Privacy Policy

Notice Of Privacy Practices

Walk-In Chiropractic Back Relief

Each time you visit our offices, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of your personal doctor.

Our Responsibilities

In compliance with the HIPAA regulations CFR 164.520, Walk-In Chiropractic Back Relief is required to make available to each patient or prospective patient a “Notice of Privacy Practices”. This notice is to inform you of the uses and disclosures of confidential information that may be made by the practices, and of your rights and the practice’s legal duties with respect to confidential information.

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, therapy assistants or other office personnel who are involved in taking care of you. For example, we may be in contact with your primary care physician on issues involving the progress of your care.

For Payment: we may use and disclose health information about your treatment and services company or a third party payer. For example, we may need to give your insurance company information about your treatment plan so they will pay us or reimburse you for treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it

For Healthcare Operations: we may also use and disclose health information:

– To business associates we have contracted with to perform the agreed upon service and billing for it:

– To remind you that you have an appointment for medical care.

– To assess your satisfactions with our services

– To tell you about possible treatment alternatives

– To tell you about health-related benefits or services

– For conducting training programs or reviewing competence of health care professionals.

When disclosing information, primarily appointment reminders and billing/collection efforts, we may leave messages on your answering machine/voice mail.

Business Associates: There are some new services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a member that is involved in your medical care or who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Future communications: We may communicate to you via newsletters, mail outs or other means regarding treatment options, health-related information, disease-management programs, wellness programs or other community-based initiative or activities our facilities are participating in.

Organized Healthcare Arrangement: all facilities in Walk-In Chiropractic Back Relief and the staff members have organized and are presenting you this document as a joint notice. Information will be shared, as necessary, to carry out treatment, payment and health care operations. Physicians as caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time. As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:

– Food and Drug administration

– Public Health or Legal

– Authorities charged with preventing or controlling disease, injury or disability

– Correctional Institutions

-Worker Compensation Agents

– Military Oversight Agencies

– National Security and Intelligence Agencies

– Protective Services for the President and Others

Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

State specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirement. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.

Your Health Information Rights:

Although your health record is the physical property of the health care practitioner or facility that compiled it, you have the RIGHT TO:

Inspect and Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstances. If so, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the facility will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

– Amend: if you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. We may deny your request for an amendment and, if this occurs, you will be notified of the reason for the denial.

-An Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of certain disclosures we make of your health information for purposes other than treatment, payment or health care operations where an authorization was not required.

-Request Restrictions: you have the right to request a restriction or limitation on the health information we use or disclose about for treatment, payment or healthcare operation. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like family member or friends. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with the request unless the information is needed to provide you emergency treatment.

– Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we contact you at work instead of your home. The facility will grant reasonable request for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at other locations

– A Paper Copy Of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of the notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. If the facility has a website you may print or view a copy of the notice by clicking on the Notice of Privacy Practices link. To exercise any of your rights, please obtain the required forms from the Facility Official and submit your request in writing.


We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the offices and include the effective date.


If you believe your privacy rights have been violated, you may file a complaint with the office by following the process outlined in the office’s Rights documentation. You may also file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.


Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the are that we provided to you.


This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.
Copyright Walk-In Chiropractic Back Relief 2018 - All rights reserved.