Barbera Family Chiropractic, LLC •
2719 Genesee Street
Can Download our Privacy Notice by Clicking HERE
La Barbera Family Chiropractic, LLC
2719 Genesee St.
Utica, NY 13501-6556
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.
If you have any questions about this Notice please contact
our Privacy Officer or any staff member in our office.
Our Privacy Officer is Eileen M. La Barbera
This Notice of Privacy Practices describes how we may use and
disclose your protected health information to carry out your treatment, collect
payment for your care and manage the operations of this clinic. It also
describes our policies concerning the use and disclosure of this information for
other purposes that are permitted or required by law. It describes your rights
to access and control your protected health information. "Protected Health
Information" (PHI) is information about you, including demographic
information that may identify you, that relates to your past, present, or future
physical or mental health or condition and related health care services.
We are required by federal law to abide by the terms of this
Notice of Privacy Practices. We may change the terms of our notice at any time.
The new notice will be effective for all protected health information that we
maintain at that time. You may obtain revisions to our Notice of Privacy
Practices by accessing our website www.LaBarberaChiro.com, calling the office
and requesting that a revised copy be sent to you in the mail or asking for one
at the time of your next appointment.
Uses and Disclosures of Protected Health Information
By applying to be treated in our office, you are implying
consent to the use and disclosure of your protected health information by your
doctor, our office staff and others outside of our office that are involved in
your care and treatment for the purpose of providing health care services to
you. Your protected health information may also be used and disclosed to bill
for your health care and to support the operation of the practice.
Uses and Disclosures of Protected Health Information Based Upon Your Implied
Following are examples of the types of uses and disclosures
of your protected health care information we will make, based on this implied
consent. These examples are not meant to be exhaustive but to describe the types
of uses and disclosures that may be made by our office.
Treatment: We will use and disclose your protected
health information to provide, coordinate, or manage your health care and any
related services. This includes the coordination or management of your health
care with a third party that has already obtained your permission to have
access to your protected health information. For example, we would disclose
your protected health information, as necessary, to another physician who may
be treating you. Your protected health information may be provided to a
physician to whom you have been referred to ensure that the physician has the
necessary information to diagnose or treat you.
In addition, we may disclose your protected health
information from time-to-time to another physician or health care provider
(e.g., a specialist or laboratory) who, at the request of your doctor, becomes
involved in your care by providing assistance with your health care diagnosis
Payment: Your protected health information will be
used, as needed, to obtain payment for your health care services. This may
include certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend for you
such as making a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical necessity, and
undertaking utilization review activities. For example, obtaining approval for
chiropractic spinal adjustments may require that your relevant protected
health information be disclosed to the health plan to obtain approval for
Healthcare Operations: We may use or disclose, as
needed, your protected health information in order to support the business
activities of this office. These activities may include, but are not limited
to, quality assessment activities, employee review activities and training of
For example, we may disclose your protected health
information to chiropractic interns or precepts that see patients at our
office. In addition, we may use a sign-in sheet at the registration desk where
you will be asked to sign your name. Communications between you and the doctor
or his assistants may be recorded to assist us in accurately capturing your
responses; we may also call you by your full name in the reception area when
your doctor is ready to see you. We may use or disclose your protected health
information including lab or imaging results, as necessary, or to contact you
to remind you of your appointment (via the number(s) and electronic means you
provided to us) by phone (which includes leaving a message on your answering
machine), text message, e-mail, facsimile or by any other electronic means. We
do not have open adjusting areas in the office; however, that does not prevent
others from hearing conversations through doors, walls, AC ducts or by other
We will share your protected health information with third
party "business associates" that perform various activities (e.g.,
billing, transcription services, reminder calls, accounting services, practice
coaches, trainers, consultants, IT Professionals and software vendors for the
practice). Whenever an arrangement between our office and a business associate
involves the use or disclosure of your protected health information, we will
have a written contract with that business associate that contains terms that
will protect the privacy of your protected health information.
We may use or disclose your protected health information,
as necessary, to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to you. We
may also use and disclose your protected health information for other internal
marketing activities. For example, your name, address and e-mail may be used
to send you a newsletter about our practice and the services we offer as well
as useful health information. We may also send you information about products
or services that we believe may be beneficial to you. You may contact our
Privacy Officer to request that these materials not be sent to you.
Uses and Disclosures of Protected Health Information That May Be Made Only
With Your Written Authorization
Other uses and disclosures of your protected health
information will be made only with your written authorization, unless otherwise
permitted or required by law as described below.
Disclosures of psychotherapy notes
Uses and disclosures of Protected Health Information
for marketing purposes;
Disclosures that constitute a sale of Protected
Other uses and disclosures not described in the
Notice of Privacy Practices will be made only with authorization from
You may revoke any of these authorizations, at any time, in
writing, except to the extent that your doctor or the practice has taken an
action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your
Authorization or Opportunity to Object
In the following instance where we may use and disclose your
protected health information, you have the opportunity to agree or object to the
use or disclosure of all or part of your protected health information. If you
are not present or able to agree or object to the use or disclosure of the
protected health information, then your doctor may, using professional judgment,
determine whether the disclosure is in your best interest. In this case, only
the protected health information that is relevant to your health care will be
Others Involved in Your Healthcare: Unless you
object, we may disclose to a member of your family, a relative, a close friend
or any other person you identify, your protected health information that
directly relates to that person's involvement in your health care. If you are
unable to agree or object to such a disclosure, we may disclose such
information as necessary if we determine that it is in your best interest
based on our professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member, personal
representative or any other person that is responsible for your care of your
location or general condition. Finally, we may use or disclose your protected
health information to an authorized public or private entity to assist in
disaster relief efforts and to coordinate uses and disclosures to family or
other individuals involved in your health care.
Other Permitted and Required Uses and, Disclosures That May Be Made Without
Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in
the following situations without your consent or authorization. These situations
Required By Law: We may use or disclose your
protected health information to the extent that the law requires the use or
disclosure. The use or disclosure will be made in compliance with the law and
will be limited to the relevant requirements of the law. You will be notified,
as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected
health information for public health activities and purposes to a public
health authority that is permitted by law to collect or receive the
information. The disclosure will be made for the purpose of controlling
disease, injury or disability. We may also disclose your protected health
information, if directed by the public health authority, to a foreign
government agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your
protected health information, if authorized by law, to a person who may have
been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health
information to a health oversight agency for activities authorized by law,
such as audits, investigations, and inspections. Oversight agencies seeking
this information include government agencies that oversee the health care
system, government benefit programs, other government regulatory programs and
civil rights laws.
Abuse or Neglect: We may disclose your protected
health information to a public health authority that is authorized by law to
receive reports of child abuse or neglect. In addition, we may disclose your
protected health information if we believe that you have been a victim of
abuse, neglect or domestic violence to the governmental entity or agency
authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.
Legal Proceedings: We may disclose protected health
information in the course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal (to the extent such
disclosure is expressly authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected
health information, so long as applicable legal requirements are met, for law
enforcement purposes. These law enforcement purposes include (I) legal process
and otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to victims of a crime,
(4) suspicion that death has occurred as a result of criminal conduct, (5) in
the event that a crime occurs on the premises of the Practice, and (6) medical
emergency (not on the Practice's premises) and it is likely that a crime has
Workers' Compensation: We may disclose your
protected health information, as authorized, to comply with workers'
compensation laws and other similar legally-established programs.
Required Uses and Disclosures: Under the law, we
must make disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or determine our
compliance with the requirements of Section 164.500 et. seq.
Following is a statement of your rights with respect to your
protected health information and a brief description of how you may exercise
You have the right to inspect and copy your protected
health information. This means you may inspect and obtain a copy of
protected health information about you that is contained in a designated
record set for as long as we maintain the protected health information. A
"designated record set" contains medical and billing records and any
other records that your doctor and the Practice uses for making decisions
Under federal law, however, you may not inspect or copy the
following records; psychotherapy notes; information complied in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or
proceeding, and protected health information that is subject to law that
prohibits access to protected health information. Depending on the
circumstances, a decision to deny access may be reviewed. In some
circumstances, you may have a right to have this decision reviewed. Please
contact our Privacy Officer, if you have questions about access to your
You have the right to request a restriction of your
protected health information. This means you may ask us not to use or
disclose any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You have the right to restrict
certain disclosures of Protected Health Information to a health plan when you
pay out of pocket in full for the healthcare delivered by our office. You
may also request that any part of your protected health information not be
disclosed to family members or friends who may be involved in your care or for
notification purposes as described in this Notice of Privacy Practices. Your
request must be in writing and state the specific restriction requested and to
whom you want the restriction to apply. You may opt out of fundraising
communications in which our office participates.
Your provider is not required to agree to a restriction
that you may request. If the doctor believes it is in your best interest to
permit use and disclosure of your protected health information, your protected
health information will not be restricted. If your doctor does agree to the
requested restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you
wish to request with your doctor.
You may request a restriction by presenting your request,
in writing to the staff member identified as "Privacy Officer" at
the top of this form. The Privacy Officer will provide you with
"Restriction of Consent" form. Complete the form, sign it, and ask
that the staff provide you with a photocopy of your request initialed by them.
This copy will serve as your receipt.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative location.
We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information as to how payment will be handled
or specification of an alternative address or other method of contact. We will
not request an explanation from you as to the basis for the request. Please
make this request in writing.
You may have the right to have your doctor amend your
protected health information. This means you may request an amendment
of protected health information about you in a designated record set for as
long as we maintain this information. In certain cases, we may deny your
request for an amendment. If we deny your request for amendment, you have the
right to file a statement of disagreement with us and we may prepare a
rebuttal to your statement and will provide you with a copy of any such
rebuttal. Please contact our Privacy Officer if you have questions about
amending your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information.
This right applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy practices. It
excludes disclosures we may have made to you, to family members or friends
involved in your care, pursuant to a duly executed authorization or for
notification purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14, 2003. The right to
receive this information is subject to certain exceptions, restrictions and
You have the right to be notified by our office of any
breech of privacy of your Protected Health Information.
Certain treatments may be performed in a common therapy area
and/ or you may find yourself within public areas within the clinic times, but
please note private rooms are always available, upon request, for discussing
your private health information. Whether in a private room or not, we
cannot guarantee that, even though every effort is made to keep conversations
private, your discussions with anyone in the office will not be heard through
doors, walls, AC ducts or by any other means despite our efforts to keep all
You have the right to obtain a paper copy of this notice from
us, upon request, even if you have agreed to accept this notice electronically.
You may complain to us, or the Secretary of Health and Human Services, if you
believe your privacy rights have been violated by us. To file a complaint you
may go to: http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf
Or our office can provide you with a written form in which to file your
complaint. You may also file a
complaint with us by notifying our Privacy Officer of your complaint. We will
not retaliate against you for filing a complaint.
Our Privacy Officer is Eileen M. La Barbera. You may
contact our Privacy Officer, or any staff member, including Dr. La Barbera at
the following phone number 315 724-0368 or our website www.LaBarberaChiro.com
for further information about the complaint process.
This notice was published and becomes effective on June 1,