| Privacy Policy We acknowledge your personal
medical information as being private and will not disclose
this information without written authorization from you, the
patient. That authorization may be revoked anytime in writing
to us.
Your personal health
information may be disclosed for the purposes listed below.
For purposes other than treatment, payment and healthcare
operations, authorization may not be needed.
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| 1. |
Treatment:
Your personal health information, including your clinical
records, may be disclosed to another health care provider or
hospital if it is necessary for further diagnosis,
assessment or treatment. |
| 2. |
Payment:
We may disclose personal medical information for the purpose
of payment. |
| 3. |
Healthcare
Operations: We may disclose personal medical information to
aid in measuring and improving quality, evaluating
performance, and/or training with your employer in such
cases such as workman compensation but not limited to. |
| 4. |
Court
Orders: We may disclose personal medical information in
response to a court or administrative order, subpoena, or
discovery request. In circumstances including warrants, we
may share your personal medical information with law
enforcement officials. |
| 5. |
Victims
of Abuse, Neglect, or Domestic Violence: We may disclose
personal medical information to law enforcement if we have
reason to believe the patient may be the victim of a crime. |
| 6. |
Workers
Compensation: We may disclose your personal medical
information when filing for workman's compensation. |
| 7. |
Public
Health Activities: We may disclose your personal medical
information to the Public Health Department upon request
because of emergency issues. |
You have the right to
inspect and/or copy your personal medical information for
seven years from the date that the record was created, or for
as long as the information remains in our files.
You have the right to
request and amend your personal medical information in
writing to us.
You have the right to
receive a listing of all persons or agencies that have
requested copies of your personal medical information.
If you would like any
written information to be mailed to an address other than
the address on file, please notify us in writing.
This office utilizes an
"Open-Adjusting" environment for ongoing patient
care. Patients are within sight of one another and some
ongoing routine details of care are discussed within earshot
of other patients and staff. The use of this format is
intended to make your experience more efficient and
productive as well as to enhance your access to quality
healthcare. If you choose not to be adjusted in an
"Open-Adjusting" environment, please let us know
and other arrangements will be made for you.
We are required by law to
maintain the privacy of your personal medical information.
We reserve the right to amend this notice with notification
given in writing as soon as possible following the changes.
If you have a complaint
regarding our privacy notice, our privacy practice or any
aspect of our privacy activities, please contact Dr. Jeb
Thurmond.
This notice is of EVOLUTION
CHIROPRACTIC, L.L.C. privacy practices effective 9/1/2004.
This notice, and any alteration or amendments will expire
seven years after the date upon which the record was
completed. |
