Notice of Privacy Practices

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.

LAGUNA HILLS CHIRO MED 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.

USE AND DISCLOSURE OF YOUR HEALTH CARE INFORMATION

The following examples of the types of uses and disclosures of protected health information are not meant to be exhaustive but to describe the types of uses and disclosures that may be made by our office.

Treatment:
We may use and disclose your health information to provide, coordinate and manage your treatment and any related services. We may disclose your health information to health care professionals, personnel and others who are involved in your health care and treatment. For example, it may be necessary to seek consultation regarding your condition from other health care providers. And it is our policy to provide a substitute health care provider, authorized by LAGUNA HILLS CHIRO MED, 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.

Payment:
We may use and disclose your health information so that treatment we provide to you may be billed to and payment may be collected from you and/or your insurance or other responsible third party. For example, we may disclose your health information to your insurance carrier in order to obtain prior approval or to determine whether your plan will cover any treatment or services. And as a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to LAGUNA HILLS CHIRO MED for health care services rendered. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received.

Health Care Operations:
We may use and disclose your health information to operate and manage the business activities of LAGUNA HILLS CHIRO MED. These activities may include quality assessments, employee reviews and training of chiropractic students.

We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may post a schedule of appointments visible to all patients. We may call you by name in the waiting room. We may contact you or leave a message for you regarding an appointment. We may share your health information with third party business associates that perform various activities for the practice such as billing or transcription.

Workers' Compensation:
We may disclose your health information as necessary to comply with State Workers' Compensation Laws and other similar legally established programs.

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.

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.

Judicial and Administrative Proceedings:
We may disclose your health information in the course of any administrative or judicial proceeding.

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.

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

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

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

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.

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

Marketing:
We may contact you for marketing purposes or fundraising purposes. We may send you postcards, greeting cards, newsletters and other informational material. We may contact you and invite you to participate in a charitable activity.

Change of Ownership:
In the event that LAGUNA HILLS CHIRO MED is sold or merged with another organization, your health information/record will become the property of the new owner.

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 LAGUNA HILLS CHIRO MED 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 written request.

* You have the right to inspect and copy your health information. We may deny your request to inspect and copy in certain limited circumstances.

* You have a right to request that LAGUNA HILLS CHIRO MED amend your protected health information. Please be advised, however, that LAGUNA HILLS CHIRO MED 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 LAGUNA HILLS CHIRO MED. Your request must be made in writing and may not include dates prior to April 14, 2003.

* You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices:
LAGUNA HILLS CHIRO MED 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, LAGUNA HILLS CHIRO MED is required by law to comply with this Notice.

LAGUNA HILLS CHIRO MED 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 RACHAEL ALEXANDER by calling this office at (949) 859-5192. If RACHAEL ALEXANDER is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints:
Complaints about your Privacy rights or how LAGUNA HILLS CHIRO MED has handled your health information should be directed to RACHAEL ALEXANDER by calling this office at (949) 859-5192. If RACHAEL ALEXANDER is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

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

This notice is effective as of April 14, 2003.