NOTICE OF PRIVACY PRACTICES
REJUVENATION Chiropractic + Sports Rehab
Wilmington, North Carolina
Effective Date: September 6, 2025
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.
This notice applies to health information maintained by REJUVENATION Chiropractic + Sports Rehab (“we,” “our,” or “the Practice”). This information is called Protected Health Information, or “PHI.”
Our Responsibilities
We are required by law to protect the privacy of your PHI, provide this notice, and follow the privacy practices described in the notice currently in effect. We must notify you following a breach of unsecured PHI when required by law. When another applicable law provides greater protection for your information, we follow that law.
How We Use and Share Your Information
We may use and share your information without a separate written authorization for the following purposes, subject to applicable legal requirements.
Treatment: To evaluate, provide, and coordinate your care. For example, we may share relevant records with a physician, physical therapist, imaging facility, or another healthcare professional treating you.
Payment: To bill and receive payment for services. For example, we may provide your health plan with information needed to process a claim.
Practice operations: To manage our practice, improve care, train staff, review quality, and perform billing, compliance, and administrative activities. For example, we may review patient records to evaluate treatment outcomes.
We use electronic health record and practice-management systems, including ChiroTouch/CT Cloud. Service providers handling PHI on our behalf must meet applicable privacy requirements, including business associate agreements when required.
Communications: To contact you about appointments, treatment, follow-up care, billing, and related matters. We may use telephone calls, voicemail, text messages, email, or a patient portal, subject to applicable law and your communication preferences.
Other Permitted or Required Disclosures
We may also use or share information for the following purposes when legal requirements are met:
Public health and safety: Reporting certain diseases, adverse reactions, product problems, suspected abuse or neglect, or preventing a serious and imminent threat to health or safety.
Health oversight: Audits, inspections, licensing, investigations, and other authorized oversight activities.
Legal requirements: Complying with applicable laws, including providing information to the U.S. Department of Health and Human Services to evaluate privacy compliance.
Legal proceedings and law enforcement: Responding to qualifying court orders, subpoenas, or other lawful requests when the required privacy protections are satisfied.
Workers’ compensation: Processing claims and meeting applicable workers’ compensation requirements.
Research: Participating in research when applicable privacy requirements have been satisfied.
Organ donation and deceased individuals: Providing information to organ procurement organizations, coroners, medical examiners, or funeral directors as permitted by law.
Special government functions: Certain authorized military, national security, protective-service, or correctional activities.
We limit information to the minimum necessary when that standard applies. An injury claim or involvement of an attorney does not automatically authorize access to your records. We release information for personal-injury and other legal matters only with appropriate authorization or another valid legal basis.
Your Choices About Sharing Information
You may tell us whether we may share relevant information with family, friends, caregivers, or others involved in your care or payment for care. You may also express preferences about disclosures for disaster relief. If you cannot communicate your wishes, we may share relevant information when permitted by law and, using professional judgment, we determine that doing so is in your best interest.
Uses Requiring Written Permission
We obtain written authorization for uses and disclosures not otherwise described in this notice or permitted or required by law. Most uses and disclosures of psychotherapy notes, marketing uses requiring authorization, and disclosures constituting a sale of PHI require written authorization. We do not sell your patient medical information. You may revoke an authorization by notifying our Privacy Officer in writing. Revocation does not undo actions already taken in reliance on your authorization or affect other exceptions allowed by law.
Information With Additional Legal Protections
Some records have additional protections that limit the uses and disclosures described above.
Substance use disorder records: If we receive or maintain records protected by 42 CFR Part 2, we follow the additional requirements applicable to those records. Such records, or testimony describing their contents, cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your specific written consent or an appropriate court order issued after the required notice and opportunity to be heard. A court order authorizing disclosure must also be accompanied by a subpoena or another legal requirement compelling disclosure.
North Carolina protections: North Carolina law restricts disclosure of information identifying people who have or may have certain reportable diseases or conditions, including HIV. We disclose such information only with appropriate written consent or under a legally permitted exception.
Your Rights
Contact our Privacy Officer using the information below to exercise these rights. We may ask you to submit certain requests in writing and verify your identity.
Access your records. You may inspect or request an electronic or paper copy of medical, billing, and other information used to make decisions about you. We generally act within 30 days. If a legally permitted extension is necessary, we will explain the reason and expected completion date in writing. We may charge a reasonable, cost-based copying fee when permitted by law. If access is denied, we will explain the reason and any available review rights.
Request a correction. You may request an amendment to information you believe is incorrect or incomplete. We generally respond within 60 days, subject to a legally permitted extension with written notice. If we deny your request, we will explain why and how you may submit a statement of disagreement.
Request confidential communications. You may ask us to contact you in a particular way or at a different location. We will accommodate reasonable requests.
Request limits on sharing. You may request restrictions on information used or shared for treatment, payment, or practice operations. We generally do not have to agree. However, if you pay for a service in full out of pocket and request that we not disclose information about that service to your health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law.
Request an accounting of disclosures. You may request a list of certain disclosures made during the preceding six years. This generally excludes disclosures for treatment, payment, healthcare operations, and certain other purposes. The first accounting in a 12-month period is free. We may charge a reasonable fee for additional requests after explaining the fee and allowing you to withdraw or modify your request.
Receive this notice. You may request a paper copy at any time, even if you previously agreed to receive it electronically.
Use an authorized representative. A person legally authorized to act for you may exercise your rights within the scope of that authority. We verify authority and follow applicable exceptions, including laws protecting minors’ confidential care.
File a complaint. You may complain to our Privacy Officer or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you or deny treatment because you filed a complaint.
Questions, Requests, or Complaints
Contact our Privacy Officer by telephone, email, or by delivering a written request to our office:
Dr. Jasmine Brewster Piper, DC, DACBSP®
REJUVENATION Chiropractic + Sports Rehab
Phone: 910-685-4481
Email: info@rejuvenationchiro.com
Website: www.rejuvenationchiro.com
Please avoid including sensitive medical information in unsecured email. Contact us for an appropriate way to submit records or sensitive requests. To file a complaint with the U.S. Department of Health and Human Services, visit: https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Changes to This Notice
We may revise this notice and apply the revised practices to information we already maintain and information we receive in the future, as permitted by law. The current notice will be available upon request, in our office, and on our website.