact our Privacy Officer
Dr. Haroun Fetteh, DC — Core Chiropractic Center and Rehab
17070 W 12 Mile Rd Ste B, Southfield, MI 48076
Phone: (248) 327-6931 • Email: info@corechirorehab.com