HIPAA Disclaimer

NOTICE OF PRIVACY PRACTICES

Effective Date: May 26, 2026

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.

How Hart Chiropractic & Functional Wellness May Use or Disclose Your Health Information
When Hart Chiropractic & Functional Wellness May Not Use or Disclose Your Health Information
Your Health Information Rights:
1. Right to Request Special Privacy Protections
2. Right to Request Confidential Communications
3. Right to Inspect and Copy
4. Right to Amend or Supplement
5. Right to an Accounting of Disclosures
6. Right to a Paper or Electronic Copy of this Notice
Changes to this Notice of Privacy Practices
How to File a Complaint

A. How Hart Chiropractic & Functional Wellness May Use or Disclose Your Health Information

Hart Chiropractic & Functional Wellness collects health information about you and maintains it in a paper and/or electronic record. That record is the property of this practice, but the information in it belongs to you. The law permits us to use or disclose your health information for the following purposes:

1. Treatment

We use your health information to provide chiropractic care, functional wellness services, nutritional counseling, acupuncture, massage therapy, functional fitness, lymphatic and body sculpting services, and any other care provided at this practice. We may share your information with other members of your care team at Hart Chiropractic & Functional Wellness, with outside healthcare providers who provide services we do not offer, with laboratories, pharmacists, or other treating professionals. We may also share relevant information with family members or others involved in your care when appropriate.

2. Payment

We use and disclose your health information to obtain payment for services we provide. This includes sharing information with your health plan, insurance carrier, or other payers as required to process claims and receive reimbursement. We may also assist other providers in obtaining payment for services they have rendered to you.

3. Health Care Operations

We may use and disclose your health information to operate this practice effectively. This includes activities such as quality improvement, staff training, legal and compliance reviews, fraud and abuse detection, business planning, and auditing. We may share information with business associates — such as our billing service — who perform administrative functions on our behalf. Each business associate is bound by a written agreement requiring them to protect the confidentiality and security of your information.

We may also share information with other healthcare providers, health plans, or clearinghouses that have a relationship with you for purposes related to quality improvement, patient safety, care coordination, accreditation, or fraud prevention.

4. Appointment Reminders

We may use and disclose your health information to contact you with appointment reminders. If you are not available, we may leave a message on your voicemail or with a person who answers your phone.

5. Sign-In and Check-In

When you arrive at our office, we may ask you to sign in. We may also call your name when we are ready to see you. This is a routine part of operating a healthcare practice.

6. Notification and Communication With Family

We may disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care — regarding your location, general condition, or in the event of your death. In a disaster situation, we may share information with relief organizations to coordinate care and notification. If you are available and able to do so, we will give you the opportunity to object before making these disclosures. If you are unable to object, our clinical staff will use professional judgment in determining what is appropriate to share.

7. Marketing

We may contact you to share information about products or services related to your treatment, care coordination, or health management — provided we receive no payment for doing so. We may describe services offered at Hart Chiropractic & Functional Wellness, inform you about participating health plans, encourage you to maintain healthy habits, or share information about government-sponsored health programs. We will not use or disclose your health information for other marketing purposes, or accept payment for marketing communications, without your prior written authorization. You may revoke any such authorization at any time.

8. Sale of Health Information

We will not sell your health information without your prior written authorization. Any authorization will clearly disclose that compensation will be received. You may revoke that authorization at any time, and we will stop any future sale of your information.

9. Required by Law

We will use and disclose your health information when required to do so by law, limiting any disclosure to what the law specifically requires.

10. Public Health

We may be required by law to disclose your health information to public health authorities for purposes that include: preventing or controlling disease, injury, or disability; reporting child, elder, or dependent adult abuse or neglect; reporting domestic violence; reporting problems with products or medication reactions to the FDA; and reporting disease or infection exposure. When we report suspected elder abuse or domestic violence, we will notify you or your personal representative promptly, unless we believe doing so would put you at risk of serious harm.

11. Health Oversight Activities

We may be required by law to disclose your health information to health oversight agencies in the course of audits, investigations, inspections, licensure reviews, and other proceedings, subject to applicable legal limitations.

12. Judicial and Administrative Proceedings

We may disclose your health information in the course of judicial or administrative proceedings when expressly authorized by a court or administrative order. We may also disclose information in response to a subpoena, discovery request, or other lawful legal process, provided reasonable efforts have been made to notify you and you have not objected — or your objections have been resolved by court order.

13. Law Enforcement

We may be required to disclose your health information to law enforcement officials for purposes such as identifying or locating a suspect, complying with a court order or warrant, or fulfilling other lawful law enforcement functions.

14. Coroners and Medical Examiners

We may be required to disclose your health information to coroners or medical examiners in connection with their investigation of a death.

15. Organ or Tissue Donation

We may share your health information with organizations involved in procuring, banking, or transplanting organs and tissues.

16. Public Safety

We may disclose your health information to prevent or reduce a serious and imminent threat to the health or safety of a specific person or the general public.

17. Specialized Government Functions

We may disclose your health information for military or national security purposes, or to correctional institutions or law enforcement officers who have you in their lawful custody.

18. Workers’ Compensation

We may disclose your health information as required to comply with workers’ compensation laws, including periodic reports to your employer or insurer regarding your condition and work-related injury or illness.

19. Change of Ownership

In the event that Hart Chiropractic & Functional Wellness is sold or merged with another organization, your health records will become the property of the new owner. You retain the right to request that copies of your health information be transferred to another provider of your choosing.

20. Breach Notification

In the event of a breach of unsecured protected health information, we will notify you as required by law — by email if you have provided a current address, and by other appropriate means as circumstances require.

B. When Hart Chiropractic & Functional Wellness May Not Use or Disclose Your Health Information

Except as described in this Notice, Hart Chiropractic & Functional Wellness will not use or disclose your health information without your written authorization. If you authorize us to use or disclose your health information for a purpose not described here, you may revoke that authorization in writing at any time.

C. Your Health Information Rights

Right to Request Special Privacy Protections

You have the right to request restrictions on certain uses and disclosures of your health information. Submit your request in writing, specifying what information you want to limit and what limitations you are requesting. If you ask us not to disclose information to your commercial health plan for items or services you paid for in full out of pocket, we will honor that request — unless disclosure is required for treatment or legal reasons. We reserve the right to accept or decline other restriction requests and will inform you of our decision.

Right to Request Confidential Communications

You have the right to request that we communicate with you in a specific way or at a specific location — for example, by email to a particular account or by mail to your work address. We will comply with all reasonable written requests that specify how or where you would like to receive communications.

Right to Inspect and Copy

You have the right to inspect and copy your health information, with limited exceptions. To request access, submit a written request identifying the information you want to review or copy, and your preferred format. We will provide copies in your requested format if readily available, or offer an acceptable alternative. We may charge a reasonable fee to cover labor, supplies, and postage. We may deny access in limited circumstances; if so, you will be informed of your right to appeal.

Right to Amend or Supplement

You have the right to request that we correct health information you believe is inaccurate or incomplete. Submit your request in writing and explain why the information should be changed. We are not required to make the requested amendment, but we will inform you of our decision and how to respond if we decline. If we deny your request, you may submit a written statement of disagreement for inclusion in your record.

Right to an Accounting of Disclosures

You have the right to receive an accounting of disclosures of your health information made by this practice, with certain exceptions. Disclosures made for treatment, payment, health care operations, notification to family, specialized government functions, and certain other purposes described in this Notice are not subject to accounting. To request an accounting, contact our Privacy Officer.

Right to a Paper or Electronic Copy of this Notice

You have the right to receive a paper or electronic copy of this Notice of Privacy Practices at any time, even if you previously requested it electronically. To request a copy, contact our Privacy Officer.

For questions about any of these rights, or to exercise them, please contact:

Dr. Matthew Hart, Privacy Officer

Hart Chiropractic & Functional Wellness

1803 W. State St., Ste. 150 | Geneva, IL 60134

Phone: 630-262-1421 | Email: info@hartchiropractic.com

D. Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice at any time. Until an amendment is made, we are required to comply with the terms currently in effect. After any amendment, the revised Notice will apply to all protected health information we maintain, regardless of when it was created or received.

A current copy of this Notice will be posted in our reception area and made available at every appointment. It will also be posted on our website at hartchiropractic.com.

E. How to File a Complaint

If you have concerns about this Notice or the way Hart Chiropractic & Functional Wellness handles your health information, please contact our Privacy Officer using the information above.

If you are not satisfied with how your concern is addressed, you may also file a formal complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Email: OCRMail@hhs.gov

Complaint form: www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf

You will not be penalized in any way for filing a complaint.