Notice of Privacy Practice
Effective Date: September 10, 2026
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.
Belden Village Chiropractic & Wellness Center ("we," "us," or "our") is required by law to maintain the privacy of your protected health information ("PHI"), to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to abide by the terms of this Notice while it is in effect. We are required to notify affected individuals following a breach of unsecured PHI.
How We May Use and Disclose Your Health Information
The following categories describe the ways we may use and disclose your PHI without your written authorization.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may share information with other healthcare providers involved in your care, such as a referring physician or imaging center.
Payment
We may use and disclose your PHI to bill and collect payment for the services we provide, including submitting claims to your health insurance company or other payer and verifying coverage or eligibility.
Healthcare Operations
We may use and disclose your PHI for our operations, such as quality assessment and improvement activities, staff training, licensing, and other administrative and business functions necessary to run our practice.
Other Permitted or Required Uses and Disclosures
We may also use or disclose your PHI, generally without your written authorization, in the following circumstances:
-As required by law, including reporting to public health authorities for purposes such as disease control or reporting;
-To report suspected abuse, neglect, or domestic violence to appropriate government authorities;
-For health oversight activities, such as audits or investigations by government agencies;
-In connection with judicial or administrative proceedings, such as in response to a court order or subpoena;
-For law enforcement purposes, as permitted or required by law;
-To coroners, medical examiners, or funeral directors as necessary for their duties;
-For organ, eye, or tissue donation purposes, if applicable;
-To avert a serious threat to health or safety of you or others;
-For workers' compensation purposes, as authorized by applicable law;
-To business associates who perform services on our behalf and agree in writing to protect your information.
Any other use or disclosure of your PHI not described in this Notice will be made only with your written authorization. You may revoke that authorization in writing at any time, except to the extent we have already relied on it.
Your Rights Regarding Your Health Information
You have the following rights with respect to your PHI. Requests related to these rights should be submitted in writing to our office using the contact information below.
Right to Access and Copy
You have the right to inspect and obtain a copy of your PHI that we maintain in a designated record set, with limited exceptions. We may charge a reasonable, cost-based fee for copies.
Right to Request Amendment
You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances, and we will explain our reasons in writing if we do.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your PHI that we have made, other than for treatment, payment, healthcare operations, and certain other excepted purposes.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to a requested restriction, except in certain circumstances involving disclosures to a health plan when you have paid for a service in full out-of-pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a specific way or at a specific location (for example, by mailing information to a different address). We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.
Right to Be Notified of a Breach
You have the right to be notified in the event of a breach of your unsecured PHI, as required by law.
Our Responsibilities
We are required by law to maintain the privacy and security of your PHI, provide you with this Notice describing our legal duties and privacy practices, follow the terms of the Notice currently in effect, and notify you if a breach occurs that may have compromised the privacy or security of your information. We reserve the right to change the terms of this Notice and to make the revised Notice effective for all PHI we maintain, including information created or received before the revision. Any material revisions to this Notice will be made available upon request and posted at our office and/or on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
Contact Us
If you have questions or concerns about this Privacy Policy or our privacy practices, please contact us:
Belden Village Chiropractic & Wellness Center
4200 Munson Street NW, Suite B, Canton, Ohio 44718
330-493-0009
