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Notice of Privacy Practices
This Notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information has always been important to us and we are committed to protecting it. Federal laws, however, require that we provide each of our patients with an official notice of our privacy practices. This notice will inform you of ways we use and share your information and it will describe your rights and our duties regarding the use and disclosure of health information.

Law requires us to:

• Keep your health information private
• Give you this Notice of Privacy Practices
• Abide by the terms of the Notice of Privacy Practices currently in effect

We have the right to:

• Change our privacy practices and the terms of this notice at any time, provided that law permits the changes. If we make changes, we will update this notice and make the new notice available upon request.

Listed here are some of the ways we may use or disclose your information without your specific consent or authorization. Not all possible uses or disclosures are listed.
For Treatment: We may use health information about you to provide you with treatment or services. We may disclose health information about you to doctors, nurses, technicians, or other people who are taking care of you. We may also share health information about you with your other health care providers to assist them in treating you.
For Payment: We may use and disclose your health information for payment purposes.
For Health Care Operations: We may use and disclose your health information for our health care operations. For example, we may use health information about you to review our treatment and services and evaluate the performance of our staff in caring for you.

Other Possible Uses and Disclosures:

• In response to a legal proceeding
• For other healthcare providers' treatment activities
• For other covered entities and provider’s payment activities
• In case of threat to public health or safety
• To notify a family member in certain emergency situations
• To workers’ compensation or similar programs for processing of claims
• In domestic violence or neglect situations
• Other uses and disclosures not in this notice will be made only as allowed or required by law or with your written authorization.

The health and billing records we create are the property of this healthcare facility. The health information in it, however, generally belongs to you.
You have the right to do the following:

• Request and receive from us a copy of the most current Notice of Privacy Practices.
• Look at or receive copies of your health information. You may make this request in writing and we have a form available for that purpose. We reserve the right to charge a fee for the costs of copying, mailing or other supplies associated with your request.
• Ask us to restrict certain uses and disclosures. You must submit this request in writing. We are not required to grant the request but will comply with any request granted.
• Have us review a denial of access to your health information -- except in certain circumstances.
• Ask us to change your health care information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record and included with any release of records.
• Request a list of disclosures of your health information. The list will not include disclosures to third party payers. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
• Ask that your health information be given to you by other means or at another location. Please sign, date and give us your request in writing. We reserve the right to deny a request if it imposes an unreasonable burden on the practice.
• Cancel a prior authorization to use or disclose health information by giving us a written revocation. Your revocation does not affect any information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.

Open or Group Adjusting Authorization Request: You will receive chiropractic adjustments in a room where other clients are also receiving chiropractic care. In the course of your care in such an environment, routine details of your condition and care may be disclosed to other clients or staff in the approximate vicinity of where your care is being delivered. We cannot assure that any of the details of your care will be addressed and considered as confidential by other clients. However, we can offer you the opportunity to discuss your health care in a more private setting at your request.
We are requesting your authorization in this regard to assure that you are fully informed and in agreement with all of the methods and circumstances in which we deliver chiropractic care. Your care will not be conditioned on your agreement to this authorization. You have the right not to sign this authorization and you also have the right to revoke this authorization at a later date if that is your wish. If you wish to revoke this authorization at some time in the future, please advise us accordingly in writing.
Patient Information: We keep patient information on spreadsheet for team use. These sheets are password protected through google sign in. 

Photographs and Testimonials: From time to time we have our practice members write out or verbally share their experience with care, to share with other practice members. We also take photos of kids in the practice in celebration of health and wellness, and display them on the wall. We are requesting your authorization for this matter. We may also have sign up sheets posted at the front desk for email lists or health class sign up sheets (and the like).  We also have a sign in sheet which discloses your name each time you come in.

If you have questions or wish to report a problem, you may contact the Privacy Officer at 908.399.3499
If you believe you privacy rights have been violated, you may discuss your concerns with any staff member. You may also file a complaint with the Privacy Officer at our practice, or with the U.S. Secretary of Health and Human Services. All complaints must be in writing. You will not be penalized or discriminated against for filing a complaint.
 
To contact us: LightSource Chiropractic Center 16 Leigh St, Suite 2B, Main Street, Clinton NJ 08809 
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