Ferstl Chiropractic Clinic Privacy Policy 3

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Copyright 2010 Ferstl Chiropractic Clinic, P.C. Web Design and Hosting by MEMNetService (i) Judicial and Administrative Proceeding - For example, Ferstl Chiropractic Clinic, PC may be required to disclose your PHI in response to a court order or a lawfully issued subpoena. (j) Law Enforcement Purposes - In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or. Ferstl Chiropractic Clinic, PC may disclose your PHI if Ferstl Chiropractic Clinic, PC believes that your death was the result of criminal conduct. (k) Coroner or Medical Examiner - Ferstl Chiropractic Clinic, PC may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death. (1) Organ, Eye or Tissue Donation - If you are an organ donor, Ferstl Chiropractic Clinic, PC may disclose your PHI to the entity to whom you have agreed to donate your organs. (m) Research - If Ferstl Chiropractic Clinic, PC is involved in research activities, your PI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI. (n) Avert a Threat to Health or Safety – Ferstl Chiropractic Clinic, PC may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat. (o) Specialized Government Functions - This refers to disclosures of PHI that relate primarily to military and veteran activity. (p) Workers' Compensation - If you are involved in a Workers' Compensation claim, Ferstl Chiropractic Clinic, PC may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system. (q) National Security and Intelligence Activities - Ferstl Chiropractic Clinic, PC may disclose your PHI in order to provide authorized governmental officials with necessary intelligence information for national security activities and purposes authorized by law. (r) Military and Veterans - If you are a member of the armed forces, Ferstl Chiropractic Clinic, PC may disclose your PHI as required by the military command authorities. APPOINTMENT REMINDER Ferstl Chiropractic Clinic, PC may, from time to time, contact you to provide appointment reminders or information about treatment alternatives or other health- related benefits and services that may be of interest to you. The following appointment reminders are used by Ferstl Chiropractic Clinic, PC: a) a postcard mailed to you at the address provided by you; and b) telephoning your home and leaving a message on your answering machine or with the individual answering the phone. -3-

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.c om