Thomsen Chiropractic – Notice of Privacy Practices

Thomsen Chiropractic, LLC
Dr. Riley Thomsen, D.C.
715 S E St, Broken Bow, NE 68822
Phone: 308-293-6340 | Email: thomsenchiropractic@gmail.com

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.

Effective date: July 5th, 2025

Your Health Information Rights and Our Privacy Responsibilities

Thomsen Chiropractic, LLC is committed to safeguarding your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and applicable state law.

How We May Use and Share Your Health Information

We may use or disclose your PHI for the following purposes without additional authorization:

1. Treatment, Payment, and Healthcare Operations

• Treatment: We may use and share your PHI to coordinate or manage your care with other healthcare providers. For example, if your primary care provider needs to know what services you have received with Thomsen Chiropractic in order to determine whether additional therapies are required, we may share your PHI with your primary care provider.
• Payment: We may use and share your PHI to bill and receive payment from insurance companies or third-party payers. For example, we may share your PHI with your insurance company to prove we provided a service and get paid for that service.
• Healthcare Operations: We may use and share your PHI to run the clinic and make sure all patients receive good care, improve your care, and run the clinic better. For example, we may use your PHI for administrative purposes such as quality assessment, training, and business management.

2. Other Permitted or Required Disclosures:

• Business Associates: We have individuals and entities that perform functions and activities on behalf of the clinic, which may have access to your PHI. Examples of Business Associates include, but are not limited to, billing companies, accountants, and lawyers.
• Legal Requirements: In response to law enforcement requests, subpoenas, court orders, or public health requirements.
• Emergencies or Communication Barriers: When necessary to act in your best interest if you are unable to communicate.
• Family or Friend: We may disclose to a family member, other relative, or a close personal friend of yours, or any other person identified by you, the PHI directly relevant to that person’s involvement with your care or payment.
• Notice: To give notice to your family member, your personal representative, or another person responsible for your care of your location, general condition, or death.
• Fundraising:  We may contact you to raise funds for the clinic, but you have the option to opt out of these communications.
• Breach Notification: We will notify you if a breach involving your unsecured PHI occurs.
• Other Special Cases: For research, military or national security purposes, organ donation, and workers' compensation, as permitted by law.
  

Uses and Disclosures that Require Authorization

We will not use or disclose your PHI without your written authorization with regard to your psychotherapy notes, marketing, or the sale of your PHI.

Any other uses and disclosures not described in this notice will be made unless you provide written authorization.

If you provide a written authorization, you may revoke the written authorization at any time by providing the clinic with a written revocation. However, revocation may not be effective if we have already taken action in reliance of the written authorization or the written authorization was obtained as a condition of obtaining insurance coverage (other law provides the insurer with the right to contest a claim under the policy or the policy itself).

Prohibited Uses and Disclosures

We will not use or disclose your PHI as provided in 45 C.F.R. 164.502(a)(5)(iii), which regards reproductive health care. For example, we will not use or disclose your PHI to impose criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care.

Redisclosure

Once your PHI is used or disclosed pursuant to the reasons set forth above, your PHI is subject to redisclosure by the recipient and no longer protected under 45 C.F.R. 164, Subpart E.

Your Rights Regarding Your Health Information

You have the right to:

• Access, Inspect, and Copy Your Records: Access your records, inspect your records, and request a paper or digital copy of your health records, unless restricted or prohibited by law.
• Request Restrictions: Request limitations on how we use or share your information. You may request that we not use or disclose your PHI to carry out treatment, payment, or health care operations, or with other individuals regarding your care and payments. We may not agree to the requested restriction, but we will in cases where disclosure restrictions are required (i.e., health plans).
• Confidential Communications: Request that we contact you at a specific address, phone number, or method.
• Amend Your Records: Request corrections to your health information if you believe it is inaccurate or incomplete. We may deny the amendment, however.
• Accounting of Disclosures: Request a list of disclosures made in the past six (6) years, excluding certain disclosures, such as for treatment, payment, and healthcare operations.
• Revoke Authorizations: Cancel previously granted authorizations at any time in writing.
• Receive a Paper Copy: Request a paper copy of this notice at any time.
• File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, please call or email the Privacy Officer. The Contact Information for the Privacy Officer is listed below. We will not retaliate against you for filing a complaint.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI, to provide you with notice of our legal duties and privacy practices, and to notify you if there has been a breach of unsecured PHI.
• We must and will follow the terms of this notice as currently in effect.
• We reserve the right to change the terms of this notice and make the new notice provisions effective for all PHI we maintain. If we make any material changes to our privacy practices, we will update this Notice and make the revised version available in our office and on our website, if applicable. You may also request a copy of the revised Notice at any time.

Contact Information

For questions, complaints, or to exercise your rights, please contact:

Privacy Officer: Dr. Riley Thomsen, D.C.
Phone: 308-293-6340
Email: thomsenchiropractic@gmail.com