Toy Chiropractic Clinic
7007 NW Cache Road
Lawton, OK 73505
580-536-4844

Your Information. Your Rights. Our Responsibilities.

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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and relates to your past, present, or future physical or mental health condition and related health care services.

Uses and Disclosures of Protected Health Information

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your health care and related services. For example, your information may be shared with a physician to whom you have been referred.

Payment

Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require disclosure to your health plan.

Healthcare Operations

We may use or disclose your protected health information to support the business activities of the physician’s practice, including quality assessment, employee review, training, licensing, and other operations.

We may use a sign-in sheet at registration, call you by name in the waiting room, contact you for appointment reminders, or inform you of treatment alternatives or health-related services that may interest you.

We may also use or disclose your protected health information without authorization in situations required by law, including:

• Public health requirements
• Communicable diseases
• Health oversight activities
• Abuse or neglect reporting
• FDA requirements
• Legal proceedings
• Law enforcement
• Coroners and funeral directors
• Organ donation
• Research
• Criminal activity
• Military and national security
• Workers’ compensation
• Inmates

Other permitted or required uses and disclosures will be made only with your consent or authorization unless required by law. You may revoke authorization in writing at any time, except where action has already been taken in reliance on it.

Your Rights

Right to Inspect and Copy

You have the right to inspect and copy your protected health information (fees may apply). Certain records are excluded under federal law, including psychotherapy notes and information prepared for legal proceedings.

Right to Request Restrictions

You may request restrictions on certain uses and disclosures of your PHI. We must comply when the PHI pertains solely to services paid out-of-pocket in full. Restrictions cannot apply to treatment purposes.

Right to Confidential Communications

You may request communications by alternative means or locations. You may also request a paper copy of this notice.

Right to Request Amendment

You may request an amendment to your protected health information. If denied, you may file a statement of disagreement.

Right to Accounting of Disclosures

You have the right to receive an accounting of disclosures except for treatment, payment, healthcare operations, authorized disclosures, and disclosures prior to April 14, 2003, or six years prior to the request date.

Right to Choose Someone to Act for You

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions regarding your health information.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Compliance Officer or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of your protected health information and to provide this notice of our legal duties and privacy practices. We must abide by the terms currently in effect.

If you have questions about this notice, please contact our HIPAA Compliance Officer at 580-536-4844.