Effective Date: 05/01/2019
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU MAY GET ACCESS TO THIS INFORMATION, AND HOW TO FILE A COMPLAINT. PLEASE REVIEW IT CAREFULLY.
Strong Life Chiropractic & Performance (“Strong Life,” “we,” “us,” or “our”) is committed to protecting the privacy of your protected health information (“PHI”). PHI is information that identifies you and relates to your past, present, or future physical or mental health or condition; the healthcare services you receive; or payment for those services.
This Notice describes our privacy practices, our legal duties, and your rights concerning PHI. We are required by law to maintain the privacy and security of your PHI, provide you with this Notice of our legal duties and privacy practices, follow the terms of the Notice currently in effect, and notify you following a breach of unsecured PHI when required by law.
This Notice applies to records created or maintained by Strong Life in connection with the healthcare services we provide. It does not replace the separate Website Privacy Policy that applies to information collected through our website, such as cookies, analytics, and general website inquiries.
We may use and disclose your PHI for treatment, payment, and healthcare operations without your written authorization, as described below.
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This may include communicating with other healthcare professionals who are involved in your care.
Example: A chiropractor or another provider involved in your care may review your health history, examination findings, imaging reports, treatment plan, and progress notes to determine appropriate care or coordinate a referral.
We may use or disclose your PHI to bill for and obtain payment for services provided to you. This may include communicating with you about balances, processing payments, submitting claims if applicable, verifying coverage, obtaining authorization, or responding to questions from a health plan.
Example: If we submit an insurance claim, we may provide your insurer with information about the services you received so that it can determine coverage or payment. If you are self-pay, we may use your information to provide invoices, receipts, or payment reminders.
We may use or disclose your PHI for our healthcare operations—activities needed to operate our practice and maintain quality care.
Example: We may review records for quality assurance, compliance, training, credentialing, auditing, business planning, or improving patient care and practice operations. We may also use qualified service providers that help us perform these functions, subject to appropriate privacy and security obligations.
We may use or disclose your PHI without written authorization when permitted or required by applicable law, including the following circumstances:
Unless you object, we may disclose relevant PHI to a family member, friend, or another person you identify when that person is involved in your care or payment for your care. If you are unavailable, incapacitated, or facing an emergency, we may use our professional judgment to determine whether disclosure is in your best interest and disclose only information directly relevant to that person’s involvement.
We may use or disclose PHI to contact you with appointment reminders, scheduling information, treatment follow-up, or information about health-related products or services that may be of interest to you, as permitted by law.
We may use or disclose PHI when required by federal, state, or local law.
We may disclose PHI for public-health activities, such as reporting or preventing disease, injury, or disability; reporting suspected abuse, neglect, or domestic violence when permitted or required by law; reporting adverse reactions to medications or products; or helping prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
We may disclose PHI to health-oversight agencies for authorized activities, such as audits, investigations, inspections, licensure, and compliance reviews.
We may disclose PHI in response to a court order, administrative order, subpoena, discovery request, warrant, summons, or other lawful process, subject to applicable requirements. We may also disclose PHI to law-enforcement officials for purposes permitted by law, such as reporting certain crimes, responding to emergencies, identifying or locating a suspect, fugitive, material witness, or missing person, or reporting a crime on our premises.
We may disclose PHI to a coroner, medical examiner, or funeral director as authorized by law. We may also disclose PHI to organizations involved in organ, eye, or tissue donation and transplantation.
We may use or disclose PHI for research when permitted by law. Research may require your written authorization unless an institutional review board, privacy board, or applicable law permits use or disclosure without authorization.
We may disclose PHI as authorized by workers’ compensation laws and similar programs. We may disclose PHI for certain specialized government functions, including military, national-security, intelligence, protective-services, correctional-institution, or law-enforcement-custody purposes, when permitted or required by law.
We may disclose limited PHI to a public or private entity authorized to assist in disaster-relief efforts to help locate or notify a family member, personal representative, or another person responsible for your care.
We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, unless permitted or required by law.
Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing that require authorization, and the sale of PHI require your written authorization. We will also obtain authorization before using your image, testimonial, story, or other identifying information for promotional purposes, unless a legal exception applies.
You may revoke an authorization in writing at any time. Your revocation will not affect uses or disclosures we already made in reliance on the authorization before receiving your written revocation.
Important note regarding Part 2 records: If we create or receive records relating to substance-use-disorder treatment that are subject to 42 CFR Part 2, additional federal confidentiality protections may apply. We will use and disclose any such records only as permitted by applicable law.
You have the following rights regarding the PHI we maintain about you. To exercise a right, contact our Privacy Officer using the contact information at the end of this Notice. We may ask you to submit your request in writing and may require reasonable verification of your identity.
You have the right to inspect and obtain a copy of PHI used to make decisions about your care, subject to limited exceptions. You may request an electronic copy if we maintain the information electronically and it is readily producible in the requested format. We may charge a reasonable, cost-based fee as permitted by law.
If you believe PHI in your record is incorrect or incomplete, you may request an amendment. Your request must be in writing and explain the reason for the amendment. We may deny an amendment request in certain circumstances, including if we did not create the information, the information is not part of the record you may inspect, or we determine the record is accurate and complete. If we deny your request, you may submit a written statement of disagreement as permitted by law.
You may request a list of certain disclosures of your PHI that we have made. This right does not apply to every disclosure, including certain disclosures for treatment, payment, healthcare operations, disclosures you authorized, and other disclosures excluded by law. The first accounting in a 12-month period is generally provided without charge; a reasonable cost-based fee may apply to additional requests.
You may request restrictions on how we use or disclose PHI for treatment, payment, or healthcare operations, or to people involved in your care. We are not required to agree to most requested restrictions.
However, if you pay out of pocket in full for a healthcare item or service and request that we not disclose PHI about that item or service to your health plan for payment or healthcare operations, we will honor that request unless disclosure is otherwise required by law.
You may request that we communicate with you about health matters in a particular way or at a particular location—for example, only by email, only by mail, or at a particular phone number. We will accommodate reasonable requests. You do not need to explain why you are making the request.
You have the right to receive a paper copy of this Notice at any time, even if you agreed to receive it electronically. You may request a copy from our office or download it from our website.
You have the right to be notified following a breach of unsecured PHI when notification is required by law.
We are required by law to:
We reserve the right to change this Notice and make the revised Notice effective for PHI we already have and for PHI we receive in the future. If we make a material change, we will post the revised Notice at our office and on our website, make a copy available upon request, and update the effective date at the top of the Notice.
If you believe your privacy rights have been violated, you may file a complaint with Strong Life or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
Privacy Officer: Michael Cardinal, DC - OWNER
Practice: Strong Life Chiropractic & Performance
Mailing Address: 7145 SW Varns street, suite 102, Tigard OR 97223
Phone: 208-821-4784
Email: stronglifechiro@gmail.com
Website: https://www.stronglifechiro.com
To make a complaint, submit it in writing to the Privacy Officer using the contact information above. Please include your name, a description of the concern, and your preferred contact information.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
Strong Life provides care in accordance with applicable federal and state civil-rights laws. We do not discriminate on the basis of race, color, national origin, age, disability, sex, or any other classification protected by applicable law.
Free language-assistance services and appropriate auxiliary aids and services are available upon request to help you communicate with us, including qualified interpreters and other reasonable accommodations when required by law. Please contact our office before or during your visit if you need language assistance or an accommodation.
To file a grievance regarding discrimination, contact the Privacy Officer at the information listed above. You may also file a civil-rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, using the contact information in Section 6.
As applicable to chiropractic patient records, Strong Life retains health-care and billing records for at least the minimum period required by Oregon law. This retention practice does not limit your right to request access to records as described above.
Acknowledgment of Receipt: We may ask you to sign a separate acknowledgment confirming that you received or were offered this Notice. Signing an acknowledgment does not waive any of your privacy rights.
