Notice of Privacy Practices

We understand the importance of your privacy and are committed to maintaining the confidentiality of your medical information. We create and receive medical records in order to provide you with quality care, to comply with legal requirements, and to support the operations of our practice. We are required by law to maintain the privacy of protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and notify you if a breach of unsecured PHI occurs.

This Notice describes how we may use or disclose your medical information, your rights regarding that information, and our obligations under federal and state law. If you have any questions about this Notice, please contact our Privacy Officer listed above.

TABLE OF CONTENTS

A. How This Medical Practice May Use or Disclose Your Health Information
B. When This Medical Practice May Not Use or Disclose Your Health Information
C. Your Health Information Rights
 • Right to Request Special Privacy Protections
 • Right to Request Confidential Communications
 • Right to Inspect and Copy
 • Right to Amend or Supplement
 • Right to an Accounting of Disclosures
 • Right to a Paper or Electronic Copy of this Notice
D. Changes to This Notice of Privacy Practices
E. Complaints

A. How This Medical Practice May Use or Disclose Your Health Information

We maintain a medical record for each patient that includes your protected health information. Although the medical record belongs to our practice, the information within it belongs to you. The law permits us to use or disclose your PHI for the following purposes:

1. Treatment

We may use or disclose your health information to provide, coordinate, or manage your healthcare. For example:

• Sharing information with other physicians, chiropractors, therapists, or healthcare providers participating in your care

• Providing records to imaging centers, laboratories, or pharmacies

• Communicating with family members or caregivers involved in your treatment (unless you object)

2. Payment

We may use or disclose your information to obtain payment for services. For example:

• Submitting claims to your health plan

• Confirming coverage or treatment authorization

• Sharing information with other providers so they can bill appropriately

3. Health Care Operations

We may use or disclose your information to support the business and administrative operations of our practice, such as:

• Quality assessment and improvement activities

• Licensing, accreditation, training, and credentialing

• Medical reviews, audits, legal services, and compliance programs

• Business associate functions such as billing, record storage, or IT services (all under legally required confidentiality agreements)

We may also share PHI with other healthcare organizations involved in organized health care arrangements (OHCAs) for their operational purposes.

4. Appointment Reminders

We may use or disclose information to remind you of appointments. If you are unreachable, a message may be left with limited details.

5. Sign-In Sheets and Calling Names

You may be asked to sign in at the front desk, and your name may be called when we are ready to see you.

6. Notification and Communication With Family

We may disclose information to family members, personal representatives, or others involved in your care when:

• You authorize us

• You do not object when given the opportunity

• You are unable to object due to emergency circumstances

In a disaster situation, disclosures may be made to authorized relief agencies.

7. Marketing

We may contact you with information related to:

• Appointment reminders

• Care coordination

• Products or services directly related to your treatment or health

We will not use your PHI for paid marketing or third-party marketing without your written authorization.

8. Sale of Health Information

We will not sell your PHI without your prior written authorization.

9. Required by Law

We may disclose PHI when required by federal, state, or local laws. This includes:

• Mandatory reporting of abuse or neglect

• Judicial or administrative orders

• Certain law enforcement requests

10. Public Health

We may disclose information for public health activities such as:

• Preventing or controlling disease

• Reporting reactions to medications

• Reporting abuse or neglect

11. Health Oversight

We may disclose PHI to health oversight agencies for audits, investigations, inspections, or licensure purposes.

12. Judicial and Administrative Proceedings

We may disclose PHI in response to:

• Court orders

• Subpoenas or legal requests (with required patient notifications)

13. Law Enforcement

We may disclose PHI for law enforcement purposes as required or allowed by law.

14. Coroners, Medical Examiners, and Funeral Directors

We may disclose PHI to assist in identifying a deceased person or determining cause of death.

15. Organ and Tissue Donation

We may provide PHI to organizations involved in organ, eye, or tissue donation.

16. Public Safety

We may disclose PHI to prevent or lessen serious and imminent threats to you, others, or the public.

17. Immunization Disclosures

We may provide proof of immunization to schools with your agreement.

18. Specialized Government Functions

We may disclose PHI for military, national security, or correctional institution purposes.

19. Workers’ Compensation

We may disclose PHI to comply with workers' compensation laws or for related claims.

20. Change of Ownership

If our practice is sold or merged, your medical records will transfer to the new owner, but you retain rights to request copies.

21. Breach Notification

If there is a breach involving your unsecured PHI, we will notify you as required by law.

B. When This Medical Practice May Not Use or Disclose Your Health Information

Except as outlined in this Notice, we will not use or disclose your PHI without your written authorization.
You may revoke an authorization at any time in writing, except to the extent we have already relied on it.

C. Your Health Information Rights

1. Right to Request Special Privacy Protections

You may request restrictions on certain uses or disclosures. We are not required to agree, except when you pay for services entirely out of pocket and request that the information not be disclosed to your health plan.

2. Right to Request Confidential Communications

You may request that we communicate with you in a specific way (e.g., email, alternate address). We will accommodate reasonable requests submitted in writing.

3. Right to Inspect and Copy

You have the right to inspect and obtain copies of your health information, with limited exceptions. Requests must be submitted in writing.

We may charge a reasonable cost-based fee for copies, mailing, or preparing summaries.

4. Right to Amend or Supplement

If you believe your PHI is incorrect or incomplete, you may request an amendment in writing. We may deny the request under certain circumstances, but you may submit a written disagreement which will be included in your record.

5. Right to an Accounting of Disclosures

You may request an accounting of certain disclosures of your PHI within the past six years. Some disclosures are exempt from accounting requirements.

6. Right to a Paper or Electronic Copy of this Notice

You may request a paper or electronic copy of this Notice at any time, even if you received it electronically.

D. Changes to This Notice of Privacy Practices

We reserve the right to amend this Notice at any time. Revised versions will apply to all PHI we maintain and will be posted prominently in our office and on our website.

E. Complaints

If you believe your privacy rights have been violated, you may submit a complaint to:

The Spine Works Chiropractic
301 14th Ave N, Suite 101
Nashville, TN 37203
info@thespineworks.com
(615) 730-8131

or to the U.S. Department of Health & Human Services Office for Civil Rights:

Email: OCRMail@hhs.gov
Complaint Info: https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/

You will not be penalized for filing a complaint.