Effective Date: [January 2, 2025]
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.
At Griz Chiropractic Sports & Wellness, we are committed to protecting the privacy of your health information in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Your Rights
You have the right to:
- Access your medical records – You may request to see or obtain a copy of your health records.
- Request corrections – If you believe your records are inaccurate or incomplete, you may ask us to amend them.
- Request confidential communications – You may ask us to contact you in a specific way (e.g., at your home or work).
- Limit disclosures – You may request restrictions on how your information is shared. While we will consider all requests, we are not required to agree in all cases.
- Receive a list of disclosures – You may request an accounting of certain disclosures of your health information.
- Receive a copy of this notice – You are entitled to a copy of this notice at any time.
Our Responsibilities
We are required by law to:
- Maintain the privacy and security of your protected health information.
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
- Provide you with this Notice of our legal duties and privacy practices.
- Follow the terms of the Notice currently in effect.
How We May Use and Share Your Information
We may use or share your health information in the following ways:
- Treatment – To provide, coordinate, or manage your healthcare and related services.
- Payment – To bill and collect payment for services rendered.
- Healthcare operations – For administrative, quality improvement, and training purposes.
- As required by law – For public health, legal matters, and other required disclosures.
Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke that authorization at any time.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
To file a complaint with our office:
Griz Chiropractic Sports & Wellness
2522 Lansing Ave, Jackson, MI 49202
[Insert Phone Number]
To file a complaint with HHS:
Office for Civil Rights
U.S. Department of Health & Human Services
www.hhs.gov/ocr/privacy/hipaa/complaints/
Contact Us
If you have questions about this Notice or how your information may be used, please contact:
Griz Chiropractic Sports & Wellness
griz@grizchiropractic.com