NOTICE OF PRIVACY PRACTICES Schwartz Family Chiropractic      503 East Main Street Plaza, Suite #2 Mandan, ND 58554 Telephone:  701-663-3380 ____________________________________________________________________________________________________ THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US. ______________________________________________________________________________________________________________________________ OUR LEGAL DUTY We are required by applicable federal and state law to maintain the privacy of your health information.  We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.  We must follow the privacy practices that are described in this Notice while it is in effect.  This Notice takes effect April 14th, 2003  and will remain in effect until we replace it.  We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law.  We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes.  Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.   You may request a copy of our notice at any time.  For more information about our privacy practices, or for additional copies of this notice, please contact us using information listed at the end of this notice.   USES AND DISCLOSURES OF HEALTH INFORMATION The following section describes different ways that we use and disclose medical information.  Not every use or disclosure will be listed.  However, we have listed different ways we are permitted to use and disclose medical information.  We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization.  Any specific written authorization you provide may be revoked at any time by writing to us.    Treatment: We may use or disclose your health information to a physician or other health-care provider providing treatment to you.   Payment: We may use and disclose your health information to obtain payment for services we provide you.   Healthcare Operations: We may use and disclose your medical information for healthcare operations.  This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.  We may use medical information to remind you of appointments with us (such as voicemail messages, postcards, or letters).  We may contact you with information about treatment alternatives or other health related benefits or services that may be of interest to you.  We may use medical information to contact you about marketing and fundraising activities.   Notification of Family and Friends: We will share information about your location, general condition, or death.  If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission.  In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment.  We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you.   Required by Law: We may use or disclose your health information when we are required to do so by law.   Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.   National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal or state officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.   Workers Compensation: We may disclose health information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.         PATIENT RIGHTS Access: You have the right to look at or get copies of your health information, with limited exceptions.  You may request that we provide copies in a format other than photocopies.  We will use the format you request unless we cannot practicably do so.  (You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information listed at the end of this notice.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  You may also request access by sending us a letter to the address at the end of this notice.  If you request copies, we will charge you $1.00  for each page, and postage if you want the copies mailed to you.  If you request an alternative format, we will charge a cost-based fee for providing your health information in that format.  If you prefer, we will prepare a summary or an explanation of your health information for a fee.  Contact us using the information listed at the end of this notice for a full explanation of our fee structure.)   Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last six years, but not before April 14th, 2003.  If you request this accounting more than once in a twelve-month period, we may charge you a reasonable, cost based fee for responding to these additional requests.   Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).   Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations.  (You must make your request in writing.)  Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.   Amendment: You have the right to request that we amend your health information.  (You request must be in writing, and it must explain why the information should be amended.)  We may deny your request under certain circumstances.   Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form.     QUESTIONS AND COMPLAINTS If you want more information about our privacy practices or have questions or concerns, please contact us.   If you think that we may have violated your privacy rights, contact the person named below.  You may also submit a written complaint to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services.  We will not retaliate in anyway if you choose to file a complaint.   Contact Officer:  Sandi Gieger_________________________________ Telephone:  701-663-3380_______________ Fax:  701-663-0083_________________ E-mail:  sfcchiropractic@msn.com____________________ Address:  Schwartz Family Chiropractic., 503 East Main Street Plaza, Suite #2  Mandan, ND 58554