4137 South Sherwood Forest Blvd., Suite 110
New Patient Privacy Laws Go Into Effect
New Federal Laws Require that you be informed about your rights to privacy of your health information. As a part of those requirements, the following privacy notice is placed on this web site to assure you that our office will make every effort to maintain your privacy in accordance with the Federal Privacy Laws. If you have any questions or need further explanation about the contents of this disclosure, please contact our office.
Consent for Use or Disclosure of Health Information
Our Privacy Pledge
We are very concerned with protecting your privacy. While the law requires us to give you this disclosure, please understand that we have, and always will, respect the privacy of your health information.
There are several circumstances in which we may have to use or disclose your health care information.
· We may have to disclose your health information to another health care provider or a hospital if it is necessary to refer you to them for the diagnosis, assessment, or treatment of your health condition.
· We may have to disclose your health information and billing records to another party if they are potentially responsible for the payment of your services.
· We may need to use your health information within our practice for quality control or other operational purposes.
We have a more complete notice that provides a detailed description of how your health information may be used or disclosed. You have the right to review that notice before you sign this consent form (PL 164.520). We reserve the right to change our privacy practices as described in that notice. If we make a change to our privacy practices, we will notify you in writing when you come in for treatment or by mail. Please feel free to call us at any time for a copy of our privacy notices.
Your right to limit uses or disclosures
You have the right to request that we do not disclose your health information to specific individuals, companies, or organizations. If you would like to place any restrictions on the use or disclosure of your health information, please let us know in writing. We are not required to agree to your restrictions. However, if we agree with your restrictions the restriction is binding on us.
Your right to revoke your authorization
You may revoke your consent to us at any time; however, your revocation must by in writing. We will not be able to honor your revocation request if we have already released your health information before we receive your request to revoke your authorization. If you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information if they decide to contest any of your claims.
Any information you provide through the various forms and questionnaires on this web site or by e-mailing this office will be handled just as though your information was provided at our physical location.
Baton Rouge, LA 70809
|Notice: All pain and other symptoms of discomfort, no matter the degree, are considered serious and require prompt professional attention. This internet site is not a substitute for prompt professional care. The owners, hosts, and producers of this site bear no responsibility for the use or misuse of any information provided for any reason, nor do they bear the responsibility for any action or inaction undertaken as a result of the information provided here, or lack of information provided. If you have pain, contact your physician, or call (225) 291-2626 for more information about Millervillage Chiropractic Center.|