Notice of Privacy Practices

When it comes to your health information, you have certain rights.

You generally have the right to:

• Obtain an electronic or paper copy of your medical record
• Ask us to correct or amend your medical record
• Request confidential communications
• Ask us to limit certain uses or disclosures
• Request an accounting of certain disclosures
• Receive a copy of this Notice of Privacy Practices
• Choose someone legally authorized to act for you
• File a complaint if you believe your privacy rights have been violated

Summit also has legal responsibilities concerning how your health information is maintained, used, disclosed, and protected.

To request your healthcare records from Summit Spine & Wellness, submit a written records request.

Your request should include, when applicable:

• Your full legal name
• Date of birth
• Current contact information
• A description of the records you are requesting
• Approximate date range of the records
• Whether you want paper or electronic records
• Where you want the records delivered
• Your signature
• Documentation showing authority to act for another patient, when applicable

You may submit your written request:

Call the office if you need the appropriate records-request form or instructions for a secure electronic submission method.

Please do not send sensitive medical information, copies of identification, insurance information, or medical records through ordinary email unless Summit specifically provides a secure method for doing so.

Summit may need to verify your identity before releasing records.

Requests by a personal representative, parent, guardian, attorney, or another third party may require appropriate documentation or authorization.

You may ask us to communicate with you in a particular way or at a particular location.

For example, you may ask us to:

• Call a particular telephone number
• Send mail to a different address
• Use another reasonable communication method
• Limit information included in voicemail when reasonably possible

We will accommodate reasonable requests as required by law.

Please keep Summit informed of your current contact information and communication preferences.

You may ask for a list, sometimes called an accounting of disclosures, showing certain occasions when Summit disclosed your health information.

Under HIPAA, an accounting generally may cover disclosures made during the six years before your request.

Certain disclosures do not have to be included, such as many disclosures made for:

• Treatment
• Payment
• Healthcare operations
• Disclosures you specifically authorized
• Other disclosures excluded by applicable law

We will provide an accounting and charge fees only as permitted by law.

If another person has legal authority to act on your behalf, that individual may be able to exercise your privacy rights.

Examples may include:

• A legal guardian
• A parent or guardian acting for a minor when permitted by law
• A person holding appropriate medical power of attorney
• Another legally authorized personal representative

Summit may verify that the person has appropriate authority before providing access or allowing that person to exercise your rights.

Summit will not use or disclose your protected health information for marketing purposes when authorization is required by applicable federal or Texas law.

We will also not sell protected health information except as specifically permitted by law.

Texas law provides additional protections concerning use and disclosure of PHI for marketing purposes.

When written authorization is required, Summit will obtain that authorization before using or sharing the information for the applicable purpose.

Texas law provides confidentiality protections specifically for communications between chiropractors and their patients and for chiropractic records concerning a patient's identity, diagnosis, evaluation, or treatment.

Summit Spine & Wellness will maintain and disclose chiropractic records only as permitted or required by applicable federal and Texas law.

Nothing in this notice is intended to reduce privacy protections provided under Texas law.

If Texas law provides a greater privacy protection or patient right than HIPAA in a particular circumstance, Summit will follow the applicable requirement.

Summit Spine & Wellness is required to:

• Maintain the privacy of protected health information as required by law
• Maintain reasonable administrative, physical, and technical safeguards
• Follow the privacy practices described in the current Notice of Privacy Practices
• Provide patients with this notice as required
• Notify affected individuals when legally required following certain breaches
• Respect applicable rights concerning access, amendment, restrictions, and confidential communications
• Follow applicable federal and Texas privacy laws

We will not use or disclose PHI in a manner inconsistent with this notice unless the use or disclosure is otherwise permitted or required by law or appropriately authorized.

If you believe Summit has violated your privacy rights, you may contact:

Please avoid including unnecessary medical details in ordinary email.

Summit will not retaliate against you for filing a complaint or exercising a privacy right.

Summit may change the terms of this Notice of Privacy Practices as permitted by law.

Changes may apply to health information Summit already maintains as well as information created or received in the future.

If the notice is materially revised, the current version will be made available:

• At Summit Spine & Wellness
• Upon request
• On the Summit Spine & Wellness website

The effective and last-updated dates identify the current version.

If you have questions about:

• This Notice of Privacy Practices
• Requesting medical records
• Correcting your information
• Confidential communications
• Privacy restrictions
• Authorized disclosures
• Electronic disclosure of PHI
• Privacy complaints
• Other HIPAA or Texas privacy rights

contact:

Please do not send detailed medical information through ordinary email.