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Copyright 2010 Ferstl Chiropractic Clinic, P.C. Web Design and Hosting by MEMNetService
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THAT INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
I This Practice is committed to maintaining the privacy of your protected health information ("PHI"), which includes
information about your health condition and the care and treatment you receive from Ferstl Chiropractic Clinic, PC.
The creation of a record detailing the care and services you receive helps this office to provide you with quality health
care. This Notice details how your PHI may be used and disclosed to third parties. This Notice also details your rights
regarding your PHI.
CONSENT
1. Ferstl Chiropractic Clinic, PC may use and/or disclose your PHI provided that it first obtains a valid Consent signed
by you. The Consent will allow Ferstl Chiropractic Clinic, PC to use and/or disclose your PHI for the purposes of:
(a) Treatment - In order to provide you with the health care you require, Ferstl Chiropractic Clinic, PC will provide your
PHI to those health care professionals, whether on Ferstl Chiropractic Clinic, PC's staff or not, directly involved in your
care so that they may understand your health condition and needs. For example, a physician treating you for lower
back pain may need to know the results of your latest physical examination by this office.
(b) Payment - In order to get paid for services provided to you, Ferstl Chiropractic Clinic, PC will provide your PHI,
directly or through a billing service, to appropriate third party payors, pursuant to their billing and payment
requirements. For example, Ferstl Chiropractic Clinic, PC may need to provide the Medicare program with information
about health care services that you received from Ferstl Chiropractic Clinic, PC so that Ferstl Chiropractic Clinic, PC
can be properly reimbursed. Ferstl Chiropractic Clinic, PC may also need to tell your insurance plan about treatment
you are going to receive so that it can determine whether or not it will cover the treatment expense.
(c) Health Care Operations In order for Ferstl Chiropractic Clinic, PC to operate in accordance with applicable law
and insurance requirements and in order for Ferstl Chiropractic Clinic, PC to continue to provide quality and efficient
care, it may be necessary for Ferstl Chiropractic Clinic, PC to compile, use and/or disclose your PHI. For example,
Ferstl Chiropractic Clinic, PC may use your PHI in order to evaluate the performance of Ferstl Chiropractic Clinic, PC’s
personnel in providing care to you.
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Copyright 2010 Ferstl Chiropractic Clinic P.C. Web Design and Hosting by MEMNetService
Privacy Policy
Ferstl Chiropractic
Clinic, P.C.
If you have any questions
regarding our privacy
policies, please feel free to
contact us during regular
business hours.
Joseph F Ferstl DC FACO
Director at Large, Illinois
Chiropractic Society
Second Vice President
American College of
Chiropractic Orthopedics
1557 Weatherstone Ln
Elgin IL 60123
847-741-3355
847-741-3597 fax
info@ferstlchiropractic.co
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Privacy Policy