Notice of Privacy Practices

Spine Spot Chiropractic | Dr. James Fraser

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.

1. Our Commitment to Your Privacy

At Spine Spot Chiropractic ("the Practice"), we understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Practice to provide you with quality care and to comply with certain legal requirements. This record is the property of Spine Spot Chiropractic, but the information in the record belongs to you.

This Notice applies to all of the records of your care generated by this Practice, whether made by Practice personnel or your personal doctor.

We are required by law to:

• Make sure that medical information that identifies you is kept private (with certain exceptions defined by law).
• Give you this Notice of our legal duties and privacy practices with respect to medical information about you.
• Notify you in the event of a breach of your unsecured protected health information (PHI).
• Follow the terms of the Notice that is currently in effect.

2. How We May Use and Disclose Medical Information About You

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

A. Treatment

We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Practice personnel who are involved in taking care of you.

• Example: Dr. Fraser may need to share your X-rays with a radiologist to confirm a diagnosis, or discuss your case with your primary care physician to coordinate your care regarding a specific injury.
• Referrals: If we refer you to another specialist (e.g., an orthopedist or physical therapist), we may provide them with the necessary information to assist in your treatment.

B. Payment

We may use and disclose medical information about you so that the treatment and services you receive at the Practice may be billed to and payment may be collected from you, an insurance company, or a third party.

• Example: We may need to give your health plan information about an adjustment you received at Spine Spot Chiropractic so your health plan will pay us or reimburse you for the visit.
• Prior Approval: We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

C. Health Care Operations

We may use and disclose medical information about you for Practice operations. These uses and disclosures are necessary to run the Practice and ensure that all of our patients receive quality care.

• Quality Assessment: We may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.
• Training: We may disclose information to doctors, nurses, technicians, medical students, and other Practice personnel for review and learning purposes.
• Business Associates: We may share your medical information with third-party "business associates" that perform various activities (e.g., billing, transcriptions) for the Practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

D. Appointment Reminders

We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the Practice. This may occur via phone, text message, or email, based on the contact preferences you have provided.

E. Sign-In Sheet

We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name in the waiting room when we are ready to see you.

F. Individuals Involved in Your Care or Payment for Your Care

We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.

• Emergencies: In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
• Your Rights: If you are present and able to do so, we will give you an opportunity to object to such disclosures before they occur. If you are not present or able to agree or object, we will use our professional judgment to determine whether the disclosure is in your best interest.

G. Research

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the Practice.

3. Special Situations (Required by Law)

We may use or disclose your health information in the following specific situations without your permission, as required by federal, state, or local law:

1. As Required By Law: We will disclose medical information about you when required to do so by federal, state, or local law.
2. Public Health Risks: We may disclose medical information about you for public health activities, such as:
• To prevent or control disease, injury, or disability.
• To report births and deaths.
• To report child abuse or neglect.
• To report reactions to medications or problems with products.
• To notify people of recalls of products they may be using.
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
3. Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
4. Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
5. Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
• In response to a court order, subpoena, warrant, summons, or similar process.
• To identify or locate a suspect, fugitive, material witness, or missing person.
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement.
• About a death we believe may be the result of criminal conduct.
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
6. Coroners, Medical Examiners, and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Practice to funeral directors as necessary to carry out their duties.
7. National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
8. Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or conduct special investigations.
9. Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

4. Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

A. Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

B. Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us.
• Is not part of the medical information kept by or for the Practice.
• Is not part of the information which you would be permitted to inspect and copy.
• Is accurate and complete.

C. Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you, excluding disclosures for treatment, payment, and health care operations. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time period which may not be longer than six years.

D. Right to Request Restrictions

You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

E. Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

F. Right to a Paper Copy of This Notice

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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

5. Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the Practice. The Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the Practice for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services.

To file a complaint with the Practice, contact our Privacy Officer using the information below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

7. Contact Information

If you have any questions about this Notice, please contact:

Spine Spot Chiropractic Privacy Officer: James R. Fraser III, D.C.

Office Manager Address: 341 Market St, Basalt, CO 81621 

Phone: 970-924-1015 Email: [email protected]

Effective Date: January 1, 2026