Privacy Statement

For Miami Back Center, Inc.
3785 NW 82 Ave. Suite # 315
Miami, Fl. 33166
(305) 471-1021

Miami Back Center is committed to protecting the confidentiality of your health information. We are required by law to maintain the privacy of your medical information. We are also required to notify you of our legal duties and privacy practices regarding your medical information, and abide by the practices of this Notice, unless more stringent laws or regulations apply.

This Notice describes this organization's practices and those of:

• Any healthcare professional authorized to enter information into your record.
• Any member of the medical staff credentialed to practice here.
• All departments and units of this facility.
• All employees, staff, and other personnel.
• Any volunteer, intern, or student we allow to help you while you are a patient.

This Notice of Privacy Practices provides detailed information about how we may use and disclose your medical information with or without authorization as well as more information about your specific rights with respect to your medical information.

How We Collect Information About You: Miami Back Center Inc. and its employees and volunteers collect data through a variety of means including but not necessarily limited to letters, phone calls, emails, voice mails, and from the submission of applications that is either required by law, or necessary to process applications or other requests for assistance through our organization.

What We Do Not Do With Your Information:

Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voice mails), contained in or attached to intakes, or directly or indirectly given to us, is held in strictest confidence.

We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about applicants or clients who receive our services that is considered patient confidential, is restricted by law, or has been specifically restricted by a patient/client in a signed HIPAA consent form.

How We Do Use Your Information:

Information is only used as is reasonably necessary to process your application or to provide you with health or counseling services which may require communication between Miami Back Center, Inc. and health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to: verify your medical information is accurate; determine the type of medical supplies or any health care services you need including, but not limited to; to obtain or purchase any type of medical supplies, devices, medications, or insurance.

Disclosures of your medical information that we may make without your authorization:


Your information may be shared with any provider who is providing you with healthcare services. This includes coordinating your care with other providers and providing referrals to other providers. Examples of healthcare providers who may need your information to treat you include your doctor, pharmacist, nurse, and other providers such as physical therapists, home health providers, and x-ray technicians. We may also use your information to contact you for appointments and to provide information about health-related products and services that we believe may be helpful to you. We may share your information electronically with your health care providers in order to make sure they have your information as quickly as possible to treat you. We will use the utmost care in any situation where we need to disclose your information electronically.

We may also share your medical information with any family member or friend who is involved in assisting with your healthcare. We will only do this if you agree, and will only share with them the information they need in order to help you. If you are unable to either agree or object to such a disclosure, we may disclose your healthcare information as necessary if we determine that it is in your best interest based on our professional judgment.


In order to get your healthcare services paid for, we may have to provide your medical information to the party responsible for paying. This may include Medicare, Medicaid (state health plan), or your insurance company. Your insurance company or health plan may need your information for activities such as determining your eligibility for coverage, reviewing the medical necessity of the healthcare services, or providing approval for hospital stays.

Healthcare Operations:

Your medical information may be used by us in order to support the business activities of the facility and to ensure that quality healthcare services are being provided. Some of the activities which would be part of our operations would be quality assessment activity, employee review, training of medical personnel, licensure and accreditation, data aggregation and audits by regulatory agencies.

We may share your protected health information with third parties who perform services such as transcription or billing. In those cases we have written agreements with the third parties that they will not use or disclose your information for any other purposes, except as required by law.

Other disclosures that we may make without your aurthorization:

There are a number of ways that your medical information may be used without your authorization, generally either because they are required by law or for public health and safety purposes. Those include:

Required by Law:

Your medical information may be used or disclosed by us when required by law. If this happens, we will comply with the law and will only disclose the information necessary. You will be notified, as required by law, of any such uses or disclosures.

Public Health:

Your medical information may be used for public health activities. Public health authorities are authorized to collect or receive the information for purposes such as controlling disease, injury or disability.

Disaster Relief:

We may disclose healthcare information about you to an entity assisting in a disaster relief effort so that your family and friends can be notified about your condition, status, and location.

Incidental Disclosures:

Certain incidental disclosures of your healthcare information may occur as a by-product of lawful and permitted use and disclosures of your healthcare information. For example, a visitor may overhear a discussion about your care at the nursing station. These incidental disclosures are permitted if we apply reasonable safeguards to protect the confidentiality of your healthcare information.

Limited Data Set Information:

We may disclose limited healthcare information to third parties for purposes of research, public health and healthcare operations. Before disclosing this information, we must enter into an agreement with the recipient of the information that limits who may use or receive the data and requires the recipient to agree not to re-identify the data or contact you. The recipient of your information is required to have appropriate safeguards to prevent inappropriate use or disclosure of your information.

Communicable Diseases:

If required by law to do so, we may disclose your medical information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight:

Health oversight agencies are authorized to have access to medical information maintained by us for activities such as audits, investigations, and inspections. Agencies with this authority include government agencies that oversee the healthcare system, government benefit programs, government regulatory programs and civil rights laws.

Abuse or Neglect:

We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your protected health information to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. Any disclosures of this nature will be made consistent with state and federal law.

Food and Drug Administration:

We may disclose your medical information to a person or agency required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or for product recalls, repairs or replacements.

Legal Proceedings:

We may disclose your medical information if required to by a court or administrative order to do so for an administrative or judicial proceeding, or in some cases in response to a subpoena, discovery request or other legal process.

Law Enforcement:

As required by state and federal laws, we may disclose your medical information, so long as applicable legal requirements are met, for law enforcement purposes.

How we will use and disclose your medical information with authorization:

Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke the authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.

If you need for us to share your medical information with someone for purposes other than those listed here, you should contact Life Chiropractic Center to arrange authorization.

Your Rights:

The following information describes your rights with respect to your medical information that we maintain.

Right to Request Restrictions:

You have the right to ask us to place restrictions on the way we use or disclose your medical information for treatment, payment, or healthcare operations. We are not required to agree to the restriction, but if we agree to a restriction, we will not use or disclose your medical information in violation of that restriction, unless it is needed for an emergency. If a restriction is no longer feasible, we will notify you.

Confidential Communications:

We will accommodate reasonable requests to communicate with you about your medical information by different methods or alternative locations if you make your request in writing. For example, if you are covered on a health plan but are not the subscriber, and would like your medical information sent to a different address than the subscriber, we can usually do that for you. Access to Your Medical Information: You have the right to receive a copy of your medical information that we maintain, with some limited exceptions. You may request access to those records in writing and provide us with information about the specific information you need so that we can fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies.

Amendment of Your Medical Information:

You have the right to ask us to change any of your medical information. You need to request this amendment in writing. In certain situations we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement.

Accounting of Certain Disclosures:

You have a right to a listing of the disclosures we make of your medical information, except for those disclosures made for treatment, payment, or healthcare operations, or those disclosures made pursuant to your authorization. The type of disclosures typically contained in a listing would be disclosures made for mandatory public health purposes, law enforcement, legal proceedings, or for other required reporting.

Changes to Privacy Practices:

Miami Back Center, Inc. reserves the right to change its privacy practices and its Notice of Privacy Practices at any time. The new notice will be effective for any medical information we create or maintain as of the date of the change.

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