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Knapp Chiropractic
Notice of Patient Privacy Rights
Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even
apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such
things to be as sacred secrets.
Oath of Hippocrates, 4th Century, B.C.E.

Knapp Chiropractic is committed to maintaining the privacy of your protected health information ("PHI"), which includes information about your health condition and the health care you receive from Knapp Chiropractic. The creation of a record detailing the care and services you receive helps this office to provide you with quality health care. This Notice details how your PHI may be used and disclosed to third parties. This Notice also details your right s regarding your PHI. Knapp Chiropractic may use and/or disclose your PHI for the following purposes:
Health Care - In order to provide you with the health care you require, Knapp Chiropractic will provide your PHI to those health care professionals, whether on our staff or not, directly involved in your care so that they may understand your health condition and needs. For example, a chiropractor adjusting you for a subluxation in the cervical spine may need to know the results of your latest chiropractic examination by this office.
Payment - In order to get paid for services provided to you, Knapp Chiropractic will provide your PHI, directly to appropriate third party payers, pursuant to their billing and payment requirements. For example, Knapp Chiropractic may need to provide the Medicare program with information about health care services that you received from the Knapp Chiropractic so that Knapp Chiropractic, or you, can be properly reimbursed. Knapp Chiropractic may also need to tell your insurance plan about the care you are going to receive so that it can determine whether or not it will cover the health care expenses.
Health Care Options - In order for Knapp Chiropractic to operate in accordance with applicable law and insurance requirements and in order for Knapp Chiropractic to continue to provide quality and efficient care, it may be necessary for Knapp Chiropractic to compile, use and/or disclose your PHI. For example, Knapp Chiropractic may use your PHI in order to evaluate the performance of Knapp Chiropractic's personnel in providing care to you. Knapp Chiropractic may also use and/or disclose your PHI without your specific authorization in the following additional instances:
De-identified Information - Information that does not identify you and, even without your name, cannot be used to identify you.
Business Associates - To a business associate if Knapp Chiropractic obtains

satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists Knapp Chiropractic in undertaking some essential function, such as a billing company that assists the office in submitting claims for payment to insurance companies or other payers.
Personal Representative - To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
Emergency Situations - For the purpose of obtaining or rendering emergency treatment to you if the opportunity for you to object cannot be obtained due to your incapacity or emergent treatment circumstances and the treatment is consistent with your prior expressed preferences and is in your best interest, or to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
Public Health Activities - Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent serious harm.
Abuse, Neglect or Domestic Violence - To a government authority if Knapp Chiropractic is required by law to make such disclosure. If Knapp Chiropractic is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm.
Health Oversight Activities - Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community's health care system. For example, Knapp Chiropractic may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
Law Enforcement Purpose - In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or, Knapp Chiropractic believes your death was the result of a criminal conduct.
Coroner or Medical Examiner - Knapp Chiropractic may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.

Organ, Eye or Tissue Donation - If you are an organ donor, Knapp Chiropractic may disclose your PHI to the entity to whom you have agreed to donate your organs.
Research - If Knapp Chiropractic is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI.
Avert a Threat to Health or Safety - Knapp Chiropractic may disclose your PHI if it believes disclosure is necessary to prevent or lesson a serious and imminent threat to the health or safety of a person or the public and disclosure is to an individual who is reasonably able to prevent or lessen the threat.
Specialized government Function - This refers to disclosures of PHI that related primarily to military and veterans activity.
Workers Compensation - If you are involved in a Workers' Compensation claim, Knapp Chiropractic may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.
National Security and Intelligence Activities - Knapp Chiropractic may disclose your PHI in order to provide authorized governmental officials with necessary intelligence information for national security activities and purposes authorized by law.
Military and Veterans - If you are a member of the armed forces, Knapp Chiropractic may disclose your PHI as required by the military command authorities.
Fundraising - In order to conduct or assist business associates and/or other institutionally related foundations raise funds for a charitable purpose, such as local hospital, the American Red Cross or other private or public disaster relief agency, Breast Cancer or AIDS-related research, etc., this Office/Practice does engage in any fundraising activity, it must include instructions how you may decline to receive further fundraising communications from Knapp Chiropractic.
APPOINTMENT REMINDERS - Knapp Chiropractic may, from time to time, contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. The following appointment reminders are used by Knapp Chiropractic: a postcard mailed to you at the address provided by you; and

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telephoning your home and leaving a message on your answering machine or with the individual answering the phone.
DIRECTORY/SIGN-IN LOG - Knapp Chiropractic maintains a directory of and sign-in log for individuals seeking care and treatment in the office. Directory and sign-in log are located in a position where staff can readily see who is seeking care in the office, as well as the individual's located within Knapp Chiropractic's office suite. This information may be seen by, and is accessible to, others who are seeking care or services in Knapp Chiropractic's offices.
FAMILY/FRIENDS - Knapp Chiropractic may disclose to your family member, other relative, a close personal friend, or any other reason identified by you, your PHI directly relevant to such persons involvement with your care or the payment for your care. Knapp Chiropractic may also use or disclose your PHI to notify or assist in the notification (including identifying or location, general condition or death. However, in both cases, the following conditions will apply: (a) If you are present at or prior to the use or disclosure of your PHI, Knapp Chiropractic may use or disclose your PHI if you agree, or if Knapp Chiropractic can reasonably infer from the circumstances, based on the exercise of its professional judgment that you do not object to the use or disclosure. (b) If you are not present, Knapp Chiropractic's will in the exercise of professional judgment, determine whether the use or disclosure is in your best interests, and, if so, disclose only the PHI that is directly relevant to the person's involvement with your care.
AUTHORIZATION - Uses and/or disclosures, other than those described above, will be made only with your written Authorization.
YOUR RIGHTS - You have the right to: (a)Revoke any Authorization in writing, at any time. To request a revocation, you must submit a written request to Knapp Chiropractic's Privacy Officer. (b)Request restrictions on certain use and/or disclosure of your PHI as provided by law. However, Knapp Chiropractic is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to Knapp Chiropractic's Privacy

Officer. In your written request, you must inform Knapp Chiropractic of what information you want to limit, whether you want to limit Knapp Chiropractic's use or disclosure, or both, and to whom you want the limits to apply. If Knapp Chiropractic agrees to your request, Knapp Chiropractic will comply with your request unless the information is needed in order to provide you with emergency treatment. c.) Receive confidential communication or PHI by alternative means or at alternative locations. You must make your request in writing to Knapp Chiropractic's Privacy Officer. Knapp Chiropractic will accommodate all reasonable requests. d.)Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to Knapp Chiropractic Privacy Officer. Knapp Chiropractic can charge you a fee for the cost of copying, mailing or other supplies associated with your request. In certain situations that are defined by law, Knapp Chiropractic may deny your request, but you will have the right to have the denial; reviewed as set forth more fully in the written denial notice. e.)Amend your PHI as provided by law. To request an amendment, you must submit a written request to Knapp Chiropractic's Privacy Officer. You must provide a reason that supports your request. Knapp Chiropractic may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by Knapp Chiropractic (unless the individual or the entirety that created the information is no longer available), if the information is not part of your PHI maintained by Knapp Chiropractic, if the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with Knapp Chiropractic's denial, you will have the right to submit a written statement of the disagreement. f.)Receive an accounting of disclosures of your PHI as provided by law. To request an accounting, you must submit a written request to Knapp Chiropractic's Privacy Officer. The request must state a time period which may not be longer than six years and may not include dated before April 14, 2003.

The request should indicate in what form you want the list (such as paper or electronic copy). The first list you request within a twelve month period will be free, but Knapp Chiropractic may charge you for the cost of providing additional lists. Knapp Chiropractic will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred. g.)Receive a paper copy of this Privacy Notice from Knapp Chiropractic upon request to Knapp Chiropractic's Privacy Officer. h.)Complain to the Knapp Chiropractic or to the Secretary of HHS if you believe your privacy rights have been violated. To file a complaint with Knapp Chiropractic, you must contact Knapp Chiropractic's Privacy Officer. All complaints must be in writing. i.)To obtain more information on, or have your questions about your rights answered, you may contact Knapp Chiropractic's Privacy Officer, Christopher G. Knapp, D.C., at (814) 337-5800, or via email at drknapp@knappchiro.com.
PRACTICE'S REQUIREMENT - Knapp Chiropractic: a.)is required by federal law to maintain the privacy Notice detailing Knapp Chiropractic's legal duties and privacy practices with respect to your PHI. b.)Is required by State Law to maintain a higher level of confidentiality with respect to certain portions of your medical information than is provided for under federal law. c.)Is required to abide by the terms of this Privacy Notice. d.)Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for all of your PHI that it maintains. e.)Will distribute any revised Privacy Notice to you prior to implementation. f.) Will not retaliate against you for filing a complaint.
EFFECTIVE DATE - This Notice is in effect as of 04/18/2003.