WELCOME TO THE LEGAULT CHIROPRACTIC HEALTH
CENTER
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
OFFICE POLICY
Notice of Privacy Practice
Including PRIVACY PRACTICES & our
Privacy Statement:
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.
PATIENT’S RIGHTS
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
care."
HIPAA Pamphlet-1st Printing- 3/03/2003; 1st Revision 6/2013