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Dr John M. Rizzo graduated from Palmer College of
Chiropractic in Davenport, IA on October 1992. At Palmer, Dr Rizzo
received his Doctor of Chiropractic degree. In 1994, He also completed
an additional year of continuing education credits to receive a
Certification in Chiropractic Rehabilitation (CCRD). Presently he is one
of a few chiropractors in the state of Pennsylvania to have a CCRD
designation, Certified Chiropractic Rehabilitation Doctor.
Dr Rizzo specializes in neuro-musculo-skeletal
disorders of the spine and the extremities (feet, ankles, knees, hips,
shoulders, elbows, and wrist). He is also specialized in the
rehabilitation of most post-traumatic back and neck injuries as well as post surgical
spinal and extremity
rehabilitation.
A Full Service Rehabilitation (see Below),
Nutritional Consultation Center, along with X-ray facilities are available along with ultrasonic, intersegmental traction,
and electro-therapy modalities. Dr Rizzo works in two locations
both Patton and Ebensburg Pa.
Finally, a place where you can receive chiropractic
care, rehabilitation, nutritional consultation, and therapeutic
modalities all in the same facility.
Our Privacy Policy
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH
INFORMATION
THIS NOTICE
DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures
Here are some examples of how we might have to
disclose your health care information:
1)
Your chiropractor or a staff member may have to disclose your
health information including all of your clinical records to another
health care provider or a hospital if it is necessary to refer you to
them for diagnosis, assessment, or treatment of your health condition.
2)
Our insurance and billing staff may have to disclose your
examination and treatment records and your billing records to another
party, such as an insurance carrier, an HMO, a PPO, or your employer, if
they are potentially responsible for the payment of your services.
3)
Your chiropractor and members of the staff may need to use your
health information, examination and treatment records and your billing
records for quality control purposes or for other administrative
purposes to efficiently and effectively run our practice.
4)
Your chiropractor and members of the practice staff may need to
use your name, address, phone number, and your clinical records to
contact you to provide appointment reminders, information about
treatment alternatives, or other health related information that may be
of interest to you. 164.520(b)(1)(iii)(A).
If you are not at home to receive an appointment reminder, a
message will be left on your answering machine.
5)
The practice maintains a sign-in log for individuals seeking care
and treatment in the office. The
sign-in log is located in a position at the front desk where staff can
readily see who is seeking care or services in the chiropractic office.
6)
Your chiropractic may send you a postcard or letter periodically:
welcoming you the office; wishing you a happy birthday; thanking
you for a referral; informing you of the benefits of chiropractic;
or wishing you a Merry Christmas.
These letters or postcards will be mailed to your home and be
viewed by those who receive your mail.
7)
From time to time your chiropractor may send marketing or
promotional offers to you via the mail; patient appreciation day fliers,
valentine’s day specials, etc.
ds (birthday, thank-you
for referral, reminders), patient appreciation day flyers for special
days, Christmas cards, and appointment reminders.
You have the right to
refuse to give us authorization to contact you to provide appointment
reminders, information about treatment alternatives, or other health
related information. If you
do not give us authorization, it will not affect the treatment we
provide to you or the methods we use to obtain reimbursement for your
care.
You may inspect or copy
the information that we use to contact you to provide appointment
reminders, information about treatment alternatives, or other health
related information at any time.
Our Privacy Pledge
We have and always will respect your privacy.
Other than the uses and disclosures we described above, we
will not sell or provide any of your health information to any outside
marketing organization.
Permitted uses and disclosures without your consent or authorization
Under federal law, we are also permitted or
required to use or disclose your health information without your consent
or authorization in these following circumstances:
1)
We are permitted to use or disclose your health information if we
are providing health care services to you based on the orders of another
health care provider.
2)
We are permitted to use or disclose your health information if we
provide health care services to you as an inmate.
3)
We are permitted to use or disclose your health information if we
provide health care services to you in an emergency.
4)
We are permitted to use or disclose your health information if we
are required by law to treat you and we are unable to obtain your
consent after attempting to do so.
5)
We are permitted to use or disclose your health information if
there are substantial barriers to communicating with you, but in our
professional judgment we believe that you intend for us to provide care.
Other than the circumstances described in the
receding five examples, any other use or disclosure of your health
information will only be made with your written consent.
Your right to revoke your authorization
You may revoke your authorization to us at any
time; however, your revocation must be in writing.
There are two circumstances under which we will not be able to
honor your revocation request:
1)
If we already released your health information before we receive
your request to revoke your authorization.164.508 (b)(5)(i)
2)
If you were required to give your authorization as a condition of
obtaining insurance, the insurance company may have a right to your
health information if they decide to contest any of your claims.
If you wish to revoke your authorization please write us at
Rizzo Chiropractic
P.O.
Box 813
Ebensburg,
PA 15931
Your right to limit uses or disclosures
If there are health care providers,
hospitals, employers, insurers or other individuals or organizations to
whom you do not want us to disclose your health information, please let
us know, in writing, what individuals or organizations to whom you do
not want us to disclose your health care information.
We are not required to agree to your restrictions.
However, if we agree with your restrictions, the restriction
binding on us. If we do not
agree to your restrictions, you may drop your request or you are free to
seek care from another health care provider.
Your right to receive confidential communications regarding your
health information
We normally provide information about your
health to you in person at the time you receive chiropractic services
from us. We may also mail
you information regarding your health or about the status of your
account. We will do our best to accommodate any reasonable request if
you would like to receive information about your health or the services
that we provide at a place other than your home or, if you would like
the information in a different form.
To help us respond to your needs, please make any request in
writing.
Your right to inspect and copy your health information
You have the right to inspect and/or copy
your health information for seven years from the date that the record
was created or as long as the information remains in our files. We require your request to inspect and/or copy your health
information to be in writing.
Your right to amend your health information
You have the right to request that we amend
your health information for seven years from the date that the record
was created or as long as the information remains in our files. We require your request to amend your records to be in
writing and for you to give us a reason to support the change you are
requesting us to make.
Your right to receive an accounting of the disclosures we have made
of your records
You have the right to request that we give
you an accounting of the disclosures we have made of your health
information for the last six years before the date of your request. The accounting will include all disclosures except
- those disclosures
required for your treatment, to obtain payment for your services, or to
run our practice.
- those disclosures made
to you.
- those disclosures
necessary to maintain a directory of the individuals in our facility or
to individuals involved with your care.
- those disclosures for
national security or intelligence purposes.
- those disclosures made
to correctional officers or law enforcement officers.
- those disclosures that
were made prior to the effective date of the HIPAA privacy law.
We will provide the first accounting within any
12-month period without charge. There
is a fee for any additional requests during the next 12 months.
When you make your request we will tell you the amount of the fee
and you will have the opportunity to withdraw or modify your request.
Your right to obtain paper copy of this notice
If you have agreed to receive privacy notices by
e-mail, you may request a paper copy or this notice at any time.
Our duties
We are required by law to maintain the privacy of
your health information. We
are also required to provide you with this notice of our legal duties
and our privacy practices with respect to your health information.
We must abide by the terms of this notice while it
is in effect. However, we
reserve the right to change the terms of our privacy notices.
If we make a change to the terms of our privacy agreement we will
notify you in writing when you come in for treatment or by mail.
If we make a change in our privacy terms the change will apply
for all of your health information in our files.
Re-disclosure
Information that we use or disclose may be subject
to re-disclosure by the person to whom we provide the information and
may no longer be protected by the federal privacy rules.
Your right to complain
You may complain to us or to the Secretary of
Health and Human Services if you feel that we have violated your privacy
rights. We respect your
right to file a complaint and will not take any action against you if
you file a complaint. While
you make an oral complaint at any time, written comments should be
addressed to:
CMS
7500
Security Blvd.
Baltimore,
MD 21244
To contact us
If you would like further information about our
privacy policies and practices please contact:
Dr. John M. Rizzo
Rizzo
Chiropractic
110
North Center Street
Ebensburg,
PA 15931
814-472-6050
This notice is effective as of __________________.
This notice will expire seven years after the date upon which the
record was created. By
signing below, I acknowledge that I have received a copy of this notice.
______________________ ________________ Patient Name Printed
Date
___________________________ _________________________
Patient Signature/
Authorized
Provider
Representative
____________________________ _________________________
Personal Representative Printed
Personal Representative Signature
_______________________________________________________ Description of personal representative’s
authority to act for the patient.
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