Privacy Policy

Notice of privacy practices

Notice of Privacy Practices

 Kauffman Chiropractic LLC




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.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.


You have the right to:

Get an electronic or paper copy of your medical record

         You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

         We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

         You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

         We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

         You can ask us to contact you in a specific way about your medical information (for example, home or office phone) or to send your medical information to a different address.

         We will say, “yes” to all reasonable requests.

Ask us to limit what we use or share

         You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

         If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

         You can ask for a list (accounting) of the times we’ve shared (disclosed) your health information, for up to six years prior to the date you ask, who we shared it with, and why.

         We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.


Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.


File a complaint if you feel your rights are violated

You can file a complaint with us if you feel we have violated your rights by contacting our Privacy Officer.

         To file a complaint with our organization, please submit your request in writing to the Privacy Officer (insert name of officer), (insert address, phone number, email) (insert city, state, zip).

         You can file a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 877-696-6775, or visiting

         We will not retaliate against you for filing a complaint.


Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, contact us. Tell us what you want us to do, and we will follow your instructions.


In these cases, you have both the right and choice to tell us to:

         Share information with your family, close friends, or others involved in your care

         Share information in a disaster relief situation

         Include your information in a hospital directory

If you are not able to tell us your preference - for example, if you are unconscious, we may share your information if we believe it is in your best interest to do so. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these following cases, we never share your information unless you give us written permission:

         Marketing purposes

         Sale of your protected health information

         Most sharing of psychotherapy notes

In the case of fundraising:

         We may contact you for fundraising efforts, but you can tell us not to contact you again. We will honor your request to not contact you again.

Confidentiality of Alcohol and Drug Abuse Records
The confidentiality of alcohol and drug abuse patient records maintained by us is protected by Federal law and regulations, including those regulations contained in 42 CFR Part 2. Generally, we may not say to a person outside of our facility that you are a patient of the treatment center, or disclose any information identifying you as an alcohol or drug abuser, unless:


       You consent in writing;

       The disclosure is allowed by a court order; or

       The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation.

Violation of the Federal law and regulations by our facility is a crime. Suspected violations may be reported to appropriate authorities in accordance with Federal regulations.

Federal law and regulations do not protect any information about a crime committed by you either at our facility or against any person who works for the facility or about any threat to commit such a crime.

Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

See 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations.


Our Uses and Disclosures

We typically use or share your health information in the following ways:


We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.

       Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

       Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

         Preventing disease

         Helping with product recalls

         Reporting adverse reactions to medications

         Reporting suspected abuse, neglect, or domestic violence

         Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.


As Required by law

If federal, state, and/or local law requires a use or disclosure of your PHI, we may use or disclose your PHI to the extent that the use or disclosure complies with such law and is limited to the requirements of such law. If two or more laws or regulations governing the same use or disclosure conflict with each other, we will comply with the more restrictive laws or regulations. An example of when we may be required to share information under federal law is when the Secretary of the Department of Health and Human Services (DHHS) requires that we disclose such information to DHHS. The Secretary of DHHS may require that we disclose such information to it to determine whether we are complying with HIPAA or other federal law.


Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.


Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.


Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

         For workers’ compensation claims

         For law enforcement purposes or with a law enforcement official

         With health oversight agencies for activities authorized by law

         For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.


Our Responsibilities

         We are required by law to maintain the privacy and security of your protected health information.

         We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

         We must follow the duties and privacy practices described in this notice and give you a copy of it.

         We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our website, and we will mail a copy to you.

Effective Date of Notice :  9/15/2021














Patient signature will be retained on the form labeled __ Acknowledgment of receipt of Notice of Privacy Practices__ in regard to receipt of this notice upon request. This notice is posted in the office at the front desk, as well as on the website for the practice at for ease of access.