THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Julia Lewis, D.C. dba Non-Force Chiropractic Center is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of Your Health Care Information

Treatment
We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example)

"On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Julia Lewis, D.C. dba Non-Force Chiropractic Center."

"It is our policy to provide a substitute health care provider, authorized by Julia Lewis, D.C. dba Non-Force Chiropractic Center to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider's absence due to vacation, sickness, or other emergency situation."

Payment
We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (example)

"As a courtesy to our patients, we provide an itemized receipt upon payment at the time of service. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the health care services received. Should your insurance carrier contact Julia Lewis, D.C. dba Non-Force Chiropractic Center regarding payment for the services rendered, they will only be given information pertaining to the particular treatment in question."

Workers' Compensation
We may disclose your health information as necessary to comply with State Workers' Compensation Laws.

Emergencies
We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Judicial and Administrative Proceedings
We may disclose your health information in the course of any administrative or judicial proceeding.

Public Health
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Law Enforcement
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Deceased Persons
We may disclose your health information to coroners or medical examiners.

Research
We may disclose your health information to researchers conducting research, but we will not reveal your identity.

Public Safety
It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies
We may disclose your health information for military, national security, prisoner and government benefits purposes.

Marketing
We may contact you for marketing purposes or fundraising purposes, as described below: (example)

"As a courtesy to our patients, it is our policy to call you on occasion to remind you of your appointment time. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. Some patients have requested that we call them at work, so we will call the location that you prefer. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment."

"It is our policy to send informative newsletters on a semi-regular basis. Should you wish to be removed from our mailing list, we are happy to accommodate your wishes."

"It is our practice to participate in charitable events to raise awareness, food donations, gifts, money, etc. During these times, we may send you a letter, post card, invitation or call your home to invite you to participate in the charitable activity. We will never give your name to any charitable organization without your permission. It is not our policy to disclose any personal health information about your condition for the purpose of Julia Lewis, D.C. dba Non-Force Chiropractic Center sponsored fund-raising events."

Change of Ownership
In the event that Julia Lewis, D.C. dba Non-Force Chiropractic Center is sold or merged with another organization, your health information/record will become the property of the new owner.



Your Health Information Rights

• You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Julia Lewis, D.C. dba Non-Force Chiropractic Center is not required to agree to the restriction that you requested.
  
  
• You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
  
  
• You have the right to inspect and copy your health information. There will be a modest fee to cover the cost of copying.
  
  
• You have a right to request that Julia Lewis, D.C. dba Non-Force Chiropractic Center amend your protected health information. Please be advised, however, that Julia Lewis, D.C. dba Non-Force Chiropractic Center is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial.
  
  
• You have a right to receive an accounting of disclosures of your protected health information made by Julia Lewis, D.C. dba Non-Force Chiropractic Center.
  
  
• You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices

Julia Lewis, D.C. dba Non-Force Chiropractic Center reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Julia Lewis, D.C. dba Non-Force Chiropractic Center is required by law to comply with this Notice.

Julia Lewis, D.C. dba Non-Force Chiropractic Center is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: Julia Lewis, D.C. by calling this office at 408-526-9423. If Julia Lewis, D.C. is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints

Complaints about your Privacy rights, or how Julia Lewis, D.C. dba Non-Force Chiropractic Center has handled your health information should be directed to Julia Lewis, D.C. by calling this office at 408-526-9423. If Julia Lewis, D.C. is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201