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 Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed.  It also informs you of  your rights and access to that information.


Baertlein Chiropractic is committed to maintaining the privacy of your protected health information(PHI). The HIPPA privacy policy is to inform you of how your PHI may be used and disclosed to third parties.  If your files need to be physically moved from this office they will be carried in a box or brief case and kept within the custody of a doctor or employee to a facility where a patient is confined or to be treated,  If you have further questions please contact the office 262-925-8600.


a) Treatment-The practice will provide your health records to those health care professionals that are directly involved in your treatment to provide you with the most comprehensive care possible. A new physician may require information on exams or treatments that were performed in this office.

b) Payment- In order for payment, this office will provide PHI, directly or indirectly through a billing service to appropriate third party payors pursuant of their billing and payment requirements.  Insurance companies may request records for treatment before payment.

c) Health Care Operations-Your PHI may be compiled, used or disclosed in order to remain complaint with applicable law and health insurance requirements. The care the practices personnel provide to you may be evaluated using you PHI.

1. The Practice may use and or disclose your PHI without a written consent from you in the following instances:

a) De-identified Information- Information that does not identify you and, even without your name, cannot be used to identify you.

b) Business Associate- Any business associate of the practice that gives written assurance in accordance of the law will safeguard your PHI. this is a person who assists the practice in essential function.

c) Personal Representative- A person who, under applicable law has the authority to represent you in making health care decisions.

d) Emergency situations-

   i) rendering emergency treatment with an attempt at your consent as soon as possible: or

   ii) to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for coordinating            your care with such entities in emergency situations.

e) Communication barriers- If, due to substantial communication barriers or inability to communicate, the Practice has been unable to obtain your Consent and the Practice determines, in the exercise of professional judgment, that your Consent to receive treatment is clearly inferred.

f)  Public Health Activities- A public health authority may collect PHI as long as you cannot be identified by name or record.

g) Abuse, Neglect or Domestic Violence- To a government authority is the the Practice is required by law to make such a disclosure.  If the Practice is authorized by law to make that disclosure it will do so if it is to prevent serious harm.

h) Health Oversight Activities- Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the communities health care system.

i) Judicial and Administrative Proceeding- For example the Practice may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.

j) Law enforcement Purposes- In certain instances your PHI may have to be disclosed to a law enforcement official.

k) Coroner or Medical Examiner- The Practice may disclose you PHI to either /both parties for the purpose of determining your cause of death.

l) Organ, Eye, or Tissue Donation- If you are an organ donor, the Practice may disclose your PHI to the entity to whom you have agreed to donate your organs.

m) Research- If the Practice is involved in research activities, your PHI may be used. Your PHI, even without your name will not be able to identify you.

n) Avert a Threat to Health and Safety- The Practice may disclose your PHI if it believes that such a disclosure is necessary to prevent or lesson a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lesson the threat.

o) Worker's Compensation-  If you are involved in a Worker's Compensation claim, the Practice may be required to disclose your PHI to an individual or entity that is part of the Worker's Compensation system.

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