The Health Insurance Portability and Accountability Act of 2013, commonly referred to as HIPAA, requires this office to implement and maintain a number of policies and safeguards to insure that patients’ protected health information (PHI) remains secure and only used in a manner consistent with HIPAA and similar laws.

General Rules and Definitions

Protected Health Information, also referred to as PHI, means any patiently identifiable health information, including demographic data which relates to:

                -The patient’s past, present or future physical or mental health or condition

                -the provision of health care to the patient, or

                -the past, present, or future payment for the provision of health care to the patient

And identifies the patient or for which there is a reasonable basis to believe it can be used to identify the patient. Patiently identifiable health information includes many common identifiers (e.g. name, address, birth date, social security number).

Covered Entity means: a) any health care provider, including this office, b) Health Plans, such as a health insurance company, an JMO, a government health program such as Medicare and Medicaid, c) a health care clearing house that processes nonstandard health information from one covered entity into a standard format such as a billing agent.

Minimum Necessary. A central aspect of HIPAA is the principle of “minimum necessary” use and disclosure. This office will make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request. This office will develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. When the minimum necessary standard applies to a use or disclosure this office will not use, disclose, or request the entire medical record for a particular purpose, unless it can specifically justify the whole record as the amount reasonably needed  for the purpose.

The minimum necessary requirement is not imposed in any of the following circumstances: (a) disclosure to or a request by a health care provider for treatment; (b) disclosure to a patient who is the subject of the information , or the patients personal representative; (c) use or disclosure made pursuant to an authorization; (d) disclosure to HHS for complaint investigation, compliance  review or enforcement; (e) use or disclosure that is required by law; or (f) use or disclosures required for compliance with the HIPAA Transactions Rule for other HIPAA Administrative Simplification Rules.

For the purposes of the minimum necessary requirement, the following employees/positions have the corresponding access to PHI:

Doctor or other health care provider or treats or directs treatment of patients: All PHI related to the patient under the doctor’s care, or as the office’s electronic billing/records system permits, necessary to diagnose, treat and perform other healthcare operations.

Chiropractic Assistant or Chiropractic Technical Assistant (as certified by the state or Integrity Management):  All PHI related to the patient under the doctors’ care, or as the office’s billing/electronic records system permits necessary to treat and perform other healthcare operations.

Billing: All PHI as is minimally necessary to perform the duties of billing or obtain prior authorization of services, including but not limits to, demographic information and doctors’ notes, patients’ medical history or as the office’s electronic billing/records system permits.

Front Desk/Receptionist: All PHI as is minimally necessary to schedule appointments for patients and process patient’s demographic and billing information or as the office’s electronic billing/records system permits. This may include patient’s demographic information, health care payer information and statements made by the patient regarding their current or past medical condition.

Practice Representative: All PHI as is minimally necessary to scheduled appointments for patients or as the office’s electronic billing/records system permits.

We recognize that our office may have employees covering several positions on a temporary or permanent basis. Therefore, the level of access to PHI shall be as necessary to perform the functions of the position.

Business Associate: In general, a Business Associate is defined by HIPAA as a person or organization other than a member of a covered entities workforce, that involves the use or disclosure of patient identifiable health information. Business Associates function or activities on behalf of a covered entity include claims processing, data analysis, utilization review, and billing. Business Associate services to a covered entity are limit to legal, actuarial, accounting, Consulting, data aggregation, management, administrative, accreditation, or financial services. However, persons or organization s are not considered Business Associates if their functions or services do not involve the use or disclosure of protected health information by such persons would be incidental, if at all. A covered entity can be the business associate of another covered entity.

Personal Representatives. HIPAA requires this office to treat a “personal representative the same as the patient, with respect to uses and disclosures of the patient’s protected health by HIPPA’s a person legally authorized to make health care decisions on a patient’s behalf or to act for a deceased patient or the Estate. HIPAA permits a deception when we have a reasonable belief that the personal representative my be abusing or neglecting the patient or that treating the person as the personal representative could otherwise endanger the patient.

Special Case: Minors. In most cases, parents are the personal representatives for their minor children. Therefore, in most cases, parents can exercise patient rights, such as access to the medical record, on behalf of their minor children. In certain exceptional cases, the parent is not considered the personal representative. In these situations, HIPAA defers to the State and other laws to determine the rights of parents to access and control the protected health information of their minor children. If State and other law is silent concerning parental access to the minors’ protected health information, our office has discretion to provide or deny a parent access to the minor’s health information, provide the decision is made by a licensed health care professional, such as our doctor(s), in the exercise of professional judgement.

General Principals for Uses and Disclosures of PHI

Basic Principle. A major purpose of HIPAA is to define and limit the circumstances in which a patient’s protected health information may be used or disclosed by covered entities. This office may not use or disclose protected health information, except either (1) as the HIPAA laws permit or require; or (2) as the patient who is the subject of the information (or the patient’s personal representative) authorizes in writing.

Any information that is disclosed should be the minimum amount of information necessary to accomplish the task, such as submitting a bill to an insurance company or obtaining a prior authorization.

Required Disclosures: This office must disclose protected health information in only two situations: (a) to patients (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information; and (b) to US Department of Heath and Human Services when it is undertaking a compliance investigation or review, or enforcement action.

Permitted Uses and Disclosures of PHI

Permitted Uses and Disclosures: This office is permitted to use and disclose protected health information, without a patient’s authorization, for the following purposes or situations: 1) To the patient (unless required for access or accounting of disclosures); (2)Treatment, Payment and Health Care Operations; (3)Opportunity to agree or object; (4) incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6), limited dataset for the purposes of research, public health or health care operations. We will rely on our professional ethics and best judgements in deciding which of these permissive uses and disclosures to make

1)      To the Patient: This office may disclose protected health in formation to the patient who is the subject of the information.

2)      Treatment, Payment, Health Care Operations. This office may use and disclose protected health information for its own treatment, payment and health care operations activities. We mya also disclose protected health information for the treatment activities of any health care provider, the payment activities of another covered entity and of any health care provider, or the healthcare operations of another covered entity involving either quality or competency assurance activities or fraud and abuse detection and compliance activities, if both covered entities have or had a relationship with the patient and the protected health information pertains to the relationship

a)       Treatment is the provision, coordination, or management of health care and related services for a patient by one or more health care providers, including, consultation, between providers regarding a patient and referral of a patient by one provider to another.

b)      Payment Encompasses activities of a health plan to obtain premiums, determine or fulfill responsibilities for coverage and provision of benefits, and furnish or obtain reimbursement for health care delivered to a patient and activities of a health care provider to obtain payment or reimbursed for the provision of health care to a patient.

c)       Health care operations are any of the following activities: a) quality assessment and improvement activities, including case management and care coordination; b) competency assurance activities, including provider or health plan performance evaluation, and credentialing and accreditation; c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; d) specified insurance functions such as underwriting, risk rating, and reinsuring risk; e) business planning, development, management, and administration; and f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.

In the unlikely event this office might obtain, use, or disclose psychotherapy, substance abuse, or reproductive history notes for treatment, payment and health care operations purposes, we will require a written authorization from the patient prior to use or disclosure of the psychotherapy, substance abuse or reproductive history notes. We will take extra precautions with information regarding substance abuse and reproductive history and will only release them upon receiving a court subpoena.

3)      Uses and Disclosures with Opportunity to Agree or Object. Informal permission may be obtained by asking the patient outright, or by circumstances that clearly give the patient the opportunity to agree, acquiesce, or object. Where the patient is incapacitated, in an emergency situation, or not available, this office may generally make such uses and disclosures, if in the exercise of our professional judgement, the use or disclosure is determined to be in the best interests of the patient.

a.       Facility Directories. It is a common practice in many health care facilities, such as hospitals, to maintain a directory of patient contact information, A covered health care provider may rely on a patient’s informal permission to list in its facility directory the patient’s name, general condition, religious affiliation and location in the provider’s facility. The provider may then disclose the patient’s condition and location in the facility to anyone asking for the patient by name, and also may disclose religious affiliation to clergy. Members of the clergy are not required to ask for the patient by name when inquiring about patient religious affiliation. We do not anticipate creating such a Facility Directory, but we need to advise you of the scope of the rule.

b.       For Notification and Other Purposes. This office may also rely on a patient’s informal permission to disclose to the patient’s family, relatives, or friends or to other persons from the patient identifies, protected health information directly relevant to that person’s involvement in the patient’s care or payment for care. This provision, for example allows a pharmacist to dispense filled prescriptions to a person acting on behalf of the patient. Similarly, a covered entity may rely on a patient’s informal permission to use or disclose protected health information for the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for the patient’s care, of the patient’s location, general condition, or death. In addition, protected health information may be disclosed for notification purposes to public or private entities authorized by law or charter to assist in disaster relief efforts.

(4) Incidental Use and Disclosure. The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. A use or disclosure of this information that occurs as a result of, or as “incident to,” an otherwise permitted use or disclosure is permitted as long as this office has adopted reasonable safeguards as required by the Privacy rule, and the information being shared was limited to the “minimum necessary,” as required by HIPAA.

(5) Public Interest and Benefit Activities. HIPAA permits use and disclosure of protected health information, without a patient’s authorization or permission, for 12 national priority purposes. These disclosures are permitted, although not required, by the Rule in recognition of the important uses made of health information outside of health care context. Specific conditions or limitations apply to each public interest purpose, striking the balance between the patient privacy interest and the public interest need for this information. Those purposes are:

Required by Law: This office may use and disclose protected health information without patient authorization as required by law (including by statute, regulation, or court orders.)

Public Health Activities. This office may disclose protected health information to: 1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect; 2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance; 3) patients who may have contracted or been exposed to a communicable disease when notification is authorized by law; and 4) employers, regarding employees, when requested by employers for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MHSA), or similar state law.

Victims of Abuse, Neglect or Domestic Violence. In certain circumstances, this office may disclose protected health information to appropriate government authorities regarding victims of abuse, neglect, or domestic violence 31

Health Oversight Activities. This office may disclose protected health information to health oversight agencies, as defined by HIPAA, for purposes of legally authorized health oversight activities, such as audits, and investigations necessary for oversight of the health care system and government benefit programs.

Judicial and Administrative Proceedings. This office may disclose protected health information in a judicial or administrative proceeding if the request for the information is though an order from a court or administrative tribunal. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notices to the patient or a protective order are provided.

Law Enforcement Purposes. Thei office may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: 1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; 2) to identify or locate a suspect, fugitive, material witness, or missing person; 3) in response to a law enforcement officials’ request for information about a victim or suspected victim of a crime; 4) to alert law enforcement of a persons’ death, if the covered entity suspects that criminal activity caused the death; 5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and 6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

Decedents. This office may disclose protected health information to funeral directors as needed, and to coroners or medial examiners to identify a deceased person, determine the cause of death and perform other functions authorized by law.

Cadaveric Organ, Eye, or Tissue Donation. This office may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.

Research. “Research” is defined by HIPAA as any systemic investigation designed to develop or contribute to generalizable knowledge. HIPAA permits this office to use and disclose protected health information for research purposes, without a patient’s authorization, provided the covered entity obtains either: 1) documentation that an alteration or waiver of patient’s authorization for the use or disclosure of protected health information about them for research purposes has been approved by an Institutional Review Board or Privacy Board; 2) representations from the researcher that the use or disclosure of the protected heath information is solely to prepare a research protocol or for similarly purpose preparatory to research, that the researcher will not remove any protected health information from the covered entity, and that protected health information for which access is sought is necessary for the research; or 3) representation from the researcher that the use or disclosure sought is solely for research on the protected health information of decedents, that the protected health information sought is necessary for the research, and, at the request of the covered entity, documentation of the death of the patients about whom information is sought. A covered entity also may use or disclose, without a patient’s authorization, a limited data set of protected health information for research purposes.

Serious Threat to Health or Safety. This office may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). This office may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.

Essential Government Functions. An authorization is not required to use or disclose protected health information for certain essential government functions. Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the eligibility for or conduction enrollment in certain government benefit programs.

6) Limited Data Set. A limited data set is defined by HIPAA as protected health information from which certain specified direct identifiers of patients and their relatives, household members, and employers have been removed. A limited data set may be used and disclosed for research health care operations, and public health purposes, provided the recipient enters into a data use agreement promising specified safeguards for the protected health information within the limited data set.

Privacy Practices Notice. Our office, with certain exceptions, must provide a notice of its privacy practices, HIPAA, and that the notice must contain certain elements. The notice must describe the ways in which the covered entity may use and disclose protected health information. The notice must state our office’s duties to protect privacy, provide a notice or privacy practices, and abide by the terms of the current notice. The notice must describe the patients’ rights, including the right to complain to HHS and to this office if they believe their privacy rights have been violated. The notice must include a point of contact for further information and for making complaints to our office. We must act in accordance with their notices. HIPAA also contains specific distribution requirements for direct treatment providers, all other health care providers and health plans.

Notice Distribution. For every patient of our office, we must have delivered a privacy practices notice to patients:

A covered entity must make its notice available to any person who asks for it. 

A covered entity must prominently post and make available its notice on any web site it maintains that provides information about its customer services or benefits.     

                Covered Direct Treatment Providers must also:

Provide the notice to the individual no later than the date of first service delivery (after the April 14, 2003 compliance date of the Privacy Rule) and, except in an emergency treatment situation, make a good faith effort to obtain the individual’s written acknowledgment of receipt of the notice. If an acknowledgment cannot be obtained, the provider must document his or her efforts to obtain the acknowledgment and the reason why it was not obtained. 

When first service delivery to an individual is provided over the Internet, through e-mail, or otherwise electronically, the provider must send an electronic notice automatically and contemporaneously in response to the individual’s first request for service. The provider must make a good faith effort to obtain a return receipt or other transmission from the individual in response to receiving the notice. 

In an emergency treatment situation, provide the notice as soon as it is reasonably practicable to do so after the emergency situation has ended. In these situations, providers are not required to make a good faith effort to obtain a written acknowledgment from individuals. 

Make the latest notice (i.e., the one that reflects any changes in privacy policies) available at the provider’s office or facility for individuals to request to take with them, and post it in a clear and prominent location at the facility. 

A covered entity may e-mail the notice to an individual if the individual agrees to receive an electronic notice.

(This information was obtained from the www.hhs.gov/hipaa website)

Acknowledgement of Notice or Receipt. Our office must make a good faith effort to obtain written acknowledgement from patients of receipt of the privacy practices notice. HIPAA does not prescribe any particular content for the acknowledgement. The provider must document the reason for any failure to obtain the patient’s written acknowledgement. The provider is relieved of the need to request acknowledgement in an emergency treatment situation.

Patient’s Rights

Access. Except in certain circumstances, patients have the right to review and obtain a copy of their protected health information within 30 days of the request. If our system cannot readily provide it to you in your requested format, we will seek to agree upon a mutually acceptable format. As a last resort, we may have to provide a paper copy.

Amendment. HIPAA gives patients the right to have covered entities amend their protected health information in a designated record set when that information is inaccurate or incomplete. If we accept an amendment request, it must make reasonable efforts to provide the amendment to persons that the patient has identified as needing it, and to persons that the covered entity knows might rely on the information to the patient’s detriment. If the request is denied, covered entities must provide the patient with a written denial and allow the patient to submit a statement of disagreement for including in the record HIPAA specifies processes for requesting and responding to a request for amendment. We must amend protected health information in is designate record set upon receipt of notice to amend from another covered entity.

Disclosure Accounting. Patients have a right to an accounting of the disclosures of their protected health information by this office or our business associates. The maximum disclosure accounting period is the six years immediately preceding the accounting request, except a covered entity is not obligated to account for any disclosure made before hits HIPAA compliance date.

HIPAA does not require account for disclosures: a) for treatment, payment or healthcare operations; b) to the patient or the patient’s personal representative; c) for notification of or to persons involved in a patient’s health care or payment for health care, for disaster relief, or for facility directories; d) pursuant to an authorization; e) of a limited data set; f) for national security or intelligence purposes; g) to correctional institutions or law enforcement officials for certain purposes regarding inmates or patients in lawful custody; or h) incident to other wise permitted or required uses or disclosures. Accounting for disclosures to health oversight agencies and law enforcement officials must be temporarily suspended on their written representation that an accounting would likely impede their activities.

Restriction Request. Patients have the right to request that this office restrict use or disclosure of protected health information for treatment, payment or heath care operations, disclosure to persons involved in the patient’s health care or payment for health care, or disclosure to notify family members or others about the patient’s general condition, location or death. Such requests should be documented in writing and maintained in the patient’s record.

Restriction Request for Services Paid “Out-of-Pocket.” Patients have the right to request that this office not disclose to a patient’s health insurance company, HMO, or other payer any PHI related to any treatment the patient has elected to pay “out of pocket.” The patient must complet the “HIPAA REQUEST FOR NON-DISCLOSURE OF PHI RELATING TO SERVICES PAID DIRECTLY BY THE PATIENT” form to document the request and should be maintained in the patient’s record.

Right to Revoke Authorization or Consent to Use PHI for Marketing or Fundraising Purposes. Patients have the right to revoke their consent or authorization to disclose or use their PHI for any fundraising or marketing purposes.  The patient must complete the “HIPAA REVOCATION OF AUTHORIZATION OR CONSENT TO USE PHI FOR MARKETING OR FUNDRAISING PURPOSES” form to document the request and should be maintained in the patient’s record. A list of all patient’s electing to opt our should also be kept.

The patient should be advised that they may still receive marketing and fundraising communications, but their name and other demographic information will have been derived from sources other than PHI, such as the White Pages or a community marketing list.

Sale of PHI. This office will not sell your PHI. However, we are legally required to inform you that if we were to sell your PHI, we must first obtain your authorization.

Right to Revoke All Authorizations or Consent to Use or Disclose PHI. Patients have the right to revoke any or all authorizations to use or disclose PHI by this office. The patient must complete the “HIPAA REVOCATION OF ALL AUTHORIZATIONS OR CONSENT TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION” form to document the request and should be maintained in the patient’s records. The patient should be advised that this revocation may affect this office’s ability to maintain the patient as a patient and treat them in the future.

Right to be Notified of a Breach. Patients have the right to be notified of a breach of the security of your PHI, unless there is a low probability your PHI has been compromised.

Administrative Requirements

HHS recognizes that covered entities range from the smallest provider to the largest, multi-state health plan. Therefore, the flexibility and scalability of the Rule are intended to allow covered entities to analyze their own needs and implement solutions appropriate to their own environment. What is appropriate for a particular covered entity will depend on the nature of the covered entity’s business, as well as the covered entity’s size and resources.

Privacy Policies and Procedures. A covered entity must develop and implement written privacy policies and procedures that are consistent with the Privacy Rule .64

Privacy Personnel. Our office has designated Dr. Robert Joyce and Dani DeBerg (Office Manager) as our Privacy Official responsible for developing and implementing its privacy policies and procedures, and a contact person or contact office responsible for receiving complaints and providing patients with information on this office’s privacy practices.

Mitigation. We must mitigate, to the extent practicable, any harmful effect it learns was caused by use or disclosure of protected health information by its workforce, or its business associates in violation of its privacy policies and procedures or the Privacy Rule.  

Data Safeguards. This office must maintain reasonable and appropriate administrative, technical and physical safeguards to prevent intentional or unintentional use or disclosure of protected health information in violation of HIPAA and to limit it incidental use and disclosure pursuant to otherwise permitted or required use or disclosure. Our office shall practice to ensure reasonable safe guards for patient’s health information – for instance:

-By speaking quietly when discussing a patient’s condition with family members in a waiting room or other public area;

-By avoiding using patients’ names in public hallways and elevators, and posting signs to remind employees to protect patient confidentiality;

                -By isolating or locking file cabinets or records rooms; or

-By providing additional security, such as passwords, on computers maintaining personal information

Documentation and Record Retention. Our office will maintain, until six years after the later of the date of their creating or last effective date, its privacy policies and procedures, its privacy practices notices, disposition of complaints, and other actions, activities, and designations that HIPAA requires to be documented

Changes to this Notice. We reserve the right to change this notice. Any changes contained in the new notice will apply to Health Information already in the possession of our office as well as any information we receive in the future.  A current copy of the notice will be posted in the office and on our website, if we have a website.

Complaints

Complaints. Any complaints regarding our privacy policies or procedures should be directed to our Privacy Officers, Dr. Robert Joyce or Dani DeBerg.

Retaliation and Waiver. This office will not retaliate against a person for exercising rights provided by the Privacy Rule, for assisting in an investigation by HHS or another appropriate authority, or for opposing an act or practice that the person believes in good faith violates the Privacy Rule. Our office will not require a patient to waive any rights not under HIPAA as a condition for obtaining treatment. .