Privacy Policy

Our HIPPA Compliance document is found below. At your inital visit you will be asked to sign a form acknowledging your understanding of your rights under HIPPA.

 

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.


Pine Bush Health and Chiropractic 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 Pine Bush Health and Chiropractic."
"It is our policy to provide a substitute health care provider, authorized by
Pine Bush Health and Chiropractic 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.

(example)

"As a courtesy to our patients, we will submit an itemized billing statement to your
insurance carrier for the purpose of payment to Pine Bush Health and Chiropractic for health care services rendered. If you pay for your health care services personally, we will, as
a courtesy, provide an itemized billing to your insurance carrier for the purpose of
reimbursement to you. The billing statement contains medical information,
including diagnosis, date of injury or condition, and codes which describe the
health care services received."

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.

Marketing.
We may contact you for marketing purposes or fundraising purposes, as described
below:

(example)
"As a courtesy to our patients, it is our policy to call your home on the evening
prior to your scheduled appointment to remind you of your appointment time. If
you are not at home, we leave a reminder message on your answering machine
or with the person answering the phone. No personal health information will be
disclosed during this recording or message other than the date and time of your
scheduled appointment along with a request to call our office if you need to
cancel or reschedule your appointment."


"It is our practice to participate in charitable events to raise awareness, food
donations, gifts, money, etc. During these times, we may send you a letter, post
card, invitation or call your home to invite you to participate in the charitable
activity. We will provide you with information about the type of activity, the dates
and times, and request your participation in such an event. It is not our policy to
disclose any personal health information about your condition for the purpose of
Pine Bush Health and Chiropractic sponsored fund-raising events."

Change of Ownership.

In the event that Pine Bush Health and Chiropractic is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

􀂾 You have the right to request restrictions on certain uses and disclosures of your
health information. Please be advised, however, that Pine Bush Health and Chiropractic is not
required to agree to the restriction that you requested.

􀂾 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.

􀂾 You have the right to inspect and copy your health information.

􀂾 You have a right to request that Pine Bush Health and Chiropractic amend your protected health information. Please be advised, however, that Pine Bush Health and Chiropractic 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.

􀂾 You have a right to receive an accounting of disclosures of your protected health
information made by Pine Bush Health and Chiropractic.

􀂾 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

Pine Bush Health and Chiropractic 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, Pine Bush Health and Chiropractic is required by law to comply with this Notice.


Pine Bush Health and Chiropractic 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: Pine Bush Health and Chiropractic by calling this office at 845-744-8050. If Pine Bush Health and Chiropractic 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 Pine Bush Health and Chiropractic has handled your health information should be directed to Dr. Michael Raucci by calling this office at
845-744-8050. If Dr. Michael Raucci 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


This notice is effective as of ______/______/_______


I have read the Privacy Notice and understand my rights contained in the notice.
By way of my signature, I provide Pine Bush Health and Chiropractic with my authorization and consent to use and disclosed my protected health care information for the purposes of treatment, payment and health care operations as described in the Privacy Notice.


________________________________________________
Patient's Name (print)
________________________________________________ ______________
Patient's Signature Date
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Authorized Facility Signature Date