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Alpine Chiropra cti c Center
Norman Fuller, D.C., P.C., Jason Pepperd, D.C., L.L.C.
833 Commercial Drive, Wasilla, Alaska, 99654
Phone: (907) 376-2475 Fax: (907) 373-5154
THIS NOTICE DESCRIBES HOW CHIROPRACTIC AND MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In the course of your care as a patient at Alpine Chiropractic Center we may use or disclose personal
and health related information about you in the following ways:
* Your personal health information, including your clinical records, may be disclosed to another health
care provider or hospital if it is necessary to refer you for further diagnosis, assessment or treatment.
* Your health care records as well as your billing records may be disclosed to another party, such as an
insurance carrier, an HMP, a PPO, or your employer (if they are or maybe responsible for the payment
of your services).
* Your name, address, phone number, and your health care records may be used to contact you
regarding appointment reminders, information about alternatives to your present care, or other health
related information that may be of interest to you.
If you are not at home to receive an appointment reminder, a message may be left on your answering
machine. Further, you have the right to inspect or obtain a copy of the information we will use for these
purposes. You also have the right to refuse to provide authorization for this office to contact you
regarding these matters. If you do not provide us with this authorization it will not affect the care
provided to you or the reimbursement avenues associated with your care.
Under federal law, we are also permitted or required to use or disclose your health information without
your consent or authorization in these following circumstances:
* If we are providing health care services to you based on the orders of another health care
* If we provide health care