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Disclaimer

We maintain this website as a public service and do our best to maintain its accuracy and timeliness. Nevertheless, we will not accept any liability for damages, in any form, arising from or in relation to the use of our web site. If you use our site to contact us, we may ask for your name, address, e-mail address, etc. only to be able to reply to your request.


Notice of Privacy Practices

We respect the privacy of all visitors to our website. In some places, this website offers visitors the opportunity to interact with our Clinic. At such times, we may use some of your details (i.e. your name, address or e-mail) to service you. Protecting the privacy and confidentiality of your personal information is important to each of us. We value you and the trust you put in us. We restrict access to your personal information to those employees who need to know that information to provide services to you. We maintain physical, electronic, and procedural safeguards that comply with federal standards to guard your nonpublic personal information. Your confidence in us is important and we want you to know that your personal and account information is safe.

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

1. This clinic may use and/or disclose your medical information consistent with a valid consent granted by you for the purposes of:

a. Treatment - In order to provide you with the healthcare you require, this clinic will provide your medical information to those healthcare professionals, whether on this clinic's staff or not, directly involved in your care so that they may understand your medical condition and needs;

b. Payment - In order to get paid for services provided, this clinic will provide your medical information, directly or through a billing service, to appropriate third party payers, as per their billing and payment requirements; and

c. Healthcare Operations - In order to gain an overall view of various elements of this clinic's operations, individual medical information may be collected, compiled and disseminated.

2. This clinic may use and/or disclose your medical information, without consent, in the following instances:

a. De-identified Information - Information that is not individually identifiable, in accordance with applicable laws, may be freely disclosed by this clinic;

b. Business Associate - If this clinic obtains satisfactory written assurance from the business associate, in accordance with applicable laws, that the business associate will appropriately safeguard the protected information;

c. Personal Representative - If under applicable Minnesota law a person has the authority to represent you in making decisions related to your health care.

d. Emergency Situations:

i. For the purpose of obtaining emergency treatment to you, if the clinic attempts to obtain consent but is unable to do so;
ii. 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.

e. Communication Barriers - If, due to substantial communication barriers or inability to communicate, this clinic has been unable to obtain consent and this clinic determines, in the exercise of its professional judgment, that your consent to receive treatment is clearly inferred from the circumstances;

f. Directory - In order to maintain a directory of individuals in this clinic, their location, their condition in non specific general terms, and their religious affiliation. This information can be made available in its entirety to members of the clergy and, except for religious affiliation, to anyone asking for you by name,

i. Due to your incapacity, this clinic has been unable to provide you with an opportunity to agree or object and such disclosure is:

(a) Consistent with your prior expressed preference, if any, that is known to this clinic; and
(b) In your best interest as determined by this clinic, in the exercise of its professional judgment.

g. Involvement in Care or Payment - In accordance with applicable laws, disclosure may be made to your family member, other relative, close personal friend and/or any other person identified by you, of such information that is relevant to the person's involvement with your care or payment related to your health care;

h. Notification - In order to notify or assist in the notification of a family member, a personal representative or another person responsible for your care of your location or general condition;

i. Required by Law - When and to the extent that such disclosure is required by law, complies with and is limited to the relevant requirements of such law;

j. Criminal Conduct - To a law enforcement official that this clinic believes in good faith contributes evidence of criminal conduct that occurred on the clinic premises;

k. Organ Procurement Organizations - Or other entity engaged in the procurement, banking or transportation of organs for the purpose of facilitating organ, eye or tissue donation and transplantation;

l. Threat to Health and/or Safety - If it is necessary to prevent or lessen a serious and imminent threat to the health and/or safety of a person or the public, in accordance with applicable laws; and

m. Appointment Reminders - In order to provide you with appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

3. Other uses and/or disclosures will be made only with your written authorization.

4. Your Rights - You have the right to:

a. Revoke any authorization and/or consent, in writing, at any time, which will apply to that day forward;

b. Request restrictions in writing on certain uses and/or disclosures as provided by law; however, this clinic is not obligated to agree to any requested restrictions that are legally required, or which are necessary to administer our business;

c. Receive confidential communications or protected information as required by law upon written request;

d. Inspect and copy protected information as provided by law. Your request must be in writing and you must pay to copy and mail your records. We have 30 days to comply or deny in writing. A 30-day extension may be granted if we inform you of the delay in writing. Records charges are based on the CPI from the MN Dept. of Health, MN Statute 144.335, subdivision 5.

e. Amend protected information as provided by law upon written request stating your reason for your request;

f. Receive an accounting of disclosures of protected information as provided by law. The request must be in writing and the time period it pertains to may not be longer than six years and may not include dates before April 14, 2003.

g. To receive a paper copy of this notice from this clinic upon request;

h. To complain to this clinic or to the Secretary of HHS if you believe your privacy rights have been violated; and

i. To obtain more information, or have questions about your rights answered, you may contact this clinic's Privacy Officer at (952) 445-7890.

5. Clinic Rights & Requirements - This clinic:

a. Is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected information;

b. Is required to abide by the terms of this notice;

c. Reserves the right to change the terms of this notice and to make the new notice provisions effective for all protected information that it maintains.

d. Will:

i. Distribute any revised notice at or before an appointment at the clinic prior to implementation; and
ii. Give to you, and you will be required to sign a receipt for, any revised notice.

e. Will not retaliate against you for filing a complaint.

6. This original notice is in effect as of April 14, 2003 and is prepared in accordance with the Health Insurance Portability and Accountability Act (HIPAA), 45CFR § 164.520 and applicable Minnesota healthcare privacy laws.

Shakopee Chiropractic
1240 3rd Ave. E
Shakopee, MN 55379

Phone (952) 445-7890
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