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.
Faithful Hands Sports Chiropractic & Wellness, LLC maintains information about your health and the services you receive as part of your care plan, which is called protected health information (PHI). Your protected health information is maintained in a specific set of records. I may use and disclose your protected health information in various ways. Sometimes your authorization is required for me to use or disclose your information, and other times it is not. This Notice describes your rights and how I may use and disclose your protected health information. I am required by the Health Insurance Portability and Accountability Act (HIPAA) and the Texas Medical Records Privacy Act to protect the privacy and security of your health information. The Texas Identity Theft Enforcement and Protection Act requires me to protect your sensitive personal information. It is my duty to give you this Notice and comply with these laws. I may change this Notice at any time if the law changes or my policies change. You may also access this Notice on my website: www.faithfulhands.care.
Your Health Information Rights
- Breach Notification
- You have the right to be notified if I determine that your protected health information has been breached.
- Right to Access your Records
- You have the right to access, or to inspect and obtain a copy of your protected health information. You may request that your records be provided in an electronic or paper format. You may choose to have your protected health information sent to another individual.
- Right to a Restriction
- You have the right to ask me to restrict disclosures of your protected health information for treatment, payment, or my business operations.
- Right to an Accounting
- You have a right to an accounting of disclosures of your protected health information that is maintained in a designated record set. This is a list of persons, government agencies, or businesses who have obtained your health information.
- Right to Amend your Records
- If you feel that your protected health information is incorrect or incomplete, you may ask that I amend your health records. I can refuse your request if I did not create the information, the information is not part of the information I maintain, or if the information is accurate and complete as written. You will be notified in writing if your request is refused, and you will be provided an opportunity to have your request included in your protected health information.
- Right to Choose Someone to Act for you
- You may give someone the right to act for you. Examples include a legal guardian, authorized representative, and power of attorney. The individual can exercise your rights and make choices about your health information. The individual must show written proof that they have the right to act for you. I will ensure that the individual has the proper authority and can act for you before I honor their request for your health information. I may ask the individual to verify their identity.
- Right to Communication Accommodation
- You have the right to receive confidential communications of your protected health information, such as requesting that I contact you at a certain address or phone number. I am not required to agree with your request but will consider all reasonable requests. If you will be in danger if I do not use the alternative contact information, I will agree with the request.
- Right to File a Complaint
- If you believe your privacy rights as described in this Notice have been violated, you may file a written complaint with me. You may also file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Ave., S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. You will not be penalized for filing a complaint.
- Right to Obtain the Notice of Privacy Practices
- You have the right to have a paper copy of this Notice. You may request a copy directly from me in my office or may visit my website at www.faithfulhands.care.
*To exercise any of the above rights, please contact me by e-mail.
Your Choices
- For certain health information, you can tell me your choices about what I share. If you have a clear preference for how we share your information in the situations described below, please let me know.
- You have the right and choice to request that I:
- Share information with your family, close friends, or others involved in payment for your care
- Share information in a disaster relief situation
Uses and Disclosures of Your Health Information (May be Made Without Your Authorization)
- As Required by Law
- I will disclose your protected health information when local, state, or federal law requires me to do so.
- Coroners, Medical Examiners, and Funeral Directors
- I may disclose your protected health information to a coroner, medical examiner, or a funeral director.
- For Appointment Reminders
- I may use your protected health information to remind you of appointments, including leaving a voicemail message.
- For Healthcare Operations
- I may use and disclose your protected health information when it is necessary to function as a business or provide services. When I contract with other businesses to do specific tasks or services for me, I may share your protected health information related to those tasks or services. When I do this, the business agrees in the contract to protect your protected health information and use and disclose such health information only to the extent necessary to complete the assigned tasks or as I would use it in my office. These businesses are called “Business Associates” and my contract for their services is called a “Business Associate Agreement.”
- For Incidental Disclosures
- I will be careful and aware about discussions of your protected health information; however, an incidental disclosure may include your protected health information being seen or overheard in the hallway or waiting room despite reasonable attempts to keep it confidential.
- For Payment
- I may share your protected health information with anyone who may pay for your treatment, such as your insurance carrier.
- For Surveys
- I may use and disclose your protected health information to contact you to assess your satisfaction with my services.
- For your Treatment
- I may share your protected health information with other healthcare providers for the purposes of referral, progress notes, and/or collaboration on your care. For example, if you have a musculoskeletal disorder that warrants referral to an orthopedic surgeon, I could send your contact and pertinent health information to a specific provider that has the expertise and training to provide treatment for your condition.
- Fundraising
- I may send you information as part of my fundraising activities. If you notify me that that you wish to opt out, I will not send you fundraising information or mailings in the future.
- Health Oversight Activities
- I may disclose your protected health information to a health oversight agency for activities authorized by law such as audits, investigations, and inspections of Texas Department of State Health Services (DSHS) facilities. These activities are necessary for the government to monitor the healthcare system, government programs, and civil rights laws.
- Inmates or Persons in Custody
- If you are an inmate of a correctional institution or under the custody of a law enforcement official, I may release your protected health information to the correctional institution or a law enforcement official when it is necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
- Law Enforcement
- When a law enforcement official requests your protected health information, it may be disclosed in response to a court order, subpoena, warrant, summons, or similar process. It may also be disclosed to help law enforcement identify or locate a suspect, fugitive, material witness, or missing person. I may also disclose protected health information about the victim of a crime, a death I believe may be the result of criminal conduct, criminal conduct on the premises, or in any emergency to report a crime, the location of the crime, victims of the crime, or to identify the person who committed the crime.
- Legal Proceedings
- I may disclose your protected health information if I receive a court or administrative order. I may also disclose your protected health information if I get a subpoena, or another type of discovery request. If there is no court order or judicial subpoena, the attorneys must attempt to tell you about the request for your protected health information.
- Military and Veterans
- The protected health information of members of the United States Armed Forces members or of a foreign military authority may be disclosed as required by military command authorities.
- National Security and Intelligence Activities
- When authorized by law, I may disclose your protected health information to federal officials for intelligence, counterintelligence, and other national security activities.
- Public Health Risks
- I may disclose your protected health information for public health activities which include the prevention or control of disease, injury or disability; to report child abuse or neglect; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- To Avert a Serious Threat to Health or Safety
- I may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety or the health and safety of another person.
- To Create or Share De-Identified or Partially De-Identified Health Information (Limited Data Sets)
- I may disclose your protected health information for research, public health, and health care operations if it is in the form of a limited data set, meaning that as it relates to you, your relatives, employers, or household members, direct identifiers (i.e., names, addresses, phone numbers, fax numbers, e-mail addresses, SSN’s, etc.) must be removed.
- Victims of Abuse, Neglect, or Domestic Violence
- I may disclose your protected health information to notify the appropriate government authority if I believe you have been the victim of abuse, neglect, or domestic violence. If the agency reasonably believes you are a victim of abuse, neglect, or domestic violence, I will attempt to obtain your permission; however, in some cases I may be required to alert the authorities.
- Worker’s Compensation
- I may release your protected health information for worker’s compensation or similar programs providing you benefits for work-related injuries or illness.
Other Uses and Disclosures
Additional privacy protections under state or federal law apply to substance abuse information, mental health information, certain disease-related information, or genetic information. I will not use or share these types of information unless expressly authorized by law.
I will always obtain your authorization to use or share your information for marketing purposes, to use or share your psychotherapy notes, if there is payment from a third party, or for any other disclosure not described in this notice or required by law. You have the right to cancel your authorization by letting me know in writing, except to the extent that I have acted based on your authorization.
My Responsibilities
- I am required by law to maintain the privacy and security of your protected health information. • I must let you know quickly if a breach occurs that might have compromised the security of your information.
- I must follow the duties and privacy practices described in this Notice and give you a copy of it. • I must not use or share your information other than described here, unless you tell me in writing I can. You may change your mind at any time, but you must let me know in writing. • Additional resources can be found online at HIPAA, Texas Medical Records Privacy Act, and Texas Identity Theft Enforcement and Protection Act
Changes to this Notice
I reserve the right to change this notice at any time. I reserve the right to make the revised Notice effective for protected health information that I currently maintain in my possession, as well as for any protected health information I receive, use, or disclose, in the future. A current copy of this notice is posted on my website at www.faithfulhands.care, and it will stay up to date to reflect any future changes that are made.
To ask questions about your protected health information, HIPAA privacy, or this notice, please contact:
Dr. Eric C. Olson
Chief Serving Officer
Faithful Hands Sports Chiropractic & Wellness, LLC
1400 N. Coit Rd., Ste. 302, McKinney, TX 75071
469-343-3441
drolson@faithfulhandsmsk.care