Notice of Privacy Practices
Church Street Chiropractic
601 Quail Valley Drive, Suite 109 Georgetown, Texas 78626 Phone: (512) 864-7722 www.ChurchStreetChiro.com
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.
Your RightsYou have the right to: • Get a copy of your paper or electronic medical record • Correct your paper or electronic medical record • Request confidential communication • Ask us to limit the information we share • Get a list of those with whom we’ve shared your information • Get a copy of this privacy notice • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated
Your ChoicesYou have some choices in the way that we use and share information as we: • Tell family and friends about your condition • Provide disaster relief • Market our services and sell your information • Raise funds
Our Uses and DisclosuresWe may use and share your information as we: • Treat you • Run our organization • Bill for your services • Help with public health and safety issues • Do research • Comply with the law • Respond to organ and tissue donation requests • Work with a medical examiner or funeral director • Address workers’ compensation, law enforcement, and other government requests • Respond to lawsuits and legal actions
Important Note Regarding Substance Use Disorder RecordsTo the extent that we maintain substance use disorder patient records subject to 42 CFR Part 2, we will not use or disclose that information for civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order that meets the requirements of 42 CFR Part 2.
Our Responsibilities• We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time.
Changes to the Terms of this NoticeWe can change the terms of this notice at any time. The new notice will be available upon request, in our office, and on our website.
Effective Date: June 3, 2026
For more information or to file a complaint, contact:Privacy Official Church Street Chiropractic 601 Quail Valley Drive, Suite 109 Georgetown, Texas 78626 Phone: (512) 864-7722
