WELCOME TO THE LEGAULT CHIROPRACTIC HEALTH
5745 Hollywood Blvd. Hollywood, FL 33021 (954) 966-2211 www.legaultchiro.com
Dr. Gerard Legault D.C. Dr. Virginia Legault D.C. Dr. Marcel Legault D.C. Dr. Jacqueline Legault Valcourt D.C. & Staff
Notice of Privacy Practice
Including PRIVACY PRACTICES & our
THIS NOTICE DESCRIBES HOW MEDICAL /FINAN. /PERS. INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
WE CARE PLEASE REVIEW IT CAREFULLY.
LEGAULT CHIROPRACTIC HEALTH CENTER NOTICE OF PRIVACY PRACTICES
We would like to welcome you to the Legault Chiropractic Health Center. We sincerely hope that your experience with our health center is a positive and rewarding one. Just as we need to get to know each of you, we would like you to know us better, too.
PRIVACY STATEMENT: At the Legault Chiropractic Health Center, you’ll find that we honor and respect all of our patients (past, present & future) and their rights to privacy. While the main purpose of this office is to improve the health and well being of all who enter our doors, through our chiropractic spinal adjustments and other services, it is also the regular policy of this office to minimize disclosure or dissemination of any personal or health information on any/all of our patients. Security of personal records is a high priority. The Legault Chiropractic Center facility handles all records in a manner such that no outside person nor agent has access to private health file (s) without prior authorization, except as required by law. Yet, we do like to treat each of our patients in a happy & friendly way, sending warm wishes, congratulating & thanking them openly, calling them by name, like real people [NOT making them feel like a Number], by processing their files in as expedient a fashion as possible, while at the same time, maintaining their rights to privacy. A law, with many parts & nicknamed HIPAA (See last Page- “What is HIPAA?”) has been put in effect that makes much of the “friendliness” no longer possible without having each of our patients, including YOU, sign a consent form allowing us to proceed in our usual friendly manner, while still maintaining a reasonable privacy standard for all.
We request that YOU Read this NOTICE and complete a “PATIENT’S LIMITED AUTHORIZATION TO LEGAULT CHIROPRACTIC HEALTH CENTER TO USE OR DISCLOSE PROTECTED PATIENT HEALTH INFORMATION” form in our office, to authorize the Legault Chiropractic Health Center’s personnel to be both friendly and efficient as we are caring for you, while at the same time, safe guarding your personal information.
THIS NOTICE DESCRIBES HOW MEDICAL /FINAN. /PERS. INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The following is a quick look at what you might expect in our office.
Upon arrival at Legault Chiropractic Health Center, normally you can expect to be greeted with a smile. You will be invited to place your name on a daily register sheet that gives the chiropractic assistants both your name & the order in which you entered our office. We do our best to serve each of you in "as close to your appointment time" as possible, but because there are several chiropractic doctors present at the same time, & because emergencies do happen, having you register at the time of your arrival makes it easier to keep things moving as smoothly & efficiently as possible.
On your 1st visit, you are asked to fill out a short information form, including
your name, address, telephone numbers (home, work, cellular), etc. as well as
information about the purpose of your visit (your health problem). We will take
a photocopy of your driver's license for identification & of your insurance card (s) for
verification [if applicable]. We try to get as much information as possible to increase
understanding between you and this office, to serve you better. This is done
before you see any of the doctors so that a file can be started and the doctor
can know your needs. Please be assured that this information is for our office
use only & is held in confidence.
Soon after completing the forms, you will be escorted to meet the chiropractor who will be caring for you. Your consultation will take place in the privacy of a room away from the main patient areas. The doctor will review both the problem that brought you to this office & other health problems and history. One of the chiropractors will perform a spinal orthopedic examination to determine if yours is a chiropractic case and to locate the source of problem (s). If there is a need, x-rays will be taken in this facility.
Once the examination & x-rays have been analyzed, you (and your spouse, if present) will be invited to view the x- rays and receive an explanation of the findings, as well as the chiropractor's plan of care to remedy your health problems. This report of findings may take place the same day or within the next 2-3 days, depending upon the complexity of your condition. After your report of findings, if yours is a chiropractic case, you will be escorted to a private treatment room where the chiropractor will perform your spinal adjustment.
It is customary that fees for services be paid in full on the day of that service, unless prior arrangements have been made. (Example: insurance /personal injury/ attorney.)
The Legault Chiropractic Health Center's
Use & Disclosure of Your Health Care Information
Standards of Practice
We ask that patients register [neatly print their name] on a Daily Sign-In Sheet
which includes only their name and which is left on the front counter for the
convenience of all patients and our staff.
* We believe in treating people, not numbers, so we call everyone by their name. Some prefer Mr._ or Ms. while others prefer that we use their first name. We do our best to follow their wishes.
* We collect information from the questionnaire filled out by the patient, along with a photocopy of the patient's driver's license or other photo ID &/or insurance information. A copy of the photo is attached to the patient's daily visit card for our ID purposes.
* We place patient's daily visit card or minimal file on the outside of the treatment room door to signal their presence to the treating doctor & identify who the doctor is to take care of next.
* We frequently discuss among the chiropractors (esp. of this office) findings on patient's exams and X-rays for a more thorough comprehension & coordination of the case.
* It is our policy to provide a substitute health care provider, authorized by LEGAULT CHIROPRACTIC HEALTH CENTER to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider's absence due to vacation, sickness, or other emergency situation.
* Portions of patient's files are kept in/transferred to a computer for storage, retrieval of health information for assessment, referral &/or treatment, as well as for billing &/or payment.
* Health care information will be disclosed to health & disability insurance companies for the purpose of payment or reimbursement of services; and to persons responsible for patient's health care - parents, guardian, family, nurse, etc.
* We use the fax machine, copy services, electronic billing via the internet or simply speak on the telephone to send/give/receive information to/from a patient's attorney, insurance company, billing &/or collection agencies (if applicable) for the purpose of payment, or to a laboratory, referring physicians, MRI centers, etc... for the purpose of diagnosis, assessment, treatment referral &/or to coordinate health care.
* We send insurance claims &/or receive coverage information via the internet, mail, or the fax machine and may discuss claims & coverage over the phone with the insurance company.
* When giving or sending any information to any outside entity, it is our practice to disclose only the "minimum necessary" for the purpose it is being disclosed.
* We request health/spinal information (including but not limited to X-rays, findings, and treatment) from prior health care providers (esp. other DC's) if we feel it will be beneficial to the patient's health care in our office.
* If a patient's "care needs" are the result of a worker's comp. accident or personal injury claim, the employer/payer of that claim has the right to receive health and care information on that patient.
* We maintain all health information/files and X-rays for a minimum of six (6) years.
* As a courtesy to our patients, it is possible that one of our chiropractic assistants call your home on the evening prior to your scheduled appointment to remind you of your appointment time. It is also customary that we call a patient that has missed an appointment, so that they can be rescheduled for the care that they need. In both cases, we use the phone number (s) that they have provided, unless they specify not to or they instruct us to call specifically at home, at work or a cell phone #. If the patient is not reached, we normally leave messages on the answering machine or with the person that answered the phone at their home or office.
* Although we do not presently take part in any research or statistical programs, if in the future we decide to participate, only "De-identified health information will be disclosed [all names, addresses, phones and other identifying numbers, etc that might identity the patient shall be removed before any general information is disclosed].
* We like to thank patients who have referred others to our office by sending them a Thank You card /letter / e-note & by including their name on our "Thank You for Referring Board" in our office.
* We send occasional reminder cards, congratulation cards, &/or newsletters to our patients, especially for the Holidays. This may be either via US mail or internet.
* We display Holiday cards received from patients and friends on a wall holder for all to enjoy.
* We pride ourselves in hiring only trustworthy competent employees. Everyone in the Legault Chiropractic Health Center has agreed & signed affidavits swearing to hold all personal /health information in a secure and confidential manner. This includes the associate businesses that we may deal with.
* Naturally, we lock our doors when no staff members are around to keep an eye on files, file cabinets, etc. so no ones files are exposed unknowingly.
* Security of personal records is a high priority - The Legault Chiropractic Center facility handles all records in such a manner that no outside person nor agent has access to private health file (s) without prior authorization, except as required by law.
LEGAULT CHIROPRACTIC HEALTH CENTER is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.
At the Legault Chiropractic Health Center we always do our very best to abide by all laws: State, Federal & otherwise. If you find that we aren't, please feel free to note your objections or concerns on the 'PATIENT'S LIMITED AUTHORIZATION' here mentioned.. We're human and possibly can over look something or you may wish not to participate in some of our regular practices. Your help will be appreciated.
If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: one of our Privacy Officers — DR. JACQUELINE VALCOURT, D.C., DR. VIRGINIA LEGAULT D.C. &/or MARGIE SANTANA by calling this office at 954-966-2211. If NONE of these Privacy Officers are available when you call, you may make an appointment for a private conference (in person or by telephone) within 2 working days.
If you wish to restrict any of the foregoing "Standards of Practice" the best
way to do this is to complete the “PATIENT'S LIMITED AUTHORIZATION TO LEGAULT
CHIROPRACTIC HEALTH CENTER TO USE OR DISCLOSE PROTECTED PATIENT HEALTH
INFORMATION “ form. Ex: NOT to receive any 'public relations' or reminder type
of mail from the Legault Chiropractic Health Center, you'll need to inform us of
such. Then we will remove your name from our mailing list within 30 days of
notice. [Naturally, this would not pertain to any bills/ statements.] If you are
still not satisfied, then contact one of the Privacy Officers for a "Complaint
Form". Any and ALL requests for restrictions or complaints must be made in
writing before considered "Official". You can lift or add restrictions in the
future, if you find necessary..
ADDITIONAL Uses & Disclosures of Your Health Care Information:
Payment We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (Ex: “As a courtesy to our patients, we will wait for the insurance company to pay for your services IF we have been assured by your company that they will send payment to us. After which we submit an itemized billing statement to your insurance carrier for the purpose of payment to LEGAULT CHIROPRACTIC HEALTH CENTER for health care services rendered. [NOTE: We can Not & do Not waive the collection of any “co-pay” in accordance with your insurance coverage. It’s the Law. Each patient is personally responsible to pay their co-pay on each visit/at the time of service.] OR if you have paid for your health care services, in full, personally at the time of service, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to You. In either case, the billing statement contains medical information, including diagnosis, date of injury or condition, dates of service and codes which describe the health care services received.]
Worker’ Compensation We may/must disclose your health information, as necessary, to comply with State Workers’ Compensation Laws.
Emergencies We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency.
Legal In spite of the Privacy Laws, there are also many laws that require that certain personal and health information be reported/delivered to courts, law enforcement offices, public health offices and other similar agencies. The law also requires disclosure to specialized government agencies (such as for military, national security, prisoner and government benefit purposes). In the unlikely event that a file is requested in these circumstances, the Legault Chiropractic Health Center must comply with the law.
NOTE AGAIN that in all of these cases, only the minimum necessary information is sent.
Changes to this “Notice of Privacy Practices”
Because laws do change, and additions are expected, the Legault Chiropractic Health Center reserves the right to amend this “Notice of Privacy Practices” at any time in the future, and will make the new provisions effective for all information that it maintains. Amendments &/or material revisions shall be posted in our office & to our web site (www.legaultchiro.com) within 60 days of such changes. A copy of said revised Notice shall be mailed upon written request. Unless a future law amendment total change is made, the LEGAULT CHIROPRACTIC HEALTH CENTER is required by law to comply with this Notice.
Your Health Information Rights
+ You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that LEGAULT CHIROPRACTIC HEALTH CENTER is not required to agree to the restriction that you requested. [*SEE BELOW]
+ You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
+ You have the right to inspect and/or receive a copy of your health information, but there will be a fee for the copies. NOTE: when a large number of pages &/or x-rays are to be copied, we send your file/x-rays to a copy company for this purpose.
+ You have a right to request that Legault Chiropractic Health Center amend your protected health information. Please be advised, however, that Legault Chiropractic Health Center is not required to agree to amend your protected health information. If your request to amend your health information is denied, you will be provided with an explanation of our denial reason (s) and information about how you can disagree with the denial.
+ You have a right to receive an accounting of disclosures of your protected health information made by Legault Chiropractic Health Center.
+ You have a right to a paper copy of this Notice of Privacy Practices, as well as future revisions, at any time upon request.
NOTE: Patients who wish to have their health care be paid / reimbursed by a health insurance company or through an attorney, must allow this office to make a copy their drivers license or other government photo ID & must be willing to authorize that pertinent information from their personal and health file be made available to said entity.
In the event that a patient does not wish that the Legault Chiropractic Health Center make a copy of drivers license &/or govern. photo ID and/or of any insurance card information and/or send any personal or health information to said outside entities, then those patients must keep their care charges Paid in Full on the day of service.
*If you have questions about any part of this notice or if you want more information about your privacy rights, please contact: one of our Privacy Officers. They are DR. JACQUELINE VALCOURT D.C., DR. VIRGINIA LEGAULT D.C. &lor MARGIE SANTANA by calling this office at 954-966-2211.
* If you wish to restrict any of the foregoing "Standards of Practice" the best way to do this is to complete the “PATIENT'S LIMITED AUTHORIZATION To LEGAULT CHIROPRACT!C HEALTH CENTER TO USE OR DISCLOSE PROTECTED PATIENT HEALTH INFORMATION” form.
What is HIPAA?
“HIPAA” stands for the Health Insurance Portability and Accountability Act
HIPAA is a Federal law which created a National Standard for privacy and
protection, giving all persons the right to not have personal, financial, nor
health information about them disclosed, disseminated, spread or exposed to
outside persons or entities without their prior authorization. Furthermore, it
requires that all facilities, who may have personal, financial &/or health
information about private individuals, keep that information in a secure manner,
which includes both while that information is held within the facility and
during any transfer of information to any other authorized facility.
(For instance, if a patient wishes to have their Insurance or a personal injury /attorney case pay for any of their care costs, a health facility must send pertinent personal and health information about that patient to that insurance company &/or attorney. In doing so, some of the personal & health Information must be discussed with an insurance rep over the telephone &/or must be sent via the US mail, carrier, fax, or the internet during which time it is OUT of the hands of the doctor's facility. It is now required that each facility and mode of transfer of personal information also maintain a high degree of security to avoid allowing personal information to be circulated to unauthorized entities or persons.)
Privacy is not limited just to patient files and information. It also includes the right to privacy to not receive unwanted solicitation - Mailings via US mail, internet, fax.....
As with all laws, the HIPAA law is subject to changes and additions in the future.
Another law worth mentioning is a Florida Law that states that "The patient pays
for & may receive a copy of the X-ray “Report” but that the X-ray films remain
the property of the establishment where they were made and, must be kept by said
establishment for a minimum of 4 years after the patient is released or stops
HIPAA Pamphlet-1st Printing- 3/03/2003; 1st Revision 6/2013