Notice of Privacy Practices

Kocken Chiropractic, LLC 920 Main Ave Ste B, De Pere, WI 54115 Phone: 920‑336‑2822 

Effective Date: February 2026

Your Information. Your Rights. Our Responsibilities.

This notice explains how your medical information may be used and disclosed, and how you can access it. Please review it carefully.

Your Rights

You have the right to:

Get an electronic or paper copy of your medical record

• You may ask to view or obtain a copy of your medical record or other health information.
• We may charge a reasonable, cost‑based fee for copies.

Ask us to correct your record

• You may request corrections if your information is incorrect or incomplete.
• We may deny a request, but we will explain the reason in writing within 60 days.

Request confidential communications

• You may ask us to contact you in a specific way (for example, a different phone number or address).
• We will approve all reasonable requests.

Ask us to limit what we use or share

• You may request that we not use or disclose certain health information for treatment, payment, or operations. We are not required to agree.
• If you pay for a service out-of-pocket and in full, you may request that we not share that information with your insurer. We must honor this unless a law requires disclosure.

Get a list of those with whom we’ve shared information

• You may request an accounting of disclosures for the previous six years.
• This excludes routine disclosures for treatment, payment, or operations.

Get a copy of this notice

• You may request a paper copy at any time, even if you received it electronically.

Choose someone to act for you

• If you have a medical power of attorney or legal guardian, that person may exercise your rights.

File a complaint if you feel your rights are violated

• Contact us at 920‑336‑2822.
• File a complaint with the Office for Civil Rights at www.hhs.gov/ocr/privacy/hipaa/complaints.
• We will not retaliate against you.

Your Choices

For certain information, you may tell us your preferences regarding what we share.

You may choose to allow us to:

• Share information with family, close friends, or others involved in your care.
• Share information during disaster relief efforts.
• Include your information in a facility directory.

If you cannot express your preference (for example, you are unconscious), we may share information if it is in your best interest or necessary to prevent serious harm.

We will never share your information without written authorization for:

• Marketing
• Sale of your information
• Most psychotherapy notes

Fundraising

• We may contact you for fundraising, but you may opt out at any time.

Our Uses and Disclosures

We typically share health information for:

Treatment

• We share information with other providers involved in your care.

Operations

• We use information to run our practice, improve services, and manage care.

Billing and Payment

• We share information with your health plan to process claims.

Other Uses and Disclosures

We may share information when required by law or for public benefit.

Public Health & Safety

We may share information to:

• Prevent disease
• Report adverse medication reactions
• Report suspected abuse, neglect, or domestic violence
• Prevent or reduce threats to health or safety

Research

We may share information for approved research projects.

Compliance With the Law

We must share information if required by federal or state law, including audits or investigations by HHS.

Organ and Tissue Donation

We may share information with procurement organizations.

Medical Examiners and Funeral Directors

We may release information to assist with identification, cause of death, or other duties.

Workers’ Compensation, Law Enforcement, and Government Requests

We may share information:

• For workers’ compensation claims
• With law enforcement when legally required
• With health oversight agencies
• For national security or protective services

Lawsuits and Legal Actions

We may share information in response to a court order, subpoena, or administrative request.

Sensitive Information Protections

Some types of information are protected by stricter laws, including:

• Reproductive health information
• HIV/AIDS‑related information
• Mental health treatment information
• Genetic information
• Substance Use Disorder records under 42 CFR Part 2

When these stricter rules apply, we follow the law that provides the highest level of protection.

Our Responsibilities

We are required to:

• Maintain the privacy and security of your protected health information.
• Notify you promptly if a breach occurs.
• Follow the duties described in this notice.
• Only use or disclose your information when permitted by law or when you authorize it.

Changes to This Notice

We may update this Notice at any time. Updated copies will be available in our office and on our website.

Acknowledgment of Receipt

You will be asked to sign a form stating that you received this Notice.

CHANGES TO THE TERMS OF THIS NOTICE 

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.