HIPAA Privacy Policy

Updated February 24th, 2025

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.

A. Our Commitment to Your Privacy

St. Charles Pain and Wellness Center is dedicated to maintaining the privacy of your protected health information (PHI). We operate a health center where chiropractors, therapists, and nutritionists take a patient-centered approach to address the root cause of health issues and restore patient well-being. In conducting our business, we will create records regarding you and the treatment and services we provide to you.

We are required by law (the Health Insurance Portability and Accountability Act of 1996 or HIPAA) to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our health center concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

• Your privacy rights concerning your PHI
• How we may use and disclose your PHI
• Our obligation concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by the St. Charles Pain and Wellness Center. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our health center has created or maintained in the past, and for any of your records that we may create or maintain in the future.

St. Charles Pain and Wellness Center will post a copy of our current notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. If You Have Any Questions About This Notice, Please Contact:

St. Charles Pain and Wellness Center
Privacy Officer: Dr. Jacob Hertz
Phone: (630) 513-7770

C. Uses and Disclosures of Health Information

For Treatment

We may use your PHI to provide you with treatment or services. We may disclose your PHI to doctors, nurses, technicians, chiropractic students, or other personnel who are involved in taking care of you now or in the future. We also may disclose your PHI to people outside of the health center who may be involved in your medical care.

We may also use your PHI to call you or send you a letter to remind you about an appointment, to follow up with diagnostic test results, or to provide you with information about other treatments and care that could benefit your health.

For Payment

We may use and disclose your PHI so that the treatment and services you receive at the health center may be billed and payment may be collected from you, an insurance company, or a third party.

For Healthcare Operations

Our health center may use and disclose your PHI to operate our business. For example, our health center may use your PHI to evaluate the quality of care you received from us or to conduct cost-management and business planning activities.

D. Other Disclosures

Business Associates

We will share your PHI with our business associates who perform functions on our behalf or provide us with services if the PHI is necessary for such functions or services. We will have a written contract with the business associate that contains terms that will protect the privacy of your PHI.

Communication with Others Involved in Your Care

Our health professionals may, in the event you are incapacitated or in an emergency circumstance, disclose your PHI to a family member, other relative, close personal friend, or any other person you identify, directly relevant to that person’s involvement in your care or payment related to your care.

Research

Under certain circumstances, we may use and disclose your PHI for research purposes. All research projects, however, are subject to a special approval process designed to protect the privacy of your PHI.

Required by Law

We may use or disclose your PHI as required by law, ensuring compliance with all applicable legal requirements.

Public Health Risks

Our health center may disclose your PHI to public health authorities for purposes such as:

• Maintaining vital records (e.g., births and deaths)
• Reporting child abuse or neglect
• Preventing or controlling disease, injury, or disability
• Notifying a person regarding potential exposure to a communicable disease
• Reporting reactions to drugs or problems with products

Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, such as investigations, inspections, audits, surveys, and disciplinary actions.

Legal Proceedings

We may disclose your PHI in the course of any judicial or administrative proceeding as required by law.

Law Enforcement

We may release PHI if asked to do so by a law enforcement official in certain circumstances, such as:

• Regarding a crime victim
• Concerning a death believed to result from criminal conduct
• Regarding criminal conduct on our premises

Deceased Patients

We may release PHI to a medical examiner or coroner to identify a deceased individual or to determine the cause of death.

Organ and Tissue Donation

If you are an organ or tissue donor, we may release your PHI to facilitate donation and transplantation.

Serious Threats to Health or Safety

We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of another individual or the public.

Military and National Security

We may disclose your PHI to appropriate military command authorities or authorized federal officials for intelligence, counterintelligence, and national security activities.

Inmates

If you are an inmate or under the custody of a law enforcement official, we may disclose your PHI for your care, the safety of others, or the security of the correctional institution.

Workers’ Compensation

We may release your PHI for workers’ compensation and similar programs.

E. Your Rights Regarding Your PHI

1. Confidential Communications – You may request that we communicate with you in a certain manner (e.g., at home rather than work).
2. Requesting Restrictions – You may request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations.
3. Inspection and Copies – You have the right to inspect and obtain a copy of your PHI.
4. Amendment – You may ask us to amend your PHI if you believe it is incorrect or incomplete.
5. Accounting of Disclosures – You may request a list of non-routine disclosures of your PHI.
6. Right to a Paper Copy of This Notice – You may request a paper copy of this notice at any time.
7. Right to File a Complaint – You may file a complaint if you believe your privacy rights have been violated.
8. Right to Provide an Authorization for Other Uses and Disclosures – We will obtain your written authorization for uses and disclosures not covered in this notice.
9. Right to Restrict Disclosures to Your Health Plan – If you pay for services out-of-pocket in full, you may request that we do not disclose your PHI to your health plan.
10. Right to Notification of a Breach of Your PHI – If there is a breach of your PHI, we will notify you in writing.

Effective Date: 01/01/2025