Our 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.

Medical information including health history, is collected from the patient upon initiation and subsequent visits, and is then stored in the patient's medical file.

Medical information will be used in the assessment of the patient's condition and the need for health care or referral purposes.

Some of the medical information will be transferred to a computer program for the purposes of retrieval, storage, billing and payment purposes.

Medical information will be disclosed to health and disability insurers for the purpose of payment or reimbursement of services.

The medical information contained in the medical record will be stored by Pazdel Chiropractic, Inc. for a period of no less the six (6) years.

To whom health care information will be disclosed:

• Other health care providers for the purpose of referral, consultation or coordination of health care
• Health care insurers
• Disability insurers
• Business Associates
• Persons responsible for health care, such as a parent or nurse
• Billing organizations
• Collection agencies
• Law enforcement officials or agencies
• Correctional institution
• Public Health authorities
• Family members
• Workers' compensation insurers or state agency, if applicable.

For what purposes health care information will be used and disclosed, such as:

• For the purpose of diagnosis, assessment, referral, and/or treatment,
• For the purpose of payment by a third party, such as a health insurer,
• For the purpose of day to day health care operations,
• We may disclose your health information to the 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.
• Appointment reminder notices or messages.

Examples of the likely uses and disclosures of health information routinely performed by Pazdel Chiropractic, Inc.:

• As a courtesy to our patients it is our policy to call your home when you are late for, or miss an appointment. If you are not at home we will leave a reminder message on your answering machine or with the person answering the telephone. No personal information is disclosed in our message nor will be disclosed to any other person during this call.
• As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Pazdel Chiropractic, Inc. 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.

707-429-4861

258 Sunset Ave

Suisun City, CA 94585

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