NOTICE OF PRIVACY PRACTICES

Dakota Hegi Chiropractor
Effective Date: August 11, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OUR COMMITMENT TO YOUR PRIVACY

Dakota Hegi Chiropractor is committed to protecting the privacy and confidentiality of your health information. We are required by applicable federal and state laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to maintain the privacy and security of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

Protected health information generally includes information that identifies you and relates to your past, present, or future physical or mental health condition, healthcare services provided to you, or payment for those healthcare services.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

Treatment

We may use or disclose your health information to provide, coordinate, or manage your chiropractic care and related healthcare services.

For example, we may disclose relevant information to another physician, chiropractor, physical therapist, imaging facility, hospital, or other healthcare provider involved in your care.

Payment

We may use and disclose your health information to bill and collect payment for services provided to you.

This may include submitting claims and information to health insurance companies, determining eligibility or coverage, obtaining payment, responding to insurance inquiries, or communicating with entities involved in processing healthcare payments.

Healthcare Operations

We may use and disclose your health information for activities necessary to operate our practice.

Examples include quality assessment, staff training, business management, compliance activities, auditing, legal services, and evaluating the performance of our practice.

Appointment Reminders and Communications

We may use your contact information to communicate with you regarding appointments, scheduling, treatment, billing, or other matters related to your healthcare.

Communications may occur by telephone, voicemail, text message, email, patient portal, or other communication methods you have provided or authorized.

You may request that we communicate with you using a particular method or at a particular location.

Business Associates

We may disclose your health information to third parties that perform services for our practice, such as electronic health record providers, billing companies, payment processors, information technology providers, accountants, attorneys, document storage companies, and other vendors.

When required by HIPAA, these organizations must appropriately safeguard your protected health information.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may use or disclose your health information without your written authorization when permitted or required by law, including for purposes such as:

• Public health activities;

• Reporting suspected abuse, neglect, or domestic violence when required or authorized by law;

• Health oversight activities;

• Judicial and administrative proceedings;

• Certain law enforcement purposes;

• Workers’ compensation matters;

• Preventing or reducing a serious and imminent threat to health or safety;

• Certain governmental functions;

• Coroners, medical examiners, and funeral directors as permitted by law; and

• Other uses or disclosures specifically required or permitted by federal or Kansas law.

When applicable law provides greater privacy protection than HIPAA, we will follow the more protective law.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Uses and disclosures of your protected health information that are not otherwise permitted by law generally require your written authorization.

Certain uses or disclosures may specifically require authorization under HIPAA, including certain uses of psychotherapy notes, certain marketing activities, and the sale of protected health information.

We will not sell your protected health information in violation of applicable law.

If you provide written authorization, you may generally revoke that authorization in writing at any time. Your revocation will not affect disclosures already made in reliance on your authorization.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have certain rights regarding your protected health information.

Right to Inspect and Obtain Copies

You have the right to inspect and obtain a copy of health information we maintain about you, subject to certain limited exceptions.

When your records are maintained electronically and applicable law requires it, you may request an electronic copy.

We may charge a reasonable, cost-based fee as permitted by law.

Right to Request an Amendment

If you believe information in your health record is incorrect or incomplete, you may request that we amend it.

We may deny your request under certain circumstances permitted by law. If your request is denied, you have rights concerning documentation of your disagreement.

Right to an Accounting of Disclosures

You may request an accounting of certain disclosures of your protected health information made by our practice.

The accounting does not include every disclosure. For example, certain disclosures for treatment, payment, and healthcare operations are generally excluded.

Right to Request Restrictions

You may ask us to restrict certain uses or disclosures of your protected health information.

We generally are not required to agree to all requested restrictions.

However, if you pay for a healthcare service or item completely out of pocket and request that we not disclose information about that service or item to your health plan for payment or healthcare operations purposes, we will honor the request when required by law unless disclosure is otherwise required by law.

Right to Request Confidential Communications

You may request that we communicate with you about your healthcare in a particular way or at a particular location.

For example, you may request that we contact you only at a particular telephone number or email address.

We will accommodate reasonable requests as required by law.

Right to Receive a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Right to Choose Someone to Act for You

If you have given someone medical power of attorney or another person has legal authority to act on your behalf, that person may exercise your privacy rights as permitted by law.

We may verify that person’s authority before taking action.

YOUR RIGHT TO ACCESS YOUR HEALTH INFORMATION

We will respond to requests for access to your protected health information within the time periods required by applicable law.

In certain limited circumstances, access may be denied. If access is denied, you may have the right to have the decision reviewed.

ELECTRONIC COMMUNICATIONS

Our practice may use electronic systems to provide healthcare and administrative services, including electronic health records, patient portals, electronic billing, email, and text messaging.

Electronic communications can carry privacy risks despite reasonable safeguards. Patients should use appropriate care when communicating sensitive information electronically.

You may contact our office to request reasonable alternative methods of communication.

PERSONAL REPRESENTATIVES, FAMILY MEMBERS, AND OTHERS INVOLVED IN YOUR CARE

When permitted by law, we may disclose relevant health information to a family member, friend, caregiver, or other person involved in your healthcare or payment for your healthcare.

We will generally limit the information disclosed to information relevant to that person’s involvement.

You may tell us that you do not want information shared with a particular person, subject to applicable legal requirements and emergency circumstances.

MINORS

Health information concerning minor patients will be handled in accordance with HIPAA and applicable Kansas law concerning parental, guardian, and minor rights to consent to treatment and access healthcare information.

BREACH NOTIFICATION

We are required to maintain appropriate safeguards to protect your health information.

If a breach occurs involving unsecured protected health information, we will notify affected individuals as required by applicable law.

OUR RESPONSIBILITIES

Our practice is required to:

• Maintain the privacy and security of your protected health information;

• Provide you with this Notice explaining our legal duties and privacy practices;

• Follow the privacy practices described in the Notice currently in effect;

• Notify you following a breach of unsecured protected health information when required by law; and

• Refrain from using or disclosing your protected health information except as permitted or required by law or authorized by you.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice and our privacy practices.

Changes may apply to all protected health information we maintain, including information created or received before the change.

When we make a material change, we will make the revised Notice available as required by law.

You may request the current version of this Notice from our office at any time.

SMS/Text Messaging Privacy

If you provide your mobile phone number and consent to receive text messages from our practice, we may use SMS/text messaging to communicate with you regarding appointments, appointment reminders, scheduling, rescheduling, cancellations, office updates, account-related communications, and other communications related to the services you have requested.

Consent to receive text messages is not a condition of purchasing any goods or services.

Message frequency may vary. Message and data rates may apply depending on your mobile carrier and plan.

We do not sell, rent, or share your mobile phone number, SMS opt-in information, or SMS consent with third parties or affiliates for their marketing or promotional purposes. Mobile information will not be shared with third parties or affiliates for marketing or promotional purposes. Information may be shared with service providers as necessary to provide our messaging services, subject to appropriate confidentiality and data-protection requirements.

You may opt out of SMS communications at any time by replying STOP to a text message. After opting out, you may receive a confirmation message, and no further text messages will be sent unless you subsequently provide consent again.

For assistance, reply HELP to a text message or contact our office directly.

We take reasonable administrative, technical, and physical measures to protect personal information, including information provided through our messaging services. However, standard SMS/text messaging may not always be a secure method of communication, and you should avoid sending highly sensitive information by text unless an appropriate secure method is provided.

QUESTIONS OR COMPLAINTS

If you believe your privacy rights have been violated, have questions about this Notice, or would like to exercise one of your privacy rights, you may contact:

Dakota Hegi Chiropractor
Privacy Contact: Dr. Dakota Hegi, D.C.
Derby, Kansas

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services through the Office for Civil Rights.

You will not be retaliated against or denied treatment for filing a privacy complaint.