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.
If you have any questions about this Notice, please contact our Privacy Officer or any staff member in our office.
Our Privacy Officer is: Pam Doty
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out your treatment, collect payment for your care and manage the operations of this clinic. It also describes our policies concerning the use and disclosure of this information for other purposes that are permitted or required by law. It describes your rights to access and control your protected health information.
“Protected Health Information” (PHI) is information about you, including demographic information that may identify you, that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required by federal law to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time.
You may obtain revisions to our Notice of Privacy Practices by accessing our website, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
A. Uses and Disclosures of Protected Health Information
By applying to be treated in our office, you are implying consent to the use and disclosure of your protected health information by your doctor, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to bill for your health care and to support the operation of the practice.
Uses and Disclosures Based Upon Your Implied Consent
- Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and related services. This may include sharing information with other physicians, specialists, or laboratories involved in your care.
- Payment: Your protected health information will be used, as needed, to obtain payment for your health care services, including insurance eligibility, coverage determinations, medical necessity reviews, and utilization review activities.
- Healthcare Operations: We may use or disclose your protected health information to support business activities such as quality assessments, employee reviews, training, sign-in sheets, appointment reminders, and communications within the office.
We may share your protected health information with third-party “business associates” that perform services such as billing or transcription. All such partners are contractually required to protect your privacy.
Marketing & Communications
We may use your information to contact you about treatment alternatives, health-related benefits, newsletters, or services that may interest you. You may request that these materials not be sent to you by contacting our Privacy Officer.
Uses & Disclosures Requiring Written Authorization
- Disclosures of psychotherapy notes
- Marketing uses of PHI
- Disclosures constituting sale of PHI
- Drug history or addiction treatment information
- Mental health care notes
- Any other use not described in this notice
Others Involved in Your Healthcare
Unless you object, we may disclose your protected health information to family members, relatives, close friends, or others involved in your care. We may also notify appropriate persons of your location or general condition or assist with disaster relief efforts.
Permitted & Required Disclosures Without Consent
- Required by Law
- Public Health Activities
- Communicable Disease Reporting
- Health Oversight Activities
- Abuse or Neglect Reporting
- Legal Proceedings
- Law Enforcement Purposes
- Workers’ Compensation
- Department of Health & Human Services Compliance Reviews
B. Your Rights
- Inspect and Copy: You may inspect and obtain copies of your protected health information in designated record sets, subject to federal limitations.
- Request Restrictions: You may request limits on how your information is used or disclosed. Requests must be submitted in writing to our Privacy Officer.
- Confidential Communications: You may request communication by alternative means or locations.
- Amend Records: You may request amendments to your protected health
information. - Accounting of Disclosures: You may request a list of certain disclosures made after April 14, 2003.
- Breach Notification: You have the right to be notified of any breach of your PHI.
Private rooms are always available upon request for discussing your protected health information.
You have the right to obtain a paper copy of this notice upon request, even if you agreed to receive it electronically.
C. Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of Health and Human Services.
File online:
https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html
You may also file a complaint directly with our Privacy Officer. We will not retaliate against you for filing a complaint.
Privacy Officer: Pam Doty
Phone: Lawrence (785) 842-4181 / Holton (785) 362-7500
Website: AdvancedChiropracticServices.com
Effective Date: January 01, 2026
