Notice of Privacy Practices                                           Effective April 14, 2003

Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal.  We are committed to protecting the confidentiality of your medical information.  As part of our routine operations, we create a record of the care and services you receive.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. 

Uses and Disclosures of Medical Information
The following categories describe the ways in which we may use and disclose your Protected Health Information (PHI).
Treatment: Many of the people who work for our organization may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your physician, therapists, spouse, children or parents.
Payment: We may use and disclose medical information about you so that the treatment and the services you receive at the facility may be billed to and payment may be collected from you, an insurance company or a third party.
Health Care Operations: We may use your PHI for Quality Assurance, Peer Review and Compliance Programs, or to conduct cost-management and business planning activities for our practice.
Appointment Reminders: Our organization may use and disclose PHI to contact you and remind you of visits and to reschedule visits you may have missed.
Disclosure Required by Law: Our Organization will use and disclose your PHI when required to do so by federal, state or local law.
Specialized Government Functions: We may disclose PHI for military and veterans affairs or national security and intelligence activities.
Workers Compensation: We may release PHI to Workers Compensation or similar programs.
Public Health: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Research: We may disclose PHI to researchers as long as researchers have obtained required waiver from the Institutional Review Board/Privacy Board.
Lawsuits and Disputes: We may disclose PHI in response to court order, administrative order, discovery request, subpoena or by another party involved in a dispute.
Military: We may disclose your PHI if you are a member of U.S., or foreign military forces (including Veterans), if required by appropriate military command authorities.
Serious Threats to Health or Safety: We may release PHI to prevent serious treat to your health or safety or the health and safety of the public or another person.
Inmates: We may release your PHI to correctional institutions or law enforcement officials if you are an inmate or are under the custody of a law enforcement official.
Law Enforcement: We may release PHI if asked to do so by a law enforcement official, including the following situations:
In response to a court order, subpoena, warrant, summons or similar process
To identify or locate a suspect, fugitive, material witness or missing person.
About a victim of a crime if, under certain limited circumstances, we are unable to obtain the persons agreement.
About a death we believe may be as a result of criminal conduct.
About criminal conduct at the facility.
In emergency circumstances to report a crime; the location of a crime or victims; or the identity, description or location of the person who committed a crime.

Your Health Information Rights
You have the following rights regarding the PHI we obtain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care, including medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information, you must submit your request in writing to the facility. There will be a cost associated to copying records. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed. Another licensed health care professional chosen by the facility will review your request and denial.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing to the facility. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:  was not created by us, is not part of the medical information kept by or for the facility, is not part of the information which you would be permitted to inspect or copy, or is accurate and complete.
Right to an Accounting of Disclosures.  You have the right to request a list of disclosures we made of PHI about you. Your request must be made in writing to the facility. Your request must state a time period that may not be longer than 6 years and may not include dates before 4/14/2003
Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care, like a family member or a friend. Request for restrictions are to be made in writing to the facility. Request to include the following; what information to limit; whether you want to limit our use and or disclosure. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can request that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the facility. No reason will be requested and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice: You have the right to receive a paper copy of this notice at any time. Please ask us and we will provide it.

Change of this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we have about you as well as any information we receive in the future. A copy of the current notice will be posted in the facility. The notice will contain an effective date on the front cover. Each time you are admitted to our facility we will offer you a copy of the current notice in effect.

Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer: Steven E. Karm, D.C.
Phone:  (561) 683-4001
E-mail  drkarm@impactwpb.com
Mail:  Impact Rehab and Wellness, Inc
          2247 Palm Beach Lakes Boulevard, Ste 106
          West Palm Beach, Fl 33409

or with the Secretary of the U.S. Department of Health and Human Services