hello@risewithchiro.com
hello@risewithchiro.com
Rise Family Chiropractic – 6365 Spalding Drive Building E, Peachtree Corners, GA 30092
Phone: (678) 899-7958
Email: hello@risewithchiro.com
Effective Date: 04/10/2026
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.
We recognize the importance of privacy and are committed to protecting the confidentiality of your medical information. We maintain records of the medical care we provide and may also receive records from other healthcare providers. These records are used to provide or support quality medical care, obtain payment for services provided to you as permitted by your health plan, and help us meet our professional and legal responsibilities in operating this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with this notice of our legal duties and privacy practices regarding protected health information, and to notify affected individuals following any breach of unsecured protected health information. This notice explains how your medical information may be used and disclosed. It also outlines your rights and our legal obligations related to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.
How This Medical Practice May Use or Disclose Your Health Information
When This Medical Practice May Not Use or Disclose Your Health Information
Your Health Information Rights
Right to Request Special Privacy Protections
Right to Request Confidential Communications
Right to Inspect and Copy
Right to Amend or Supplement
Right to an Accounting of Disclosures
Right to a Paper or Electronic Copy of this Notice
Changes to This Notice of Privacy Practices
Complaints
This medical practice collects health information about you and maintains it in a chart and on a computer system. This is your medical record. The medical record is the property of this medical practice, but the information contained in it belongs to you. The law allows us to use or disclose your health information for the following purposes:
We use your medical information to provide your medical care. We share medical information with our employees and others involved in delivering the care you need. For example, we may share your information with other physicians or healthcare providers who are providing services we do not offer. We may also share it with a pharmacist who needs it to fill a prescription, or a laboratory that performs testing. We may also disclose information to family members or others who assist you when you are ill or injured, or after your death.
We use and disclose your medical information to obtain payment for services provided. For example, we may submit required information to your health plan before payment is approved. We may also share information with other healthcare providers to help them receive payment for services they have provided to you.
We may use and disclose your medical information to operate this medical practice. For example, we may use it to review and improve the quality of care we provide, or to evaluate the qualifications and performance of our clinical staff. We may also use and disclose it to obtain authorization from your health plan for services or referrals. Additionally, we may use it for medical reviews, legal services, audits, fraud and abuse detection, compliance programs, and business management activities.
We may share your information with our “business associates,” such as billing companies, that support administrative functions for us. Each business associate is required under a written agreement to protect the confidentiality and security of your protected health information.
We may also share information with other healthcare providers, clearinghouses, or health plans that have a relationship with you when they request it for quality assessment, patient safety activities, population health improvement, care coordination, training, accreditation, licensing, or fraud and compliance activities.
We may also share your health information with other providers, clearinghouses, and health plans participating with us in “organized health care arrangements” (OHCAs) for shared healthcare operations. OHCAs include hospitals, physician groups, health plans, and other coordinated healthcare entities. A list of participating OHCAs is available from the Privacy Officer.
We may use and disclose your medical information to contact you and remind you about appointments. If you are not available, we may leave a message on your answering machine or with the person answering your phone.
We may use and disclose your medical information when you sign in upon arrival at our office. We may also call your name when your provider is ready to see you.
We may disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care about your location, general condition, or—unless you have instructed otherwise—in the event of your death. In disaster situations, we may also share information with relief organizations to assist with notifications.
We may disclose information to individuals involved in your care or payment for your care. If you are able to agree or object, we will give you the opportunity to do so before disclosure, although in emergency situations we may proceed if necessary. If you are unable to respond, our clinical staff will use professional judgment when communicating with others.
If we do not receive payment for these communications, we may contact you about services related to your treatment, care coordination, or other healthcare services that may benefit you. We may also inform you about services offered by this practice and the health plans we participate in.
We may encourage healthy lifestyle choices, recommend screenings, provide small promotional items, or inform you about government health programs. We may also discuss products or services during visits and may be compensated for certain communications, such as medication reminders.
We will not use or disclose your health information for marketing purposes that require authorization without your written consent. Any such authorization will specify if compensation is involved and may be revoked at any time.
We will not sell your health information without your written authorization. Any such authorization will disclose if compensation is received and may be revoked to stop future disclosures.
We will use and disclose your health information when required by law, but will limit disclosure to the minimum necessary. Where reporting is required for abuse, legal proceedings, or law enforcement, we will follow applicable legal requirements described below.
We may, and sometimes must by law, disclose your health information to public health authorities for disease control, injury prevention, reporting abuse or neglect, reporting adverse reactions, or exposure to disease. When reporting suspected abuse, we will notify you or your representative unless doing so may increase risk of harm in our professional judgment.
We may disclose your health information to government oversight agencies during audits, investigations, inspections, licensing, and other legal review processes, as permitted by law.
We may disclose your health information in legal or administrative proceedings when required by a court order or similar authority. We may also respond to subpoenas or discovery requests when proper notice has been given and objections have been resolved.
We may disclose your health information to law enforcement for purposes such as identifying or locating individuals, complying with legal processes, or responding to court orders, warrants, or subpoenas.
We may disclose health information to coroners or medical examiners for death investigations, as required by law.
We may share your health information with organizations involved in organ, tissue, or transplantation services.
We may disclose your health information when necessary to prevent or reduce a serious and imminent threat to health or safety of a person or the public.
We may provide immunization records to schools when required and with your authorization or that of your dependent.
We may disclose your health information for military, national security, correctional, or other government functions as allowed by law.
We may disclose your health information as required under workers’ compensation laws, including reporting workplace injuries or illnesses to employers or insurers.
If this medical practice is sold or merged with another organization, your health information will transfer to the new owner. You will still have the right to request copies or transfer your records to another provider.
If there is a breach of unsecured protected health information, we will notify you as required by law. We may use email if provided, and notifications may also be delivered through other appropriate methods, including through business associates if applicable.
Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information that identifies you without your written authorization.
If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosures of your health information by submitting a written request that specifies what information you want to limit and what restrictions you would like applied. If you request that we do not disclose information to your commercial health plan for services that you have paid for in full out-of-pocket, we will honor your request unless disclosure is required for treatment or legal purposes. We may accept or deny other restriction requests and will inform you of our decision.
Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific manner or at a specific location. For example, you may request that information be sent to a particular email address or work location. We will accommodate all reasonable written requests that clearly state how or where you wish to receive communications.
Right to Inspect and Copy.You have the right to review and obtain copies of your health information, with limited exceptions. To access your records, you must submit a written request describing what information you want, whether you want to inspect or receive copies, and your preferred format if copies are requested. We will provide records in your requested format if it is readily available, or offer an alternative format that is acceptable. If an agreement cannot be reached and the record is stored electronically, you may choose either an electronic or hard copy format. We may also send copies to another person you designate in writing. A reasonable fee may be charged to cover costs such as labor, materials, and postage, and if agreed in advance, any summary or explanation preparation. Certain requests may be denied under limited conditions. If access to a child’s records or an incapacitated adult’s records is denied due to risk of harm, you may have the right to appeal. If psychotherapy notes are denied, you may request that they be transferred to another mental health professional.
Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and we will provide you with information about this medical practice’s denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is. If we deny your request, you may submit a written statement of your disagreement with that decision, and we may, in turn, prepare a written rebuttal. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information.
Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to you or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notification and communication with family) and 18 (specialized government functions) of Section A of this Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers, or which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
Right to a Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer listed at the top of this Notice of Privacy Practices.
We reserve the right to amend this Notice at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. We will also post the current notice on our website.
Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer listed above.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
OCRMail@hhs.gov
The complaint form may be found at https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html. You will not be penalized in any way for filing a complaint.
