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.
Our commitment
Back in Motion Family Chiropractic is required by the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy of your health information. We are also required to provide you with this notice describing our legal duties and privacy practices regarding your protected health information (“PHI”).
How we use and disclose your PHI
We use and disclose your PHI for the following purposes:
- Treatment. Sharing information with other providers involved in your care.
- Payment. Submitting claims to your auto insurer (PIP), health insurer, or attorney for payment.
- Healthcare operations. Internal activities such as quality improvement, training, and licensing.
- As required by law. Including reporting to public health authorities or in response to legal proceedings.
Your rights
You have the right to:
- Request access to your medical records
- Request corrections to your medical records
- Request restrictions on certain uses or disclosures
- Request confidential communications
- Receive an accounting of disclosures of your PHI
- Receive a paper copy of this notice
- File a complaint with us or with the U.S. Department of Health and Human Services
How to exercise your rights or file a complaint
To exercise any of these rights or file a complaint, contact our office at (817) 518-3165 or in writing at 104 Grapevine Hwy, Suite 400, Hurst, TX 76054. You will not be retaliated against for filing a complaint.
Changes to this notice
We reserve the right to change this notice. Any change will apply to all PHI we maintain. The revised notice will be posted at our office and on this website.
Federal complaints
You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. Visit www.hhs.gov/ocr for instructions.