Effective Date: July 2026

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

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At Coastline Spine Chiropractic and Rehab, we are committed to protecting the privacy of your health information. This Notice explains how we may use and disclose your Protected Health Information (PHI), your rights regarding your medical information, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

Protected Health Information includes information that identifies you and relates to your past, present, or future physical or mental health, healthcare services, or payment for healthcare.

 

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your Protected Health Information.

• Provide you with this Notice of our legal duties and privacy practices.

• Notify you if a breach occurs that may have compromised the privacy or security of your information.

• Follow the terms of this Notice currently in effect.

 

How We May Use and Disclose Your Health Information

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Treatment

We may use and share your health information to provide, coordinate, or manage your chiropractic care.

Examples include:

• Reviewing your health history

• Creating treatment plans

• Discussing your care with other healthcare providers involved in your treatment

• Maintaining your medical records

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Payment

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

Examples include:

• Verifying insurance benefits

• Submitting insurance claims

• Collecting payment from you or your insurance company

• Responding to insurance requests for additional information

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Healthcare Operations

We may use your information to operate and improve our practice.

Examples include:

• Quality improvement activities

• Staff training

• Licensing and accreditation

• Business management

• Internal audits

• Appointment scheduling

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Appointment Reminders and Communications

We may contact you by:

• Phone

• Voicemail

• Text message

• Email

• Mail

to remind you of appointments, discuss scheduling, provide follow-up information, or communicate other healthcare-related information.

We will use reasonable safeguards to protect your privacy when communicating with you.

 

Individuals Involved in Your Care

Unless you object, we may share relevant health information with family members, caregivers, or others involved in your healthcare or payment for your care when appropriate.

 

As Required by Law

We may disclose your information when required by federal, state, or local law.

Examples include:

• Public health reporting

• Court orders

• Law enforcement requests when legally authorized

• Workers' compensation claims

• Health oversight activities

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

 

Other Uses and Disclosures

Certain uses and disclosures require your written authorization.

Examples include:

• Most marketing communications not otherwise permitted by HIPAA

• The sale of Protected Health Information

• Uses not otherwise described in this Notice

You may revoke your authorization at any time in writing, except to the extent we have already acted upon it.

 

Your Rights

You have the right to:

Obtain a Copy of Your Medical Records

You may request access to your health records. We may charge a reasonable fee for copies as permitted by law.

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Request Corrections

If you believe information in your record is incorrect or incomplete, you may request that it be amended.

We may deny your request in certain circumstances but will explain our decision in writing.

 

Request Confidential Communications

You may request that we communicate with you in a specific way or at a specific location.

For example:

• Only calling your cell phone

• Sending mail to a different address

We will accommodate reasonable requests.

 

Request Restrictions

You may ask us not to use or disclose certain information.

While we are not required to agree to every request, we will comply when required by law.

If you pay for a healthcare service in full out of pocket, you may request that we not disclose information about that service to your health insurer for payment or healthcare operations, and we will honor that request unless disclosure is otherwise required by law.

 

Receive an Accounting of Disclosures

You may request a list of certain disclosures we have made of your health information.

 

Receive a Paper Copy of This Notice

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

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Our Website

Our website may allow you to:

• Request appointments

• Complete patient forms

• Access your secure patient portal through Jane

Information submitted through our website is handled according to our Website Privacy Policy. Information that becomes part of your medical record is also protected under HIPAA.

 

Electronic Communications

If you choose to communicate with us electronically, including email or text messaging, we will make reasonable efforts to protect your privacy. However, electronic communications may involve some level of risk.

Please avoid sending highly sensitive medical information through unsecured email unless specifically requested by our office.

 

Changes to This Notice

We reserve the right to revise this Notice at any time.

Any revised Notice will apply to all Protected Health Information we maintain and will be available:

• In our office

• On our website

• Upon request

 

Questions or Complaints

If you believe your privacy rights have been violated, you may file a complaint with us.

Please direct questions or complaints to:

Privacy Officer
Coastline Spine Chiropractic and Rehab

Address: 900 FL-16 #2, St Augustine, FL 32084

Email: admin@coastline.com

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

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Acknowledgment

We are required by law to make this Notice available to our patients.

We will ask you to acknowledge that you received or had the opportunity to review this Notice of Privacy Practices. Your decision not to sign an acknowledgment does not affect your right to receive treatment.

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Thank you for trusting Coastline Spine Chiropractic and Rehab with your healthcare. We are committed to protecting your privacy and providing high-quality chiropractic and rehabilitation services.

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