Notice of Privacy Practices

1. Our Commitment to Your Privacy

Katy Chiro Careunderstands that information about you and your health is personal, and we are committed to protecting it. This Notice applies to the Protected Health Information (“PHI”) we create and maintain about your care. We are required by law to:

• Maintain the privacy of your Protected Health Information;
• Provide you with this Notice of our legal duties and privacy practices with respect to your PHI; and
• Follow the terms of the Notice that is currently in effect.

2. How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your PHI. Not every use or disclosure will be listed, but every permitted use or disclosure will fall within one of these categories.

Treatment

We may use and disclose your PHI to provide, coordinate, and manage your chiropractic care and related services. This includes sharing information among our doctor, staff, and other health care providers who are involved in your treatment.

Payment

We may use and disclose your PHI so that we can bill for and obtain payment for the services we provide to you. This may include verifying insurance coverage, submitting claims, and following up on unpaid balances.

Health Care Operations

We may use and disclose your PHI for our health care operations, including quality assessment and improvement activities, administrative functions, business management, and reviewing the performance and competence of our staff.

Appointment Reminders and Follow-Up Communications

We may use and disclose your PHI to contact you with appointment reminders or to follow up regarding your care, including by phone, text message, email, or mail using the contact information you provide.

As Required or Permitted by Law

We may use or disclose your PHI without your authorization in the following circumstances permitted or required by law:

• For public health activities;
• To report abuse, neglect, or domestic violence;
• For health oversight activities;
• For judicial and administrative proceedings;
• For law enforcement purposes;
• For workers’ compensation as authorized by law;
• To avert a serious threat to health or safety; and
• For other uses and disclosures required by law.

3. Uses and Disclosures That Require Your Written Authorization

Most uses and disclosures of your PHI not described above will be made only with your written authorization. In particular, uses and disclosures for marketing purposes, the sale of PHI, and (where applicable) the use or disclosure of psychotherapy notes require your written authorization. You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on it.

4. Your Rights Regarding Your Health Information

You have the following rights with respect to your PHI:

• The right to inspect and request a copy of your records;
• The right to request an amendment or correction of your records;
• The right to request an accounting of certain disclosures we have made;
• The right to request restrictions on certain uses and disclosures;
• The right to request confidential communications (for example, that we contact you at an alternate address or phone number);
• The right to receive a paper copy of this Notice; and
• The right to be notified following a breach of your unsecured PHI.

5. Our Responsibilities

We are required to:

• Maintain the privacy of your Protected Health Information;
• Abide by the terms of this Notice while it is in effect;
• Notify you if we are unable to agree to a requested restriction on a use or disclosure; and
• Notify you following a breach of your unsecured PHI.

6. Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for the PHI we already have about you, as well as any information we receive in the future. The current Notice will be posted in our office and on our website. You may request a copy of the Notice currently in effect at any time.

7. How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with Katy Chiro Care by directing it to our Privacy Officer using the contact details below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you in any way for filing a complaint.

8. Contact Us

To exercise any of your rights, ask questions about this Notice, or file a complaint, please contact our Privacy Officer:

• Katy Chiro Care
• 25145 Star Lane, Suite 503
• Katy, TX 77494
• Phone: (713) 337-6131
• Email: admin@katychirocare.com