Patient Privacy Notice



Pine Valley Chiropractic

10330 Coldwater Rd, Fort Wayne, IN 46825, US

Phone: (260) 203-4062

Effective Date: Dec 1, 2023

Our Legal Duty

Pine Valley Chiropractic is committed to protecting the privacy of your medical information. We are bound by federal and state laws to maintain the confidentiality of your protected health information. This notice outlines our privacy practices, legal duties, and your rights concerning your medical information.

We reserve the right to change our privacy practices and the terms of this notice, and such changes will be effective for all protected health information maintained by us. You can request a copy of the current notice at any time. For more information or additional copies, please contact us using the information provided at the end of this notice.

Uses and Disclosures of Protected Health Information

We will use and disclose your protected health information for treatment, payment, and health care operations, as outlined below:

Treatment: We may disclose your information to coordinate and manage your healthcare. This includes sharing information with third parties involved in your care, such as specialists or laboratories.

Payment: Your information may be used for billing and payment purposes, including obtaining insurance approval and determining coverage eligibility.

Health Care Operations: We may use your information for activities such as quality assessment, employee reviews, and appointment reminders. Business associates may be involved in these activities, and their access is governed by written contracts to protect your privacy.

Authorization: Other uses and disclosures will only be made with your written authorization. You may revoke this authorization in writing at any time.

Others Involved in Your Health Care: We may disclose information to family, friends, or others involved in your care, unless you object.

Marketing: We may contact you with information about treatment alternatives. You can opt-out of further communications.

Research; Death; Organ Donation: Limited disclosure for research or specific purposes related to deceased individuals may occur.

Public Health and Safety: Information may be disclosed to avert serious threats to health or safety or for public health purposes.

Health Oversight: Information may be disclosed to health oversight agencies for authorized activities.

Abuse or Neglect: Information may be disclosed to report child abuse or neglect, or if you are a victim.

Food and Drug Administration: Information may be disclosed to comply with FDA requirements.

Criminal Activity: Information may be disclosed to prevent or lessen a serious threat or aid law enforcement in certain situations.

Required by Law: Information may be disclosed when required by law, such as compliance with federal privacy laws or workers' compensation laws.

Process and Proceedings: Information may be disclosed in response to a court order or lawful process under specific circumstances.

Law Enforcement: Limited information may be disclosed to law enforcement officials in certain situations.

Patient Rights

Access: You have the right to access and obtain copies of your protected health information, with exceptions. A written request is required, and fees may apply.

Accounting of Disclosures: You have the right to receive a list of instances where your information was disclosed for non-treatment, payment, or health care operations purposes.

Restriction Requests: You may request additional restrictions on the use or disclosure of your information, although we are not obligated to agree.

Confidential Communication: You have the right to request confidential communication about your information through alternative means or locations.

Amendment: You may request amendments to your information, and we will consider and respond to such requests.

Electronic Notice: If you receive this notice electronically, you are entitled to request a written copy.

Questions and Complaints

If you have questions or concerns about our privacy practices, please contact us at the information provided below. If you believe your privacy rights were violated, you may file a complaint with us or the U.S. Department of Health and Human Services.

We value your right to privacy and will not retaliate if you choose to file a complaint.

Contact Information

Telephone: (260) 203-4062

Address: 10330 Coldwater Rd, Fort Wayne, IN 46825, US