You have the right to: Ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to these requests. For example, we may deny if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. Requests will be honored unless a law requires us to share that information.
You can ask us to contact you in a specific way.
You can request an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy within 30 days. We may charge a reasonable, cost-based fee.
You can ask us to correct incorrect or incomplete health information. We may deny your request, but we will inform you in writing within 60 days of your request. To request an amendment your request must be made in writing, submitted to the Privacy Officer.
You can ask us for a list (accounting) of the instances we’ve shared your health information for six years prior to the request date, with whom we shared it, and why. We will include all the disclosures except for those about treatment, payment, or health care operations, and certain other disclosures (such as any you asked us to make or other authorized disclosures). We will provide one accounting per year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months. To request this list of disclosures, submit your request in writing to the Privacy Officer.
You can obtain a paper copy of this notice.
If you have a medical power of attorney or legal guardian, that person can exercise your rights and make choices about your health information. If so, a copy of the document appointing that person must be provided to us. We will make reasonable efforts to verify that the person has the authority and can act for you before we take any action.
We are required to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described here. We won’t use or share your information other than described here unless you tell us we can do so in writing. If so, you may change your mind at any time by notifying us in writing.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility. The notice contains the effective date on the first page. Each time you register for treatment or health care services, we will offer you a copy of the current notice in effect. This notice is also available at www.drbriancox.com.
If you believe your privacy rights have been violated or you have questions regarding this notice please contact the Privacy Officer at 716-662-1514 or email email@example.com. You may also file a complaint with the Office of Civil Rights US Department of Health and Human Services by sending a letter to 200 Independence Ave. S.W., Washington, D.C 20201, call 1.877.696.6775 or visit www.hhs.gov/ocr/privacy/ hipaa/complaints. Filing a complaint will not affect the treatment or services you receive.
All organizations required to have a Notice of Privacy Practices and owned or controlled by Brian Cox PT & Chiro (“we”).
We may, without your written permission, use your health information within or disclose your health information to others outside for treatment, payment, and health care operations.
We may share your health information with doctors, students, or other personnel to assist in treating you. We may use and disclose your personal health Information to help us or another provider obtain payment for the healthcare services provided or to obtain prior approval or to cover the cost of future treatment.
We may use your health information to support our business and improve care. We may contact you at the address and telephone number(s) you provide (including leaving a message at the telephone numbers) about appointments, insurance, billing and/or payment matters.
We disclose your personal health information to others without your permission for research, fundraising, group health planning, as required by law, to avert a serious threat to health or safety, to workers compensation programs, or individuals involved in your care or payment, (This is limited to the information necessary for your care or for payment for your care), for public health activities, health oversight agencies, in response to a court or administrative order, in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested; by law enforcement officials, and to authorized federal officials.
Other uses and disclosures of health information not covered by this notice or the laws that apply to use will be made only with your written authorization. We are unable to take back any disclosures we have already made with your permission, and those we are required to retain our records of the care that we provided to you.
We will request that you sign a separate form or notice acknowledging you have been offered a copy of this notice. If you choose, or are not able to sign, a staff member may sign his/her name and date. This acknowledgement will be filed with your records.
If you have any questions about this notice, please contact our Privacy Officer at
4164 N. Buffalo Rd. Orchard Park, NY 14127, 716-662-1514 or at firstname.lastname@example.org