Function Performance Sport Chiropractic

NOTICE OF PRIVACY PRACTICES
Function Performance Sport Chiropractic 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

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
Described as follows are the ways we may use and disclose health information that identifies you. Except for the following purposes, we will use and disclose health information only with your written permission.

Treatment We may use and disclose health information to other health professionals within our practice for the purpose of treatment, payment, or health care operation activities.

Payment We may use and disclose health information so that we or others may bill and receive payment from you, insurance companies, or a third party for treatment and services you received.

Health Care Operations We may use and disclose health information for health operation purposes. These uses and disclosures are necessary to make sure that all our patients receive quality care to operate and manage our office. We also may share information with our entities that have a relationship with you (your health plan) for their healthcare operation activities.

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 or of your death. As required by law We will disclose health information when required to do so by international, federal, state, or local
law.

Threat to Health or Safety We will disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or to the general public.

Business Associates We may disclose health information to our business associates that perform functions on our behalf as is necessary for such functions or services. All business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than that as specific in our contract.

Specialized Government Agencies We may disclose your health information for military, national security, prisoner and government benefit purposes. Workers Compensation We may release health information as necessary to comply with state Workers’ Compensation Laws.

Public Health Risks As required by law, may disclose health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child and elder abuse or neglect; reporting domestic violence; reporting to the FDA about reactions to medications or problems with products; reporting disease or infection exposure.

Lawsuits and Disputes We may disclose health information in a response to an administrative or judicial proceeding. We also may disclose health information in a response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute.

Law Enforcement We may release health information if asked by a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.

Deceased Persons We may release health information to a coroner or medical examiner. Other Services We may use and disclose health information to contact you and remind you that you have an appointment with us or to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

YOUR RIGHTS

You have the right to request a restriction on certain uses and disclosures of your health information. Please be
advised that Function Performance Sport Chiropractic is not required to agree to the restriction that you requested.
You have the right to inspect and copy health information. This includes medical and billing records, other than
psychotherapy notes.

If you feel that health information we have is incorrect or incomplete, you may ask us to amend the information.
Please be advised that Function Performance Sport Chiropractic is not required to agree to the restriction that you
requested. You may utilize this right for as long as Function Performance Sport Chiropractic is in ownership of your
protected health information.

You have the right to request that we communicate with you about your medical matters in a certain way or at a
certain location. Your request must specify how or where you wish to be contacted. We will accommodate reasonable
requests.

You have the right to receive an accounting of disclosures of your protected health information made by Function
Performance Sport Chiropractic

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
All requests for restrictions, inspections, amendments to your health information must be made in writing and
submitted to our Privacy Officer.

CHANGES TO THIS NOTICE

We reserve the right to change this notice and make the new notice apply to health information we already have as
well as any information we receive in the future. Until such changes are made, we are required by law to comply with
this notice.

Function Performance Sport Chiropractic is required by law to maintain the privacy of your health information and to
provide you with notice of your legal duties and privacy practices regarding your health information. If you have
questions or want more information about your privacy rights, please contact us by calling 503-730-2788. If we are
unavailable, you may make an appointment for a conference in person or by telephone within 2 business days.

COMPLAINTS

Complaints about your privacy rights, or how employees of Function Performance Sport Chiropractic have handled
your health information should be directed at Dr. Ben Hokenson at 503-730-2788. If he is unavailable, you may make
an appointment for a conference in person or by telephone within 2 business days. You will not be penalized for filing
a complaint.

If you are not satisfied with how your complaint was handled, you may submit a formal complaint with the Department
of Health and Human Services. Information about filing a formal complaint can be found at:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html

WHAT PERSONAL DATA WE COLLECT AND WHY WE COLLECT IT

COMMENTS

When visitors leave comments on the site we collect the data shown in the comments form, and also the visitor’s IP address and browser user agent string to help spam detection.

An anonymized string created from your email address (also called a hash) may be provided to the Gravatar service to see if you are using it. The Gravatar service privacy policy is available here: https://automattic.com/privacy/. After approval of your comment, your profile picture is visible to the public in the context of your comment.

MEDIA

If you upload images to the website, you should avoid uploading images with embedded location data (EXIF GPS) included. Visitors to the website can download and extract any location data from images on the website.

CONTACT FORMS

COOKIES

If you leave a comment on our site you may opt-in to saving your name, email address and website in cookies. These are for your convenience so that you do not have to fill in your details again when you leave another comment. These cookies will last for one year.

If you have an account and you log in to this site, we will set a temporary cookie to determine if your browser accepts cookies. This cookie contains no personal data and is discarded when you close your browser.

When you log in, we will also set up several cookies to save your login information and your screen display choices. Login cookies last for two days, and screen options cookies last for a year. If you select “Remember Me”, your login will persist for two weeks. If you log out of your account, the login cookies will be removed.

If you edit or publish an article, an additional cookie will be saved in your browser. This cookie includes no personal data and simply indicates the post ID of the article you just edited. It expires after 1 day.

EMBEDDED CONTENT FROM OTHER WEBSITES

Articles on this site may include embedded content (e.g. videos, images, articles, etc.). Embedded content from other websites behaves in the exact same way as if the visitor has visited the other website.

These websites may collect data about you, use cookies, embed additional third-party tracking, and monitor your interaction with that embedded content, including tracking your interaction with the embedded content if you have an account and are logged in to that website.

ANALYTICS

WHO WE SHARE YOUR DATA WITH

HOW LONG WE RETAIN YOUR DATA

If you leave a comment, the comment and its metadata are retained indefinitely. This is so we can recognize and approve any follow-up comments automatically instead of holding them in a moderation queue.

For users that register on our website (if any), we also store the personal information they provide in their user profile. All users can see, edit, or delete their personal information at any time (except they cannot change their username). Website administrators can also see and edit that information.

WHAT RIGHTS YOU HAVE OVER YOUR DATA

If you have an account on this site, or have left comments, you can request to receive an exported file of the personal data we hold about you, including any data you have provided to us. You can also request that we erase any personal data we hold about you. This does not include any data we are obliged to keep for administrative, legal, or security purposes.

WHERE WE SEND YOUR DATA

Visitor comments may be checked through an automated spam detection service.

YOUR CONTACT INFORMATION

ADDITIONAL INFORMATION

HOW WE PROTECT YOUR DATA

WHAT DATA BREACH PROCEDURES WE HAVE IN PLACE

WHAT THIRD PARTIES WE RECEIVE DATA FROM

WHAT AUTOMATED DECISION MAKING AND/OR PROFILING WE DO WITH USER DATA

INDUSTRY REGULATORY DISCLOSURE REQUIREMENTS