Effective Date: August 5, 2026
CHAMPION CHIROPRACTIC & REHAB
9768 West Sample Road
Coral Springs, Florida 33065
Telephone: (954) 228-4635
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Champion Chiropractic & Rehab is committed to protecting the privacy and security of your health information. This Notice explains how we may use and disclose your protected health information, your rights concerning that information, and our legal responsibilities.
“Protected health information,” or “PHI,” generally means information that identifies you and relates to your health, healthcare, treatment or payment for healthcare services.
YOUR RIGHTS
You have the rights described below concerning your health information.
Obtain a Copy of Your Health Records
You may request to inspect or receive an electronic or paper copy of your medical records and other health information maintained by us.
We will generally provide the requested information within the period required by law. We may charge a reasonable, cost-based fee for copying, mailing, supplies or preparation of an authorized summary.
In limited circumstances, we may deny access to certain information. When required, we will explain the reason for the denial and whether you have a right to have that decision reviewed.
Request a Correction
You may ask us to correct health information that you believe is inaccurate or incomplete.
We may deny the request in certain circumstances, such as when the information was not created by us or we believe the existing record is accurate and complete. When we deny a request, we will provide a written explanation as required by law.
Request Confidential Communications
You may ask us to contact you in a particular manner or at a particular location. For example, you may ask us to call a specific telephone number or send correspondence to a different address.
We will accommodate reasonable requests.
Request Restrictions
You may ask us not to use or disclose certain health information for treatment, payment or healthcare operations. We are not always required to agree to a requested restriction.
When you pay in full out of pocket for a particular service, you may ask us not to disclose information concerning that service to your health plan for payment or healthcare operations. We will honor that request unless disclosure is required by law.
If we agree to another restriction, we will follow it except when disclosure is necessary to provide emergency treatment or is otherwise required by law.
Receive an Accounting of Disclosures
You may ask for a list of certain disclosures of your health information made during the six years preceding your request.
The list generally will not include disclosures made for treatment, payment or healthcare operations; disclosures made directly to you; disclosures you specifically authorized; or certain other disclosures excluded by law.
We will provide one accounting during any 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests during the same period after notifying you of the anticipated cost.
Obtain a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, including when you have agreed to receive it electronically.
Choose a Personal Representative
A person legally authorized to act on your behalf, such as a legal guardian or an individual holding an appropriate healthcare power of attorney, may exercise your privacy rights.
We may require documentation establishing that person’s authority before taking action.
File a Complaint
You may file a complaint with Champion Chiropractic & Rehab if you believe your privacy rights have been violated.
Contact:
Champion Chiropractic & Rehab
9768 West Sample Road
Coral Springs, Florida 33065
Telephone: (954) 228-4635
Email: DrD@ChampionChiropractic.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
Champion Chiropractic & Rehab will not retaliate against you for filing a complaint.
YOUR CHOICES
In certain circumstances, you may tell us how you want your health information used or disclosed.
You may direct us regarding whether we may:
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Share relevant information with family members, friends or others involved in your care or payment for your care.
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Share information in a disaster-relief situation.
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Contact you concerning certain communications where your authorization or choice is required.
If you are unable to tell us your preference, we may share information when we reasonably believe doing so is in your best interests or is necessary to reduce a serious and imminent threat to health or safety.
Written Authorization
We will obtain your written authorization before:
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Using or disclosing your health information for purposes that require authorization under HIPAA.
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Selling your protected health information.
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Using protected health information for most marketing purposes.
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Disclosing psychotherapy notes when written authorization is required.
Champion Chiropractic & Rehab does not sell protected health information.
You may revoke a written authorization at any time by notifying us in writing. Revocation will not affect actions already taken in reliance on your authorization.
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
Treatment
We may use your health information and share it with healthcare professionals involved in your treatment.
For example, we may provide relevant information to another physician, imaging facility, therapist or healthcare provider involved in your care.
Payment
We may use and disclose your health information to bill for services and obtain payment from you, an insurance carrier, health plan or another responsible party.
For example, we may submit information about your diagnosis, examination or treatment to your insurance company for payment.
Healthcare Operations
We may use and disclose your health information to operate our practice, improve the quality of care, train staff, conduct internal reviews, manage services and contact you when necessary.
For example, we may review patient records to evaluate the quality and effectiveness of our services.
Appointment and Service Communications
We may use your contact information to respond to an appointment request, confirm or reschedule an appointment, provide instructions related to your care or communicate necessary information concerning services.
Champion Chiropractic & Rehab does not use patient information to send unrelated marketing emails or marketing text messages without any authorization required by law.
Business Associates
We may share health information with outside companies or individuals that perform services for us, such as billing, technology, records storage, legal, accounting or administrative services.
When required by HIPAA, these service providers must enter into a written business associate agreement and appropriately protect the information.
Public Health and Safety
We may disclose health information for legally authorized public-health or safety purposes, including:
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Preventing or controlling disease.
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Reporting certain injuries or adverse events.
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Reporting suspected abuse, neglect or domestic violence.
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Preventing or reducing a serious threat to a person’s health or safety.
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Complying with product recalls or public-health investigations.
Required by Law
We may use or disclose your health information when required by federal, state or local law.
We may also disclose information to the U.S. Department of Health and Human Services when it is investigating or determining our compliance with federal privacy requirements.
Workers’ Compensation
We may disclose health information as authorized or required for workers’ compensation claims and similar programs.
Health Oversight
We may disclose health information to authorized health-oversight agencies for audits, inspections, investigations, licensing activities and other activities permitted by law.
Law Enforcement and Government Requests
We may disclose information for certain law-enforcement purposes or special government functions when permitted or required by law.
Judicial and Administrative Proceedings
We may disclose health information in response to a valid court or administrative order. We may also respond to a subpoena or other lawful request when the legal requirements governing the disclosure have been satisfied.
Medical Examiners and Funeral Directors
We may disclose relevant information to a coroner, medical examiner or funeral director when permitted by law.
Organ and Tissue Donation
When applicable, we may disclose information to organizations involved in organ, eye or tissue donation and transplantation.
Research
We may use or disclose health information for research only when the applicable legal requirements and patient protections have been satisfied.
SUBSTANCE USE DISORDER RECORDS
To the extent Champion Chiropractic & Rehab receives or maintains substance-use-disorder treatment records protected by 42 C.F.R. Part 2, those records receive additional legal protection.
Such records generally will not be used or disclosed in a civil, criminal, administrative or legislative investigation or proceeding against you unless you provide written consent or the disclosure is supported by the legally required court order and subpoena.
OUR RESPONSIBILITIES
Champion Chiropractic & Rehab is required to:
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Maintain the privacy and security of protected health information.
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Provide you with this Notice describing our legal duties and privacy practices.
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Follow the privacy practices described in the Notice currently in effect.
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Notify affected individuals following a breach when notification is required by law.
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Refrain from using or disclosing health information except as described in this Notice or otherwise permitted or required by law.
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Obtain written authorization before using or disclosing information when authorization is legally required.
CHANGES TO THIS NOTICE
We may change this Notice and make the revised Notice effective for all health information we maintain, including information created or received before the revision.
The current Notice will be available:
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Upon request.
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On our website.