Balanced Body Soft Tissue & Spine | Ankeny, Iowa Chiropractor Balanced Body Soft Tissue & Spine | Ankeny, Iowa Chiropractor

Privacy Policy



Balanced Body Chiropractic & Wellness LLC  (the “Practice”), in accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, (the “Privacy Rule”) and applicable state law, is committed to protecting the privacy of your protected health information (“PHI”) You have a right to adequate notice of the uses and disclosures that may be made by this medical practice with concern to your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or duties of this practice with respect to your PHI. The Practice understands that information about your health is personal. This Notice explains how your PHI may be used and disclosed to third parties. This Notice also details your rights regarding your PHI. The Practice is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice detailing the Practice’s legal duties and practices with respect to your PHI. The Practice is obligated to notify you promptly if a breach occurs that may have compromised the privacy and security of your PHI. The Practice is also required by law to abide by the terms of this Notice.


Uses & Disclosures of Protected Health Information: Your PHI may be used and disclosed by your physician, our office staff and other outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of your physician’s practice, and any other use required by law.

Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. We may disclose your PHI to doctors, nurses, technicians, clinicians, medical students, hospitals and other health facilities involved in or consulting in your care. We may also disclose information about you to people outside the practice, such as other health care providers involved in providing treatment to you, and to people who may be involved in your care, such as family members, clergy, or others we use to provide services that are part of your care. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: We may need to disclose information about the treatment, procedures or care at our practice provided to you in order to bill and receive payment for services we provided. We may share this information with your insurance company or any third party responsible for payment. We may also need to disclose personal health information about you with your health plan and/or referring physician in order to obtain prior authorization for treatment, to determine whether payment for the treatment is covered by your plan or to facilitate payment of a referring physician.

Healthcare Operations:  In order to help us run our practice more efficiently and provide better patient care, we may use and disclose your personal health information to business entities who need to use or disclose your information to provide a service for our medical practice, such as a billing company or software vendors who provide assistance with data management on our behalf.

Other Use & Disclosures That Are Required Or Permitted By Law

The Practice may also use and disclose your PHI without your consent or authorization in the following instances:

  • Required by Law: We will disclose medical information related to you if required to do so by state, federal or local law.
  • Public Health Activities/Risks: Your medical information may be disclosed to a public health authority that is authorized by law to collect or receive such information for public health activities. Certain disclosures may be made for public health activities in the following circumstances:
  • to prevent or control disease, injury or disability;
  • to report of births or deaths;
  • to report child, elder or dependent adult abuse or neglect;
  • to report reactions to medications or product defects;
  • notify individuals of product recalls;
  • to notify a person who may have been exposed to a communicable disease or at risk of contracting or spreading a disease or condition;
  • if our practice reasonably believes a person is the victim of abuse, neglect, or domestic violence, we may disclose personal health information to the appropriate authority. We will only make this disclosure if you agree to the disclosure or we are required or authorized to do so by law without your permission.
  • Appointment Reminders or Treatment Alternatives: Our practice may use and disclose medical information about you to provide you with reminders that you are due for care, to inform you of an upcoming appointment or to follow up on missed or cancelled appointments by mail or telephone. We may also wish to provide you with information on treatment alternatives or other health related benefits that may be of interest to you.
  • To Avert Serious Threat to Health or Safety: We will use and disclose your PHI when we have a “duty to report” under state or federal law because we believe that it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to help prevent a threat.
  • Worker’s Compensation: We may disclose your PHI to the extent necessary to comply with worker’s compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.
  • Health Oversight Activities: Your personal health information may be disclosed to federal, state or local authorities as part of an investigation or government activity authorized by law. This may include audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions or other activities necessary for the oversight of the health care system, government benefit programs and compliance with government regulatory programs or civil rights laws.
  • Law Enforcement: We may disclose your personal health information to law enforcement individuals if we are required to do so by law. We may also disclose medical information about you in compliance with a court order, warrant or subpoena or summons issued by the court. We will make best efforts to contact you about these types of requests so that you can obtain an order restricting or prohibiting disclosure of the information requested. We may also use such information to defend ourselves in actions or threatened actions that may be brought against our practice.
  • Individuals Involved in Your Care or Payment for Your Care: We may disclose to a family member, other relative, a close friend, or any other person identified by you certain limited PHI that is directly related to that person’s involvement with your care or payment for your care. We may use or disclose your PHI to notify those persons of your location or general condition. This includes in the event of your death unless you have specifically instructed us otherwise. If you are unable to specifically agree or object, we may use our best judgment when communicating with your family and others.
  • Disaster Relief: We also may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts. This will be done to coordinate information with those organizations in notifying a family member, other relative, close friend or other individual of your location and general condition.
  • De-identified Information: The Practice may use and disclose health information that may be related to your care but does not identify you and cannot be used to identify you.
  • Business Associate: The Practice may use and disclose PHI to one or more of its business associates 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 that assists the office in submitting claims for payment to insurance companies.
  • Personal Representative: The Practice may use and disclose PHI to a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
  • Emergency Situations: The Practice may use and disclose PHI for the purpose of obtaining or rendering emergency treatment to you provided that the Practice attempts to obtain your Consent as soon as possible: The Practice may also use and disclose PHI 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.
  • Judicial and Administrative Proceedings: We may disclose your PHI in response to a court or administrative order. We also may disclose information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.
  • Coroners, Medical Examiners and Funeral Directors: We may disclose your PHI to a coroner or medical examiner for purposes such as identifying a deceased person and determining cause of death. We also may disclose information to funeral directors so they can carry out their duties.
  • Organ, Eye or Tissue Donation: To facilitate organ, eye or tissue donation and transplantation, we may disclose your PHI to organizations that handle organ procurement, banking or transplantation.
  • Special Government Functions: If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release information about foreign military authority. We may disclose information about you to authorized federal officials for intelligence, counter-intelligence and other national security activities authorized by law.
  • Research: We may use and/or disclose your PHI for research projects that are subject to a special review process. If researchers are allowed access to information that identifies who you are, we will ask for your permission.
  • Fundraising: We may contact you with respect to fundraising campaigns. If you do not wish to be contacted for fundraising campaigns, please notify our Privacy Officer in writing.

Other uses and disclosures will be made only with your written authorization and you may revoke your authorization at any time.


The following uses and/or disclosures specifically require your express written permission:

  • Marketing Purposes – We will not use or disclose your PHI for marketing purposes for which we have accepted payment without your express written permission. However, we may contact you with information about products, services or treatment alternatives directly related to your treatment and care.
  • Sale of Health Information – We will not sell your PHI without your written authorization. If you do authorize such a sale, the authorization will disclose that we will receive compensation for the information that you have authorized us to sell.  You have the right to revoke the authorization at any time, which will halt any future sale.

Uses and/or disclosures other than those described in this Notice will be made only with your written authorization.  If you do authorize a use and/or disclosure, you have the right to revoke that authorization at any time by submitting a revocation in writing to our Privacy Officer.  However, revocation cannot be retroactive and will only impact uses and/or disclosures after the date of revocation.

Patient Rights
You have the following rights with respect to your personal health information:

Right to Revoke Authorization: You have the right to revoke any Authorization or consent you have given to the Practice, at any time. To request a revocation, you must submit a written request to the Practice’s Privacy Officer.

Right to Receive Confidential Communications: You have the right to receive confidential communications of your PHI by alternate means or locations. For example, if you would like for us only to communicate with you at home, and never at your work, you may request this of our practice. You must make this request in writing but do not need to disclose the reason for your request. Please be specific as to how or where you wish us to communicate with you. We will attempt to accommodate all reasonable requests.

Right to Inspect and Copy: You have the right to inspect and request copies of your information.

Under federal law, however you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health care information that is subject to law that prohibits access to protected health information.

To inspect or copy your information, you may either complete an Authorization to Release/Obtain Information form or write a letter of request, stating the type of information to be released, the date(s) of service being requested, the purpose of the request, and whether you wish to review the record or receive copies of the requested information in your preferred format.  We will abide by your request in the format you have requested, if we are able to do so.  If we cannot provide your records to you in the requested format, we will attempt to provide them in an alternative format that you agree to.  You may also request that your records be sent to another person that you have designated in writing.  Direct this request to the Practice’s Privacy Officer. You may be charged a fee for the cost of copying, mailing or other expenses related with your request.

We may deny your request to inspect and copy information in a few limited situations. If you request is denied, you may ask for our decision to be reviewed. The Practice will choose a licensed health care professional to review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of that review.

Right to Amend. If you think there is information in your record that may be inaccurate or incomplete, you have the right to request an amendment or clarification of information in your record. Your request to make an amendment to your record must include the following and may be refused if the following elements are not met:
1) Submit your request in writing
2) Describe what you would like the amendment to say and your reasoning for why the change should be made
3) The amendment must be dated, signed by you and notarized
We may deny your request for an amendment if it is not in writing or does not include a reason for wanting the amendment. We also may deny your request if the information: a) was not created by us, unless the person or entity that created the information is no longer available to amend the information, b) is not part of the information maintained by the Practice, c) is not information that you would be permitted to inspect and copy or d) is accurate and complete.

If your request is granted the Practice will make the appropriate changes and inform you and others, as needed or required. If we deny your request, we will explain the denial in writing to you and explain any further steps you may wish to take. We reserve the right to deny your request if we have reason to believe the information is accurate.

Right to Restrict Uses and Disclosures. You have the right to request restrictions on how our practice makes certain uses and disclosures of your PHI for treatment, payment or healthcare operations. You may also request that we limit the information we may provide to family members or your friend(s) regarding your treatment or payment for your care. You also have the right to restrict disclosure of information to your commercial health insurance plan regarding services or products that you paid for in full, out-of-pocket, and we will abide by that request unless we are legally obligated to do otherwise. You may restrict certain types of marketing materials related to your care or treatment.

We are not required to agree to your request or we may not be able to comply with your request, but we will do all that we can to accommodate your request. If we agree, we will follow your request unless the information is needed to a) give you emergency treatment, b) report to the Department of Health and Human Services, or c) the disclosure is described in the “Uses and Disclosures That Are Required or Permitted by Law” section. Your request must be in writing and include the following:
1) what information you would like to limit
2) whether you want to limit our use, or disclosure or both
3) to whom you want the limits to apply (e.g., disclosures to parents, children, spouse, etc.)

Either you or we can terminate restrictions at a later date.

Right to an Accounting of Uses and Disclosures. You have the right to request an accounting of disclosures. This is a list of certain disclosures we have made regarding your PHI. To request an accounting of disclosures, you must write to the Practice’s Privacy Officer. Your request must state a time period for the disclosures. The time period may be for up to six years prior to the date on which you request the list, but may not include disclosures made before April 14, 2003.

There is no charge for the first list we provide to you in any 12-month period. For additional lists, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost in advance. You may withdraw or change your request to avoid or reduce the fee.

Certain types of disclosures are not included in such an accounting. These include disclosures made for treatment, payment or healthcare operations; disclosures made to you or for our facility directory; disclosures made with your authorization; disclosures for national security or intelligence purposes or to correctional institutions or law enforcement officials in some circumstances. All requests should be submitted to the reception desk for appropriate processing.

Right to Copy of Notice. You have the right to obtain a paper copy of this Notice of Privacy Practices upon request at any time, even if you have agreed to receive this Notice electronically. Please call us at 515-963-1641 for a copy or ask for a copy at the reception desk.

Practice Contact. If you would like more information about this Notice, please contact Dr. Hommer by telephone at 515-963-1641 or at 301 NE Trilein Dr Suite 2 Ankeny, IA 50021. If you have any complaints regarding our privacy practices, please address your complaint to Dr. Hommer in writing and follow the designated complaint process below.

Complaints. If you believe your privacy rights may have been violated or you become aware of a privacy concern you would like to report to our practice, please follow this complaint process:

  1. Send a written letter to the practice contact named above, including the following information:
    1. Name and Address
    2. Social Security Number or Patient Identification Number
    3. Detailed description of the circumstances surrounding your complaint including dates, times and any relevant information to help us understand your complaint
    4. Contact Information
    5. Signature and Date
  2. Please allow fourteen (14) business days for an answer from our practice regarding your complaint.
  3. If you are not satisfied with our response to your complaint, you may notify the Secretary of the Department of Health and Human Services; you may write to: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, DC 20201. All complaints must be in writing.

We encourage your feedback and we will not retaliate against you in any way for the filing of a complaint. The Practice reserves the right to change this Notice and make the revised Notice effective for all health information that we had at the time, and any information we create or receive in the future. We will distribute any revised Notice to you prior to implementation.