Cooperstown Chiropractic – 680 Langsdorf Dr #101, Fullerton, CA 92831
Ken Cooper D.C. – (714) 525-8700
Effective Date: 8-8-13
THIS NOTICE EXPLAINS HOW YOUR MEDICAL INFORMATION MAY BE USED OR SHARED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE READ IT CAREFULLY.
We value your privacy and are committed to protecting the confidentiality of your medical records. Our office creates and maintains records regarding the care and treatment you receive, and we may also obtain records from other healthcare providers. These records help us provide quality care, coordinate services with other providers, process payments through your health plan, and meet legal and professional responsibilities necessary to operate our practice.
Federal law requires us to protect your health information, provide notice of our privacy practices and legal responsibilities, and notify affected individuals in the event of a breach involving unsecured protected health information. This Notice explains how your medical information may be used or disclosed, along with your rights regarding that information. If you have questions about this Notice, please contact our Privacy Officer listed above.
Table of Contents
- How We May Use or Share Your Health Information
- Situations Where We May Not Use or Share Your Information
- Your Privacy Rights
- Right to Request Additional Privacy Restrictions
- Right to Confidential Communications
- Right to Access and Copy Records
- Right to Request Changes to Records
- Right to Receive an Accounting of Disclosures
- Right to Receive a Paper or Electronic Copy of This Notice
- Updates to This Notice
- Complaints
A. How We May Use or Share Your Health Information
Our office collects health information about you and stores it in both electronic and paper records. While the medical record belongs to this practice, the information within the record belongs to you. The law allows us to use or disclose your health information for the following reasons:
Treatment
We use your medical information to provide healthcare services. Information may be shared with employees, physicians, specialists, pharmacies, laboratories, or other providers involved in your care. We may also share information with family members or individuals assisting with your care during illness, injury, or after death.
Payment
We may use or disclose your medical information to receive payment for services provided. For example, your health plan may require medical details before approving payment. We may also share information with other healthcare providers involved in your treatment.
Health Care Operations
Your health information may be used to support office operations, improve care quality, review staff performance, conduct audits, maintain compliance programs, or support business management activities. We may share information with business associates who assist with administrative services, provided they agree to protect your information. Information may also be shared with other providers, health plans, or healthcare organizations participating in joint healthcare activities or organized health care arrangements (OHCAs).
Appointment Reminders
We may contact you regarding scheduled appointments. If unavailable, we may leave a message with another person or on voicemail.
Sign-In Sheet
You may be asked to sign in upon arrival, and your name may be called when it is time for your appointment.
Communication With Family
We may share your health information with a family member, personal representative, or another individual involved in your care or payment for care. In emergency or disaster situations, information may also be shared with relief organizations. When possible, we will provide you the opportunity to object before sharing information.
Marketing
As long as we are not paid for the communication, we may contact you regarding treatment options, health-related services, care coordination, wellness programs, or healthcare products that may benefit you. We may also provide reminders regarding medications or refills. We will not use your information for marketing purposes that require authorization without your written consent.
Sale of Health Information
We will never sell your health information without your written authorization. Any authorization may be revoked in writing at any time.
Required by Law
We may use or disclose your health information when required by federal or state law, including situations involving abuse, neglect, legal proceedings, or law enforcement requests.
Public Health Activities
We may disclose information to public health authorities to help prevent disease, report abuse or neglect, report reactions to medications, or notify individuals exposed to disease or infection.
Health Oversight Activities
Government agencies may access your information for audits, inspections, investigations, or licensing activities as permitted by law.
Judicial and Administrative Proceedings
We may disclose your information in response to court orders, subpoenas, or lawful legal processes when required.
Law Enforcement
Your information may be disclosed to law enforcement officials for lawful purposes such as locating a missing person, responding to warrants, or complying with investigations.
Coroners
We may disclose information to coroners or medical examiners as required for investigations involving deaths.
Organ and Tissue Donation
Health information may be shared with organizations involved in organ, tissue, or transplant services.
Public Safety
We may disclose information when necessary to prevent or reduce a serious threat to an individual or the public.
Proof of Immunization
We may provide proof of immunization to schools when required and authorized.
Specialized Government Functions
Information may be shared for military, national security, correctional, or lawful custody purposes.
Workers’ Compensation
We may disclose information as necessary to comply with workers’ compensation laws or workplace injury reporting requirements.
Change of Ownership
If this practice is sold or merged, your medical records may become part of the new organization, although your rights regarding the information remain protected.
Breach Notification
If a breach involving unsecured protected health information occurs, we will notify you as required by law. Notification may be provided by mail, email, or other appropriate methods.
B. When We May Not Use or Share Your Health Information
Except as outlined in this Notice, we will not use or disclose your identifiable health information without your written authorization. If you provide authorization, you may revoke it in writing at any time.
C. Your Health Information Rights
Right to Request Additional Privacy Protections
You may request limits on certain uses or disclosures of your health information. Requests must be made in writing and specify the information and restrictions requested. If you pay for services in full out-of-pocket, you may request that information not be shared with your health plan unless legally required.
Right to Confidential Communications
You may request that communications be sent to a specific location or by a certain method, such as by mail, email, or another address. Reasonable written requests will be honored.
Right to Access and Copy Records
You have the right to inspect and receive copies of your health records with limited exceptions. Requests must be submitted in writing and include the records requested and preferred format. Reasonable fees may apply for copies, postage, or summaries. Certain requests may be denied as permitted by law.
Right to Amend or Supplement Records
You may request corrections or additions to your health information if you believe it is inaccurate or incomplete. Requests must be submitted in writing with an explanation. We may deny requests under certain legal conditions but will explain the decision and your appeal rights.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your health information made by this practice, excluding disclosures related to treatment, payment, healthcare operations, authorized disclosures, and certain legally permitted activities.
Right to a Paper or Electronic Copy of This Notice
You have the right to receive a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.
For more information about these rights or to exercise them, contact our Privacy Officer listed above.
D. Changes to This Notice
We reserve the right to update this Notice of Privacy Practices at any time. Any revised version will apply to all health information maintained by this practice, including information created before the revision date. Updated notices will be available in our office and on our website.
E. Complaints
Questions or complaints regarding this Notice or the handling of your health information should be directed to our Privacy Officer listed above.
If you are not satisfied with how your complaint is handled, you may file a complaint with the U.S. Department of Health and Human Services at:
The complaint form is available at:
HHS HIPAA Complaint Information
You will not be penalized for filing a complaint.