NOTICE OF PRIVACY POLICIES
RICHARD QUALLS, JR., D.C.

This notice describes how health information about you may be used and disclosed, and how you can get access to your health information.  This is a required privacy regulation resulting from the Health Insurance Portability and Privacy Act of 1996 (HIPPA).

Our practice is dedicated to maintaining the privacy of your health information.

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS:

1. Physicians and staff may use and disclose your health information in order to treat you or to assist others in your treatment. We may also disclose your health information to others who may assist in your care, such as spouse, parents or children.
2. Our practice may use your health information to bill and collect payments, including your insurer, or any third parties that may be responsible for such cost. We may also use your health information to bill you directly for services and items.
3. Our practice will use and disclose your health information when we are required to by the law, for example, the military, workers compensation, correctional institutions, national security activities, etc.
4. We may call you for an appointment reminder purporses. Please advise us if you do not want us to call and leave appointment reminder messages at your home, answering machine, or any co-worker at your place of work. We may also use a sign-in sheet at the front desk; we will make all efforts to keep this information confidential.
5. We may use and disclose your health information to compare our clinical data with other practices, review it with medical students, medical faculty, technicians, and others for teaching and learning purposes. We will strive to remove information that identifies you from this medical information.

1. You can request that our practice communicate with you about your health and related issues in a particular manner. We will accomodate reasonable requests.
2. You can request that we restrict our use of your health information for treatment, payment, or healthcare operations. As well as the release of this information to only certain individuals. We are not, however required to agree to your request.
3. You have the right to inspect and obtain a copy of your medical and billing records. You must submit your request in writing to Richard Qualls, Jr., D.C. You may ask us to amend your health information if you believe it is incorrect or incomplete. To request an amendment you must supply us with a reason that supports your request.
4. If you believe your privacy rights have been violated you may file a complaint with our office or with the secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Dr. Qualls at 602-862-9419.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE OR OUR HEALTH INFORMATION PRIVACY POLICIES, PLEASE CONTACT OUR OFFICE AT 602-862-9419.