Effective Date: August 7, 2026
Back In Action Chiropractic Center, LLC is committed to protecting the privacy and confidentiality of our patients’ health information.
This Notice explains how medical and health information about you may be used and disclosed, how you may obtain access to that information, and certain rights you have regarding your health information.
We follow the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and applicable Wisconsin laws governing patient healthcare records.
Our Responsibilities
We are required, when applicable, to:
- Protect the privacy and security of your Protected Health Information (“PHI”).
- Follow the privacy practices described in this Notice.
- Notify affected individuals as required by law if a breach compromises unsecured protected health information.
- Provide you with a copy of our current Notice of Privacy Practices.
- Follow applicable federal and Wisconsin confidentiality requirements.
When Wisconsin law provides greater protection for your health information than federal law, we will follow the applicable Wisconsin requirements.
How We May Use or Disclose Health Information
We may use or disclose your health information when permitted or required by applicable law, including for purposes such as:
Treatment
We may use your health information to provide, coordinate, or manage your healthcare and treatment.
Information may be shared with other healthcare professionals involved in your care when legally permitted.
Payment
We may use or disclose appropriate information for billing, insurance claims, payment collection, benefit verification, and related activities as permitted by law.
Healthcare Operations
We may use health information for activities necessary to operate our practice, including quality assessment, staff training, administrative activities, compliance, auditing, and business management.
Required or Permitted by Law
Information may also be disclosed when legally permitted or required for purposes such as:
- Public health activities
- Health oversight activities
- Workers’ compensation matters
- Certain judicial or administrative proceedings
- Certain law-enforcement purposes
- Preventing a serious threat to health or safety
- Reporting suspected abuse, neglect, or domestic violence where authorized or required
- Other disclosures specifically permitted or required by law
Any such disclosure will be made in accordance with applicable HIPAA requirements and Wisconsin law.
Uses Requiring Authorization
Uses or disclosures that are not otherwise permitted by law will generally require your written authorization.
When written authorization is required, you may revoke that authorization in writing, except to the extent that we have already relied upon it.
We will not sell your Protected Health Information in violation of HIPAA or applicable law.
Your Rights
Subject to applicable law, you may have the right to:
Access Your Records
You may request to inspect or obtain a copy of your medical and billing records.
Reasonable fees may apply where permitted by law.
Request Corrections
If you believe information in your health record is incorrect or incomplete, you may request that we amend it.
We may deny certain requests when permitted by law, but we will explain the reason for the denial.
Request Restrictions
You may ask us to limit certain uses or disclosures of your health information.
We are not required to agree to every requested restriction. However, when required by HIPAA, we will honor a request not to disclose information to a health plan regarding care that you have paid for completely out of pocket.
Request Confidential Communications
You may request that we communicate with you about health matters in a particular manner or at a particular location.
Receive an Accounting of Certain Disclosures
You may request information concerning certain disclosures we have made of your health information.
Obtain a Paper Copy
You may request a paper copy of this Notice at any time, even if you previously received it electronically.
Receive Breach Notification
You have the right to be notified when required by law if unsecured protected health information is improperly accessed, used, or disclosed.
Complaints
If you believe your health-information privacy rights have been violated, you may submit a complaint to Back In Action Chiropractic Center, LLC.
You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you for filing a privacy complaint.
Contact Us
For questions regarding this Notice, your medical records, or your privacy rights, contact:
Back In Action Chiropractic Center, LLC
500 Main Ave Ste A
De Pere, WI 54115
Phone: (920) 336-9355
Email: Biachirodepere@gmail.com
We reserve the right to update this Notice as permitted by law. The most current version will be made available through our office and website.