LaBarbera Family Chiropractic, LLC
2719 Genesee Street Utica, NY 13501
Phone 315-724-0368 Fax 315-724-0374
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LaBarbera Family Chiropractic, LLC 2719 Genesee Street Utica, NY 13501 Phone 315-724-0368 Fax 315-724-0374
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Barbera Family Chiropractic, LLC
Revised: February, 2007 Notice
of Privacy for:
Patients Protected Health
Information This notice
describes how health care information about you may be used and disclosed, and how you can
get access to this information. Please review it carefully. This
office abides by the terms described in this policy This
office uses and discloses your protected health care information for the
following reasons:
To share with other treating health care providers regarding your health
care To submit to insurance companies or Workers Compensation Claim to verify that treatment
has been rendered
To determine patient's benefits in a health care plan
Releasing information required by State or Federal Public Health law
To assist in overcoming a language barrier when caring for a patient
To business associates, provided that written assurances for your privacy
have been attained
Emergency situations
Abuse, neglect or domestic violence Written (postcard or letter) appointment reminders to household members or on answering
machines as well as written correspondences regarding your care or billing
Sign-In logs may be disclosed to verify office visits and in view of
others
Use of your full name in the office within hearing distance of others to
transact normal business
including, but not limited to, phone calls, patient greeting &
discussing your information with you
Disclosure of your health or account information to others for the direct
benefit of your care or
facilitation of payment on your account Any
other uses or disclosures will only be made with your specific written prior
authorization. You have the right to:
Revoke authorization in writing at any time by specifying what you want
restricted and to whom. Speak to our privacy officer who is Eileen M. La Barbera and can be reached at 315-724-0368 regarding
privacy issues.
Inspect, copy and amend your protected health information, and amend it
as allowed by law.
Obtain an accounting of disclosures of your protected health information.
To render a complaint to our privacy officer or the Secretary of Health
and Human Services. This
office reserves the right to change the terms of this notice and to make new
notice provisions for all protected health information that it
maintains. Patients may also get an updated copy upon request at any time by
asking the staff. This remains in
effect until revoked in writing by the patient or legal guardian. I
acknowledge that I have received and reviewed this notice with a full
understanding of its contents. _____________________ _________________________ ________ Name of Patient (print) Signature of Patient/Legal Representative Date |
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Send mail to labarberachiro@aol.com with
questions or comments about this web site.
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