Family Chiropractic Health Service

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Frequently Asked Questions

Notice of Privacy Practices

Family Chiropractic Health Service
8465 W. Broadway
Brooklyn Park, MN 55445
Please review this notice carefully. It describes how your medical information may be used and disclosed and how you make gain access to the information

Family Chiropractic Health Service (Practice) is committed to maintaining the privacy of your protected health information (PHI), which includes information about your medical condition and the care and treatment you receive from the Practice and other healthcare providers. This notice details how your PHI may be used and disclosed to third parties for purposes of your care, payment for your care,  health care operations of the Practice, and purposes permitted or required by law. This notice also details your rights regarding your PHI
The Practice may use and/or your PHI for purposes related to your care, for your care, and health care operations of the Practice. The following are examples of types of uses and/or disclosures of your PHI that may occur. These examples are not meant to include all possible types of uses and or disclosure.
·          Care - In order to provide care to you, the Practice will provide your PHI to health care professionals directly involved in your care so they may understand your medical conditions and needs and provide advice or treatment. For example your physician may need to know your condition is responding to the treatment provided by the Practice.
·          Payment - In order to get paid for some or all of the health care provided by the Practice, the Practice may provide your PHI, directly or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements. For example, the Practice may need to provide your health insurance carrier with information about health care services you received from the Practice so the Practice may be properly reimbursed.
·          Health Care Operations - In order for the Practice to operate in accordance with applicable law and insurance requirements and in order for the Practice to provide quality any efficient care, it may be necessary for the Practice to compile, use and/or disclose your PHI. For example, the Practice use your PHI to evaluate the performance of the Practice’s personnel in providing care to you.

The Practice may use and/or disclose your PHI authorization from you, in the following instances:

1.     De-identified Information – Your PHI is altered so that it does not identify you, and, even without your name, cannot be used to identify you.
2.     Business Associate – To a business associate who is someone the Practice contracts with to provide a service necessary for your treatment, payment for your treatment and/or health care operations (e.g. billing service or transcription service). The Practice will obtain satisfactory written assurance in accordance with applicable law, that the business associate will appropriately safeguard your PHI.
3.     Personal Representative – To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
4.     Public Health Activities – Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability. This includes reports or child abuse or neglect.
5.     Federal Drug Administration – If required by the Food and Drug Administration to report adverse events, product defects, problems, biological product deviations, or to track products, enable product recalls, repairs or replacements, or to conduct post marketing surveillance.
6.     Abuse, Neglect, or Domestic Violence – To a government authority, if the Practice is required by law to make such disclosure. If the Practice is authorized by law to make such disclosure, it will do so it if believes the disclosure is necessary to prevent serious harm or if the Practice believes you have been the victim of abuse, neglect or domestic violence. Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of the disclosure.
7.     Health Oversight Activities – Such activities, which must be required by law, involve government benefit programs, government regulatory programs and civil rights law. Those activities relating to the community’s health care system.
8.     Judicial and Administrative Proceeding – For example, the Practice may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
9.     Law Enforcement Purposes – For example, the Practice may be required t disclose to a law enforcement official for law enforcement purposes. These may include: (1) complying with a legal process such as subpoena or as required by law; (2) information for identification and location purposes; (3) information regarding a person who is or is suspected to be a crime victim; (4) in situations where the death of an individual may have resulted from criminal conduct; (5) in the event of a crime occurring on the premises of the Practice; and (6) a medical emergency (not on the Practice’s premises) has occurred, and it appears that a crime has occurred.
10.   Coroner or Medical Examiner – The Practice may disclose your PHI to coroner or medical examiner for the purpose of identifying you or determining your cause of death, or to a funeral director as permitted by law and as necessary to carry out its duties.
11.   Organ or other Tissue Donation – If you are an organ donor, the Practice may disclose your PHI to the entity to whom you have agreed to donate your organs.
12.   Research – If the Practice is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI such as approval of the research by an institutional review board, the de-identification of your PHI before it is used, and the requirement that protocols must be followed.
13.   Avert a Threat to Health or Safety – The Pracitce may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat t the health and safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
14.   Specialized Government Functions – When the appropriate conditions apply, the Practice may use PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service. The Practice may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.
15.   Inmate – The Practice may disclose your PHI to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates.
16.   Worker’s Compensation – If you are involved in a Worker’s Compensation claim, the Practice may be required to disclose your PHI to an individual or entity that is part of the Worker’s Compensation system.
17.   Disaster Relief Efforts – The Practice may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.
18.   Marketing – Face-to-face communication directly with the patient or promotional gifts of nominal value do not require authorization. All other situations require separate authorization.
19.   Required by Law – If otherwise required by law, but such use or disclosure will be made in compliance with the law and limited to the requirements of the law.
Uses and or disclosures, other than those described above, will be made only with your written Authorization, which you may revoke at any time. In particular the Practice would be required to obtain written Authorization if it were to (1) engage in the sale of your PHI in exchange for direct or indirect remuneration; (2) engage in marketing communication to you about a third party’s product or service for which financial remuneration is received, with these exceptions:
1.     Face-to-face communications;
2.     Promotional gifts of nominal value;
3.     Prescription refill reminders, if the remuneration received is reasonably related to the cost of making the marketing communication       

The Practice may, from time to time, contact you to provide appointment reminders. The reminder may be in the form of a letter or postcard. The Practice will try to minimize the amount of information contained in the reminder. The Practice may also contact you by phone and, if you are not available, the Practice will leave a message for you.
The Practice may, from time to time, contact you about treatment alternatives it offers, or other health benefits or services that may be of interest to you.

You have the right to:
·          Revoke any authorization, in writing, at any time. To request a revocation, you must submit a written request to the Practices Privacy Officer.
·          Request restrictions on certain use and/or disclosure of your PHI as provided by law. However, the Practice is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to the Practices Privacy Officer. In your written request, you must inform the Practice of what information you want to limit, whether you want to limit the Practice’s use or disclosure, or both, and to whom you want the limits to apply. If the Practice agrees to your request, the Practice will comply with your request unless the information is needed in your order to provide you with emergency treatment.
·          Receive confidential communications of PHI by alternative means or at alternative locations. You must make your request in writing to the Practice’s Privacy Officer. The Practice will accommodate all reasonable requests.
·          Request restrictions on certain use and/or disclosure of your PHI by Health Plans when the services or items provided were paid out of pocket in full by you.
·          Inspect and copy your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to the Practice’s Privacy Officer. In certain situations that are defined by law, the Practice may deny your request, but you will have the denial reviewed. The Practice may charge you a fee for the costs of copying including supplies, labor, and mailing or other appropriate charges associated with your request.
·          Amend your PHI as provided by law. To request an amendment, you must submit a written request to the Practice’s Privacy Officer. You must provide a reason that supports your request. The Practice may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by the Practice (unless the individual or entity that created the information is no longer available), if the information is not a part of your PHI maintained by the Practice, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with the Practice’s denial, you have the right to submit a written statement of disagreement.
·          Receive an accounting of non-routine disclosures of your PHI as provided by law. To request an accounting, you must submit a written request to the Practice’s Privacy Officer. The request must state a time period which may not be longer than six years and may not include the dates before April14, 2003. The request should indicate in what form you want the list (such as paper or electronic copy). The first list you request within a 12 month period will be free, but the practice may charge you for the cost of providing additional lists in that same 12 month period. The Practice will notify you of the costs involved and you can decide to withdraw your request before any costs are incurred.
·          Receive a paper copy of this privacy Notice from the Practice upon request.
·          To file a complaint with the Practice, please contact the Practice’s Privacy Officer. All complaints must be in writing.
·          If your complaint is not satisfactorily resolved, you may file a complaint with the Secretary of Health and Human Services, Office of Civil Rights. Our Privacy Officer will furnish you with the address upon request.
·          To obtain more information, or have your questions about your rights answered, please contact the Practice’s Privacy Officer.
The health care office:
·          Is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice upon request.
·          Is required to abide by the terms of this Privacy Notice
·          Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for your entire PHI that it maintains.
·          Will not retaliate against you for making a complaint.
·          Must make a good faith effort to obtain from you an Acknowledgement of the receipt of this Notice.
·          Will post this Privacy Notice in its lobby and on the Practice’s web site, if the Practice maintains a website.
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What are your hours?


Our hours are:

Monday7:00 a.m. to 12:30 p.m.2:00 p.m. to 6:00 p.m.
Tuesday8:00 a.m. to 12:30 p.m.2:00 p.m. to 5:30 p.m. 
Wednesday7:00 a.m. to 12:30 p.m.    2:00 p.m. to 6:00 p.m.
Friday7:00 a.m. to 12:30 p.m.         2:00 p.m. to 6:00 p.m.
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Where are you located?

We are located on the corner of West Broadway Avenue and 85th Street in the Broadway Square Mall. If you navigate by landmarks, we are across the street from North Hennepin Community College 1/2 mile East of Fleet Farm.

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Do you take insurance?

We are in-network providers for:

  • CIGNA, AETNA and most of their affiliates
  • Worker's Compensation
  • Auto Accident  and Personal Injury 

As a service to you we will call your health plan to determine the level of coverage included in your benefits plan and reveiw these with you before you begin care. We remind our patients of what their health plans regularly remind us - that the benefits and eligibility information your health plan shares with us is only an estimate of coverage and actual coverage can only be deterimined once the claims are actually paid.

We will submit your insurance claims to your health plan for you on your behalf. We ask that you come to your appointment prepared to pay your co pay and any remaining co insurance balances at the time of service.

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Meet the Doctors

We are chiropractors serious about health.

If we can help,we'll say so; if not, we'll help you find another solution. 



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