Privacy Policy & Patient Rights

Disclosure of Your Health Care Information

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.

Arbor Creek Chiropractic (member of Active Chiropractic Group) is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

1. Treatment

We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example) “On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Arbor Creek Chiropractic (member of Active Chiropractic Group).”
“It is our policy to provide a substitute health care provider, authorized by Arbor Creek Chiropractic & Acupuncture to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.”

2. Payment

We may disclose your health information to your insurance provider for the purpose of payment or health care operations.

3. Workers’ Compensation

We may disclose your health information as necessary to comply with State Workers’ Compensation Laws.

4. Emergencies

We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

5. Public Health

As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

6. Judicial and Administrative Proceedings.

We may disclose your health information in the course of any administrative or judicial proceeding.

7. Law Enforcement.

We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

8. Deceased Persons.

We may disclose your health information to coroners or medical examiners.

9. Organ Donation.

We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

10. Research.

We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

11. Public Safety.

It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

12. Specialized Government Agencies.

We may disclose your health information for military, national security, prisoner and government benefits purposes.

13. Change of Ownership.

In the event that Arbor Creek Chiropractic (member of Active Chiropractic Group) is sold or merged with another organization, your health information/record will become the property of the new owner.

14. Your Health Information Rights

  • You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Arbor Creek Chiropractic (member of Active Chiropractic Group) is not required to agree to the restriction that you requested.
  • You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
  • You have the right to inspect and copy your health information.
  • You have a right to request that Arbor Creek Chiropractic (member of Active Chiropractic Group) amend your protected health information. Please be advised, however, that Arbor Creek Chiropractic (member of Active Chiropractic Group) is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial.
  • You have a right to receive an accounting of disclosures of your protected health information made by Arbor Creek Chiropractic (member of Active Chiropractic Group).
  • You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

15. Changes to this Notice of Privacy Practices

Arbor Creek Chiropractic (member of Active Chiropractic Group) reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains.

Until such amendment is made, Arbor Creek Chiropractic (member of Active Chiropractic Group) is required by law to comply with this Notice.

Arbor Creek Chiropractic (member of Active Chiropractic Group) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact our office at tour main phone number. If the doctor is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

16. Complaints

Complaints about your Privacy rights, or how Arbor Creek Chiropractic (member of Active Chiropractic Group) has handled your health information should be directed to Arbor Creek Chiropractic (member of Active Chiropractic Group), by calling our office.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

PATIENT RIGHTS

1. Access to Care: Individuals shall be accorded impartial access to treatment of accommodations as to their request and needs for treatment or service that are within the office’s capacity, availability, its stated mission and applicable law and regulation, regardless of race, creed, sex, national origin, religion, disability/handicap or source of payment for care.

2. Respect and Dignity: All individuals, whether adult, adolescent, or newborn, have the right to considerate, respectful care at all times and under all circumstances, unless their circumstances interfere with the dignity, respect and personal rights of staff members, with recognition of the personal dignity and the psychosocial, spiritual, and cultural variables that influence their perceptions of illness.

3. Privacy and Confidentiality: The patient (or his/her parent or legal designated representative) has the right, within the law, to personal and informational privacy, as manifested by the right to:

  • Receive appropriate treatment in the least restrictive setting available.
  • Refuse to talk with or see anyone not officially connected with Arbor Creek Chiropractic & Acupuncture, including visitors or persons officially connected with the office but who are not directly involved in his/her care.
  • Wear appropriate personal clothing and religious or other symbolic items, as long as they do not interfere with diagnostic procedures or treatment.
  • Be interviewed and examined in surroundings designed to assure reasonable audiovisual privacy. This includes the right to have a person of one’s same sex present during certain parts of a physical examination, treatment or procedure performed by a health professional of the opposite sex; and the right not to remain disrobed any longer than is required for accomplishing the medical purpose for which the patient was asked to disrobe.
  • Expect that any discussion or consultation involving the patient’s case, whether adult, adolescent or newborn, will be conducted discreetly, and that individuals not directly involved in his/her care will not be present without his/her permission.
  • Have the right to review his/her medical records an have the information explained, except when restricted by law.
  • Have the medical records read only by individuals directly involved in the treatment or the monitoring of its quality, and by other individuals only on the patient’s (or his/her patient’s legal designated representative’s) written authorization. When the records are released to insurers, that confidentiality is emphasized.
  • Expect all communications and other records pertaining to his/her care, including the source of payment for treatment, to be treated as confidential.
  • Request a transfer to another treatment room if another patient or visitor is unreasonably disturbing him/her.
  • Be placed in protective privacy when considered necessary for personal safety.

4. Personal Safety: The patient, whether adult, adolescent or newborn, has the right to expect reasonable safety insofar as the office practices and environment that provides reasonable protection from harm and appropriate privacy for personal reasons.

5. Identity: The patient (or his/her parent or legal designated representative) has the right to know the identity and professional status of individuals providing service to him/her and to know which physician or other practitioners is primarily responsible for his/her care. This includes the right to know of the existence of any professional relationships among individuals who are treating him/her, as well as the relationship of the office to any other health care or educational training programs or in the gathering of data for research purposes should be voluntary.

6. Information: The patient (or his/her parent or legal designated representative) has the right to obtain (from the practitioner responsible for coordination of the degree known), treatment and any known prognosis. This information should be communicated in terms the patient (or his/her parent or legal designated representative) can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to a legally authorized individual.

7. Communication: The patient (or his/her parent or legal designated representative) has the right of access to people outside the office by means of visitors and by verbal and written communication. When the patient (or his/her parent or legal designated representative) does not speak or understand the predominant language of the community, he/she must and/or should personally obtain and utilize an interpreter. This is particularly true where language and/or communication barriers are a continuing problem.

8. Consent: The patient (or his/her parent or legal designated representative) has the right to the information necessary to enable him/her, in collaboration with the health care practitioner, to make treatment decisions involving his/her health care that reflect his/her wishes. To the degree possible, this should be based on a clear, concise explanation of his/her condition and of all proposed technical side effects or possible problems related to recuperation and probability of success. The patient should not be subjected to any procedure that is not performed with the voluntary and competent consent of the patient (or his/her parent or legal designated representative). Where medically significant need for care or treatment exists, the patient (or his/her parent or legal designated representative) shall be so informed. The patient (or his/her parent or legal designated representative) has the right to know who is responsible for authorizing and performing the procedures and/or treatment. The patient (or his/her parent or legal designated representative) shall be informed if the office proposes to engage in or perform human experimentation or other research/educational projects affecting his/her care or treatment, and the patient has the right to participate or to refuse to participate in any such activity. If the patient chooses not to participate, his/she shall receive the most effective care the office normally provides.

9. Consultation: The patient (or his/her parent or legal designated representative) has the right to accept medical care or to refuse treatment to the extent permitted by law and be informed of the medical consequences of such refusal. When refusal of treatment by the patient (or his/her parent or legal designated representative) prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the patient may be terminated with notice. The patient also has the right to an individualized treatment plan and to participate in the development of the plan.

10. Transfer and Continuity of Care: The patient (or his/her parent or legal designated representative) has the right to expect that the office will provide all necessary health services, including wellness care, to the best of its ability. Treatment, referral or transfer may be recommended. If transfer is recommended or requested, the patient will be informed of risks, benefits and alternatives. The patient will not be transferred until the other institution agrees to accept the patient.

11. Charges: Regardless of the source of payment for the individual’s care, the patient (or his/her parent or legal designated representative) has the right to request and receive an itemized and detailed explanation of his/her total bill for services rendered in the office. The patient (or his/her parent or legal designated representative) has the right to timely notice prior to termination of his/her eligibility for reimbursement by any third-party payer for the cost of his/her care.

12. Delineation of the Patient’s Rights: The rights of the patient may be delineated on behalf of the patient, to the extent permitted by law, to the patient’s guardian, next of kin or legally authorized responsible person, if the patient:

  • Has been adjudicated incompetent in accordance with the law, or
  • Is found by his/her physician to be medically incapable of understanding the procedure, or
  • Is unable to communicate his/her wishes regarding treatment, or
  • Is a minor

13. Rules and Regulations: The patient (or his/her parent or legal designated representative) should be informed of the office rules and regulations applicable to his/her conduct as a patient. Patients are entitled to information about the mechanism for the initiation, review and resolution of patient complaints.

PATIENT RESPONSIBILITES

1. The patient (or his/her parent or legal designated representative) has the responsibility to provide, to the best of his/her knowledge, accurate and complete information about the present complaints, past illness, hospitalization, medications and other matters relating to his/her health. The patient has the responsibility to report unexpected changes in his/her condition to the responsible practitioner. The patient (or his/her parent or legal designated representative) is responsible for making it known whether he/she clearly comprehends a contemplated course of action and what is expected to him/her.

2. The patient (or his/her parent or legal designated representative) is responsible for following the treatment plan recommended by the practitioner that is primarily responsible for his/her care. This may include, but is not limited to, following the instructions of health care personnel as they carry out the coordinated plan of care and implement the responsible practitioner’s orders, and as they enforce the applicable office rules and regulations. The patient (or his/her parent or legal designated representative) is responsible for keeping appointments and, when he/she is unable to do so for any reason, for notifying the responsible practitioner or the office.

3. The patient (or his/her parent or legal designated representative) is responsible for his/her actions if he/she refuses treatment or does not follow the practitioner’s instructions. If the patient cannot follow through with the treatment, he/she is responsible for informing the physician.

4. The patient (or his/her parent or legal designated representative) is responsible for assuming that the financial obligations of his/her health care are fulfilled as promptly as possible. The patient (or his/her parent or legal designated representative) is responsible for providing information for insurance.

5. The patient (or his/her parent or legal designated representative) is responsible for following the office rules and regulations affecting patient care and conduct. The patient (or his/her parent or legal designated representative) do not have the right to abuse any physician or office staff sexually, verbally or physically or in any other way. The office will dismiss any patient from care, no matter their physical or emotional condition and will immediately press charges to the full extent of the law.

6. The patient (or his/her parent or legal designated representative) is responsible for being considerate of the rights of other patients and personnel and for assisting in the control of noise, smoking and the number of visitors. The patient is responsible for being respectful of the property of other persons and of the office.

7. A patient’s health depends not just on his/her care, but in the long term, on the decisions he/she makes in his/her daily live and activities. The patient (or his/her parent or legal designated representative) is responsible for recognizing the effect of any lifestyle on his/her personal life.