HIPAA Notice of Privacy Practices

Mitchell Clinic

Effective Date: 7/22/2026

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.

Mitchell Clinic (“the Practice”) is committed to maintaining the privacy of your protected health information (“PHI”), which includes information about your health condition and the care and treatment you receive from the Practice. The creation of a record detailing the care and services you receive helps this office to provide you with quality health care. This Notice details how your PHI may be used and disclosed to third parties. This Notice also details your rights regarding your PHI. The privacy of PHI in patient files will be protected when the files are taken to and from the Practice by placing the files in a box or brief case and kept within the custody of a doctor or employee of the Practice authorized to remove the files from the Practice’s office.

No Consent Required

The Practice may use and/or disclose your PHI for the purposes of:

  • Treatment – In order to provide you with the health care you require, the Practice will provide your PHI to those health care professionals, whether on the Practice’s staff or not, directly involved in your care so that they may understand your health condition and needs.
  • Payment – In order to get paid for services provided to you, the Practice will provide your PHI, directly or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements.
  • Health Care Operations – In order for the Practice to operate in accordance with applicable law and insurance requirements and in order for the Practice to continue to provide quality and efficient care, it may be necessary for the Practice to compile, use and/or disclose your PHI.

The Practice may use and/or disclose your PHI, without a written Consent from you, in the following additional instances:

  • De-identified Information – Information that does not identify you and, even without your name, cannot be used to identify you.
  • Business Associate – To a business associate if the Practice obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists the Practice in undertaking some essential function, such as a billing company, or a scheduling/patient-communications platform (such as ChiroUp or Aloha) that assists the office in submitting claims for payment or communicating with patients.
  • Personal Representative – To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
  • Emergency Situations – (i) for the purpose of obtaining or rendering emergency treatment to you provided that the Practice attempts to obtain your Consent as soon as possible; or (ii) to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating your care with such entities in an emergency situation.
  • Communication Barriers – If, due to substantial communication barriers or inability to communicate, the Practice has been unable to obtain your Consent and the Practice determines, in the exercise of its professional judgment, that your Consent to receive treatment is clearly inferred from the circumstances.
  • Public Health Activities – Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease and that does not identify you and, even without your name, cannot be used to identify you.
  • Abuse, Neglect or Domestic Violence – To a government authority if the Practice is required by law to make such disclosure. If the Practice is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm.
  • Health Oversight Activities – Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community’s health care system.
  • Judicial and Administrative Proceeding – For example, the Practice may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
  • Law Enforcement Purposes – In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or, the Practice may disclose your PHI if the Practice believes that your death was the result of criminal conduct.
  • Coroner or Medical Examiner – The Practice may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.
  • Organ, Eye or Tissue Donation – If you are an organ donor, the Practice may disclose your PHI to the entity to whom you have agreed to donate your organs.
  • Research – If the Practice is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect your privacy, and typically involves information that does not identify you and, even without your name, cannot be used to identify you.
  • Avert a Threat to Health or Safety – The Practice may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
  • Workers’ Compensation – If you are involved in a Workers’ Compensation claim, the Practice may be required to disclose your PHI to an individual or entity that is part of the Workers’ Compensation system.

Appointment Reminders

  • Your health care provider or a staff member may disclose your health information to contact you to provide appointment reminders — including by phone, text message (SMS, currently via our platform Aloha), or other means. If you are not available to receive a reminder call, a message may be left on your answering machine, voice mail, or with the person who answers the call.
  • You have the right to refuse authorization for us to contact you to provide appointment reminders, or to request we use a specific method (for example, phone call instead of text message). If you refuse authorization, it will not affect the treatment we provide to you. To make this request, contact our office at the phone number or email below.

Sign-in Log

This Practice maintains a sign-in log for individuals seeking care and treatment in the office. This sign-in sheet is located in a position where staff can readily see who is seeking care in the office, as well as the individual’s location within the Practice’s office suite. This information may be seen by, and is accessible to, others who are seeking care or services in the Practice’s offices.

Family/Friends

The Practice may disclose to your family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person’s involvement with your care or the payment for your care, unless you direct the Practice to the contrary. The Practice may also use or disclose your PHI to notify or assist in the notification (including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition, or death. In both cases, the following conditions apply:

  • If you are present at or prior to the use or disclosure of your PHI, the Practice may use or disclose your PHI if you agree, or if the Practice can reasonably infer from the circumstances, based on the exercise of its professional judgment, that you do not object to the use or disclosure.
  • If you are not present, the Practice will, in the exercise of professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person’s involvement with your care.

Authorization

Uses and/or disclosures, other than those described above, will be made only with your written Authorization. You may revoke your authorization to us at any time; however, your revocation must be in writing.

Restrictions

You may request restrictions on certain use and/or disclosure of your PHI as provided by law. However, the Practice is not obligated to agree to any requested restriction. To request a restriction, submit a written request to the Practice’s Privacy Officer specifying what information you want to limit, whether you want to limit use, disclosure, or both, and to whom the limits should apply. If the Practice agrees to your request, it will comply unless the information is needed to provide you with emergency treatment.

Your Rights

You have the right to:

  • Inspect and obtain a copy of your PHI as provided by 45 CFR 164.524. The Practice may charge a reasonable fee for the cost of copying, mailing, or other supplies associated with your request.
  • Receive confidential communications of PHI by alternative means or at alternative locations. You must make this request in writing; the Practice will accommodate all reasonable requests.
  • Prohibit reporting of any test, examination, or treatment to your health plan or anyone else for which you pay in cash or by credit card.
  • Receive an accounting of disclosures of your PHI as provided by 45 CFR 164.528.
  • Receive a paper copy of this Notice from the Practice upon request.
  • Request copies of your PHI in electronic format if the office maintains your records in that format.
  • Amend your PHI as provided by 45 CFR 164.528, by submitting a written request with a supporting reason to the Practice’s Privacy Officer. The Practice may deny the request under certain circumstances described in applicable law; if denied, you have the right to submit a written statement of disagreement.
  • Receive notice of any breach of confidentiality of your PHI by the Practice.
  • File a complaint with the Practice or with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201, (202) 619-0257, email: ocrmail@hhs.gov, if you believe your privacy rights have been violated. All complaints to the Practice must be in writing. The Practice will not retaliate against you for filing a complaint.

The Practice’s Responsibilities

The Practice:

  • Is required by federal law to maintain the privacy of your PHI and to provide you with this Notice detailing the Practice’s legal duties and privacy practices with respect to your PHI.
  • Is required to abide by the terms of this Notice.
  • Reserves the right to change the terms of this Notice and to make the new provisions effective for all PHI it maintains.
  • Will make any revised Notice available to patients prior to implementation, including by posting the updated Notice on this website.
  • Will not retaliate against you for filing a complaint.

How to Reach Our Privacy Officer

To exercise any of the rights described in this Notice, to request a paper copy of this Notice, or to file a complaint, please contact our office:

  • Mitchell Clinic — Attn: Privacy Officer
  • 119 E Springfield St, St James, MO 65559
  • Phone: 573-265-0310
  • Email: office@mitchellclinic.com