Notice of Privacy Practices

Effective Date: [1-1-2024]

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Pledge Regarding Your Health Information:

We understand that medical information about you and your health is personal. We are committed to protecting your health information. We create a record of the care and services you receive to provide quality care and to comply with legal requirements.

This Notice Applies To:

This Notice applies to all records of your care generated by our practice. Your personal doctor may have different policies or notices regarding their use and disclosure of your medical information created in their office or clinic.

Uses and Disclosures of Health Information:

We may use and disclose your health information for different purposes. The law permits us to use or disclose your health information for the following purposes:

  1. Treatment: We may use and disclose your health information to provide you with medical treatment or services.
  2. Payment: We may use and disclose your health information to bill and receive payment for the treatment and services you receive.
  3. Healthcare Operations: We may use and disclose your health information for our healthcare operations, such as quality assessment and improvement activities.
  4. Required by Law: We may use or disclose your health information when required by law.
  5. Public Health: We may disclose your health information for public health activities, such as reporting disease outbreaks.
  6. Law Enforcement: We may disclose your health information to law enforcement officials for certain law enforcement purposes.

Your Rights Regarding Health Information:

  1. Right to Inspect and Copy: You have the right to inspect and copy your health information.
  2. Right to Amend: You have the right to request an amendment to your health information if you believe it is incorrect or incomplete.
  3. Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your health information.
  4. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
  5. Right to a Paper Copy: You have the right to obtain a paper copy of this Notice upon request.

Complaints:

If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.

Contact Information:

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact:

Dr. Dustin Bergeron DC

1721 S Austin Ave

Denison TX 75020

903-463-5151

Changes to This Notice:

We reserve the right to change this Notice. We will post a copy of the current Notice in our office and on our website.

This Notice was updated on 3-4-2024