NOTICE OF PRIVACY PRACTICES
This notice describes how Joshua J Hirsch D.C., (Jaffrey Chiropractic) may use and disclose your healthcare information and how you can obtain access to this information. Please review it carefully.
Joshua J. Hirsch D.C. is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health including demographic information, either created by Joshua J. Hirsch D.C., or received by Joshua J. Hirsch D.C. from other health care providers. Joshua J. Hirsch D.C. is required to provide you with notice of his legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice. Joshua J. Hirsch D.C. will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information. Joshua J. Hirsch D.C. reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that he maintains. Patients will be provided with a copy of any revised Notices upon request. An individual may obtain a copy of the current Notice at any time.
Uses and Disclosures of Your Protected Health Information Not Requiring Your Consent
Joshua J. Hirsch D.C. may use and disclose your protected health information without your written consent or authorization for certain treatment, payment and healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration and all other records concerning individuals who are receiving or who at any time have received services for Chiropractic health care.
Treatment related communication may include:
1. Providing, coordinating, or managing any related services by one or more healthcare providers;
2. Consultation between healthcare providers concerning a patient;
3. Referrals to other providers for treatment;
4. Referrals to nursing homes, foster care homes, or home health agencies for services you receive.
5. In emergency situations this may include communication with your primary care physician and with relatives that you have designated as emergency contacts.
This information can be viewed at any time on the Jaffrey Chiropractic website: www.jaffreychiropractic.com
For help with these rights during normal business hours, please contact:
Privacy Officer
Jaffrey Chiropractic
45 Knight Street, Suite 8
PO Box 292
Jaffrey, NH 03452
(603) 532-5629
Our Responsibilities
We are required to:
- Keep your protected health information private;
- Give you this Notice;
- Follow the terms of this Notice.
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our office to pick one up.
To Ask for Help or File a Complaint
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:
Privacy Officer
Jaffrey Chiropractic
45 Knight Street, Suite 8
PO Box 292
Jaffrey, NH 03452
(603) 532-5629
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also deliver a written complaint to:
Privacy Officer
Jaffrey Chiropractic
45 Knight Street, Suite 8
PO Box 292
Jaffrey, NH 03452
(603) 532-5629
You may also file a complaint with the U.S. Secretary of Health and Human Services.
We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services.
Other Uses and Disclosures of Protected Health Information
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
Web Site
If you receive this Notice on our web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.
Effective Date: 01/17/2018
