This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. It applies to the health records we create and keep as your chiropractic provider. It's separate from our Website Privacy Policy, which covers only the technical data this website collects from visitors. Please review this notice carefully.
Your rights
When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you use them.
Get a copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. We will say yes to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say no if it could affect your care. If you pay for a visit out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations purposes — we will say yes unless a law requires us to share it.
Get a list of those we've shared your information with
You can ask for an accounting of the times we've shared your health information over the six years before your request, who we shared it with, and why. This doesn't include disclosures for treatment, payment, or our operations. We'll provide one accounting a year for free and may charge a reasonable fee for additional requests within 12 months.
Get a copy of this notice
You can ask for a paper copy of this notice at any time, even if you've agreed to receive it electronically.
Choose someone to act for you
If someone has your medical power of attorney or is your legal guardian, that person can exercise your rights and make choices about your health information once we've confirmed their authority.
File a complaint
If you feel we've violated your privacy rights, you can complain to us using the contact information below, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or visiting hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.
Your choices
For certain health information, you can tell us your preference and we'll follow it. This includes sharing information with family, close friends, or others involved in your care, and sharing information in a disaster relief situation. If you're unable to tell us your preference — for example, if you're unconscious — we may share information if we believe it's in your best interest, or when needed to address a serious and imminent threat to health or safety.
We never share your information for the following without your written permission:
- Marketing purposes
- Sale of your information
- Psychotherapy notes, where applicable
How we use and share your health information
Treat you
We use your health information to provide your care, and may share it with other professionals involved in your treatment.
Run our practice
We use and share health information to manage your care, improve our services, and contact you when necessary — for example, appointment reminders.
Provide a superbill for insurance reimbursement
Golden Bear is out-of-network with insurance. On request, we provide a detailed superbill — including diagnosis and procedure codes — for you to submit to your insurer yourself. We do not bill insurance directly or speak with your insurer without your signed authorization.
We're also allowed or required to share health information in other, more limited situations, usually in ways that serve the public good:
- Public health and safety — such as reporting suspected abuse, neglect, or domestic violence, or addressing a serious threat to someone's safety
- Health research, under the conditions required by law
- Complying with state or federal law, including oversight by the Department of Health and Human Services
- Organ and tissue donation requests
- A coroner, medical examiner, or funeral director, when necessary
- Workers' compensation claims, law enforcement purposes, or other government functions authorized by law
- Responding to a court order, administrative order, or subpoena
Our commitment to you
We do not market or sell your health information, and we do not use your health conditions to target advertising. Golden Bear Chiropractic is a healthcare provider governed by California's Confidentiality of Medical Information Act as well as applicable federal privacy law, and we protect your health information under both.
If you use our online scheduling system, Jane, to book appointments or complete intake forms, Jane's own privacy practices apply to what you enter there.
Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us in writing that we can. You may change your mind about that at any time by telling us in writing.
Changes to this notice
We can change the terms of this notice, and any changes will apply to all health information we already have about you as well as information we receive in the future. The current notice is available on this page, in our office, and on request.
Contact us / privacy questions
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. It applies to the health records we create and keep as your chiropractic provider. It's separate from our Website Privacy Policy, which covers only the technical data this website collects from visitors. Please review this notice carefully.
Your rights
When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you use them.
Get a copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. We will say yes to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say no if it could affect your care. If you pay for a visit out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations purposes — we will say yes unless a law requires us to share it.
Get a list of those we've shared your information with
You can ask for an accounting of the times we've shared your health information over the six years before your request, who we shared it with, and why. This doesn't include disclosures for treatment, payment, or our operations. We'll provide one accounting a year for free and may charge a reasonable fee for additional requests within 12 months.
Get a copy of this notice
You can ask for a paper copy of this notice at any time, even if you've agreed to receive it electronically.
Choose someone to act for you
If someone has your medical power of attorney or is your legal guardian, that person can exercise your rights and make choices about your health information once we've confirmed their authority.
File a complaint
If you feel we've violated your privacy rights, you can complain to us using the contact information below, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or visiting hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.
Your choices
For certain health information, you can tell us your preference and we'll follow it. This includes sharing information with family, close friends, or others involved in your care, and sharing information in a disaster relief situation. If you're unable to tell us your preference — for example, if you're unconscious — we may share information if we believe it's in your best interest, or when needed to address a serious and imminent threat to health or safety.
We never share your information for the following without your written permission:
- Marketing purposes
- Sale of your information
- Psychotherapy notes, where applicable
How we use and share your health information
Treat you
We use your health information to provide your care, and may share it with other professionals involved in your treatment.
Run our practice
We use and share health information to manage your care, improve our services, and contact you when necessary — for example, appointment reminders.
Provide a superbill for insurance reimbursement
Golden Bear is out-of-network with insurance. On request, we provide a detailed superbill — including diagnosis and procedure codes — for you to submit to your insurer yourself. We do not bill insurance directly or speak with your insurer without your signed authorization.
We're also allowed or required to share health information in other, more limited situations, usually in ways that serve the public good:
- Public health and safety — such as reporting suspected abuse, neglect, or domestic violence, or addressing a serious threat to someone's safety
- Health research, under the conditions required by law
- Complying with state or federal law, including oversight by the Department of Health and Human Services
- Organ and tissue donation requests
- A coroner, medical examiner, or funeral director, when necessary
- Workers' compensation claims, law enforcement purposes, or other government functions authorized by law
- Responding to a court order, administrative order, or subpoena
Our commitment to you
We do not market or sell your health information, and we do not use your health conditions to target advertising. Golden Bear Chiropractic is a healthcare provider governed by California's Confidentiality of Medical Information Act as well as applicable federal privacy law, and we protect your health information under both.
If you use our online scheduling system, Jane, to book appointments or complete intake forms, Jane's own privacy practices apply to what you enter there.
Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us in writing that we can. You may change your mind about that at any time by telling us in writing.
Changes to this notice
We can change the terms of this notice, and any changes will apply to all health information we already have about you as well as information we receive in the future. The current notice is available on this page, in our office, and on request.
Dr. Corey Blanchette, D.C. is our privacy contact. Email DrCorey@GoldenBearChiro.com, call (510) 567-3756, or write to Golden Bear Chiropractic, 151 Callan Ave, Suite 201, San Leandro, CA 94577.