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Lombardo Chiropractic
Clinic PA Notice of Privacy Practices
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.
Lombardo Chiropractic
Clinic PA is required, by law, to maintain
the privacy and confidentiality of your
protected health information and to provide
our patients with notice of our legal duties
and privacy practices with respect to your
protected health information.
Disclosure of Your
Health Care Information
Treatment
We may disclose your health care information
to other healthcare professionals within our
practice for the purpose of treatment,
payment or healthcare operations. (example)
“On occasion, it may
be necessary to seek consultation regarding
your condition from other health care
providers associated with Lombardo
Chiropractic Clinic PA.”
“It is our policy to
provide a substitute health care provider,
authorized by Lombardo Chiropractic Clinic
PA to provide assessment and/or treatment to
our patients, without advanced notice, in
the event of your primary health care
provider’s absence due to vacation,
sickness, or other emergency situation.”
Payment
We may disclose your health information to
your insurance provider for the purpose of
payment or health care operations.
Workers’ Compensation
We may disclose your health information as
necessary to comply with State Workers’
Compensation Laws.
Emergencies
We may disclose your health information to
notify or assist in notifying a family
member, or another person responsible for
your care about your medical condition or in
the event of an emergency or of your death.
Public Health
As required by law, we may disclose your
health information to public health
authorities for purposes related to:
preventing or controlling disease, injury or
disability, reporting child abuse or
neglect, reporting domestic violence,
reporting to the Food and Drug
Administration problems with products and
reactions to medications, and reporting
disease or infection exposure.
Judicial and
Administrative Proceedings.
We may disclose your health information in
the course of any administrative or judicial
proceeding.
Law Enforcement.
We may disclose your health information to a
law enforcement official for purposes such
as identifying or locating a suspect,
fugitive, material witness or missing
person, complying with a court order or
subpoena, and other law enforcement
purposes.
Deceased Persons.
We may disclose your health information to
coroners or medical examiners.
Organ Donation.
We may disclose your health information to
organizations involved in procuring,
banking, or transplanting organs and
tissues.
Research.
We may disclose your health information to
researchers conducting research that has
been approved by an Institutional Review
Board.
Public Safety.
It may be necessary to disclose your health
information to appropriate persons in order
to prevent or lessen a serious and imminent
threat to the health or safety of a
particular person or to the general public.
Specialized Government
Agencies.
We may disclose your health information for
military, national security, prisoner and
government benefits purposes.
Change of Ownership.
In the event that Lombardo Chiropractic
Clinic PA is sold or merged with another
organization, your health information/record
will become the property of the new owner.
Your Health
Information Rights
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You have the right
to request restrictions on certain uses
and disclosures of your health
information. Please be advised, however,
that Lombardo Chiropractic Clinic PA is
not required to agree to the restriction
that you requested.
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You have the right
to have your health information received
or communicated through an alternative
method or sent to an alternative
location other than the usual method of
communication or delivery, upon your
request.
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You have the right
to inspect and copy your health
information.
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You have a right
to request that Lombardo Chiropractic
Clinic PA amend your protected health
information. Please be advised, however,
that Lombardo Chiropractic Clinic PA is
not required to agree to amend your
protected health information. If your
request to amend your health information
has been denied, you will be provided
with an explanation of our denial
reason(s)and information about how you
can disagree with the denial.
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You have a right
to receive an accounting of disclosures
of your protected health information
made by Lombardo Chiropractic Clinic PA.
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You have a right
to a paper copy of this Notice of
Privacy Practices at any time upon
request.
Changes to this Notice
of Privacy Practices
Lombardo Chiropractic Clinic PA reserves the
right to amend this Notice of Privacy
Practices at any time in the future, and
will make the new provisions effective for
all information that it maintains. Until
such amendment is made, Lombardo
Chiropractic Clinic PA is required by law to
comply with this Notice.
Lombardo Chiropractic
Clinic PA is required by law to maintain the
privacy of your health information and to
provide you with notice of its legal duties
and privacy practices with respect to your
health information. If you have questions
about any part of this notice or if you want
more information about your privacy rights,
please contact: Dr. Lombardo and/or Dr.
Nuzum by calling this office at
386.673.0400. If Dr. Lombardo and/or Dr.
Nuzum is not available, you may make an
appointment for a personal conference in
person or by telephone within 2 working
days.
Complaints
Complaints about your Privacy rights, or how
Lombardo Chiropractic Clinic PA has handled
your health information should be directed
to Dr. Lombardo or Dr. Nuzum, by calling
this office at 386.673.0400 If Dr. Lombardo
or Dr. Nuzum is not available, you may make
an appointment for a personal conference in
person or by telephone within 2 working
days.
If you are not
satisfied with the manner in which this
office handles your complaint, you may
submit a formal complaint to:
DHHS, Office of Civil
Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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