HIPAA

HIPAA NOTICE OF PRIVACY PRACTICES

Your Information.  Your Rights.  Our Responsibilities.

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.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

A  Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

We will provide a copy or a summary of your health information, usually within 15 days of your request. We may charge a reasonable, cost-based fee.

Special Privacy Protections for Substance Use Disorder Records - Records related to substance use disorder treatment receive extra protection under federal law. These records cannot be used against you for criminal prosecution or to deny you housing, employment, or access to benefits.

B.  Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.  We may say “no” to your request, but we’ll tell you why in writing within 60 days.

C.  Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.  We will say “yes” to all reasonable requests.

D.  Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

E.  Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

F.  Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

G.  Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.

H.  File a complaint if you feel your rights are violated (see end of the form)

YOUR CHOICES

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

A. Share information with your family, close friends, or others involved in your care

B. Share information in a disaster relief situation

C. Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us special, written permission:

A. Marketing purposes

B. Sale of your information

C. Most sharing of Psychotherapy notes

D. Substance Use Disorder (SUD) information (see section below)

E. We may contact you for fundraising efforts, but you can tell us not to contact you again.

OUR USES AND DISCLOSURES

1.  How do we typically use or share your health information?

We typically use or share your health information in the following ways.

A. To treat you - We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

B. To run our organization - We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

C. To bill for your services - We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

2.  How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

A. Help with public health and safety issues - We can share health information about you for certain situations such as:

i. Preventing disease

ii. Helping with product recalls

iii. Reporting adverse reactions to medications

iv. Reporting suspected abuse, neglect, or domestic violence

v. Preventing or reducing a serious threat to anyone’s health or safety

B. Doing Research - We can use or share your information for health research.

C. Comply with the law - We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

D. Respond to organ and tissue donation requests - We can share health information about you with organ procurement organizations.

E. Work with a medical examiner or funeral director - We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

F. Address workers’ compensation, law enforcement, and other government requests - We can use or share health information about you:

i. For workers’ compensation claims

ii. For law enforcement purposes or with a law enforcement official

iii. With health oversight agencies for activities authorized by law

iv. For special government functions such as military, national security, and presidential protective services

G. Respond to lawsuits and legal actions - We can share health information about you in response to a court or administrative order, or in response to a subpoena.

OUR RESPONSIBILITIES

A. We are required by law to maintain the privacy and security of your protected health information.

B. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

C. We must follow the duties and privacy practices described in this notice and give you a copy of it.

D. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

E. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

SUBSTANCE USE DISORDER (SUD) RECORDS

Substance Use Disorder (SUD) Records are afforded Special HIPAA Protections as of 02/16/2026.

A. Some of your health information may include records related to substance use disorder (SUD) diagnosis, treatment, or referral for treatment. These records are protected by federal law (42 CFR Part 2) in addition to HIPAA. A separate authorization must be signed by you in order for us to release or disclose this information. A subpoena or standard authorization may not be sufficient. We may only use and disclose SUD records for treatment, payment, and health care operations as permitted by law and consistent with your written authorization.

B. Federal law prohibits the use or disclosure of SUD records to

i. Investigate or prosecute you for a crime

ii. Deny or limit employment

iii. Deny or limit housing

iv. Deny access to courts

v. Deny access to social services or public benefits

C. Redisclosure of SUD information - SUD information disclosed pursuant to federal law may be redisclosed by the recipient in accordance with HIPAA and other applicable laws. However, redisclosure must still comply with federal protections, including restrictions on discrimination and criminal use.

D. Your Rights Regarding SUD Records – In addition to your HIPAA rights you have the right to

i Authorize or refuse disclosure of your SUD records when authorization is required

ii. Revoke an authorization at any time in writing (except for disclosures already made)

iii. Request an accounting of disclosures, including disclosures made under a general designation (such as “treating providers”)

iv. Request restrictions on certain uses or disclosures, when permitted by law

E. Why do SUD Rules apply to Chiropractors? Chiropractors are generally not part of SUD treatment programs. However, SUD-related information may still enter a chiropractic record through:

i. Patient intake disclosures

ii. Medication histories

iii. Records received from hospitals or other providers

iv. Insurance or utilization documentation

v. EHR imports from outside system

vi. If a practice receives or maintains records originating from an SUD treatment program, those records may be subject to additional federal protections, regardless of the practice’s specialty.

F. Complaints. See below.

CHANGES TO THE TERMS OF THIS NOTICE

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. If you come in for treatment, we will hand you the new version of this form prior to your treatment.

NOTICE EFFECTIVE DATE

Effective Date of this Notice:  Feb. 12, 2026. This represents the last time the form was updated.

COMPLIANCE OFFICER AND PRIVACY OFFICIAL

Name:  Dana Brigola, Office Manager

Phone/Email:  (214) 970-7643 / [email protected]

Address:  4965 Preston Park Blvd., Ste. 700, Plano, TX 75093

TO FILE A COMPLAINT

If you believe your health information, including SUD records, have been used or disclosed improperly, you may file a complaint with the Compliance Office listed above, or with the U.S. Department of Health and Human Services in one of the following ways:

A. Call 800-368-1019 or 877-696-6775 (TDD for hearing impaired – 800-537-7697)

B. Email: [email protected].

C. Send letter to Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201

D. Visiting www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.