Notice of Privacy Practices

GraceSpine Chiropractic Care is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice of our legal duties and privacy practices. We are required to abide by the terms of this notice currently in effect.

Treatment:

We may use and disclose your PHI to provide, coordinate, or manage your chiropractic care and related services.

Payment:

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

Healthcare Operations:

We may use and disclose PHI for healthcare operations necessary to run our practice and ensure all patients receive quality care.

• Right to inspect and copy your PHI
• Right to request an amendment to your PHI
• Right to an accounting of disclosures
• Right to request restrictions on uses and disclosures
• Right to request confidential communications
• Right to a paper copy of this notice
• Right to file a complaint with us or with the Secretary of HHS

GraceSpine Chiropractic Care — Privacy Officer
Pinnacle Medical Faculty Campus, Jacksonville, FL 32256
Phone: (904) 555-0180 | Email: privacy@gracespine.com