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DrBatch@aol.com <--click to send e-mail Pictured above, Dr. Daniel C. Batchelor during a recent CNN nationwide interview as he discusses "Chiropractic Sports Medicine". Dr. Batchelor was recognized as the South's foremost expert on the "Prevention and Rehabilitation of Musculo-Skeletal Imbalance" and "The Non-Surgical Correction of Back Pain". Personal: single, 6'1" 170, born in Michigan. Resident of Georgia since 1977 After graduating with honors and receiving his doctorate, Dr. Batchelor founded the Batchelor Clinic of Roswell, Georgia. Since 1980, Dr. Batchelor has been treating all types of injuries including auto accidents, on the job injury, sports injury, etc. Dr Batchelor's reputation has grown far and wide with many patients traveling from other states including Florida, North and South Carolina, Alabama, and Tennessee. Patients can call to make an appointment and be treated the same day. If you need information on hotel accomodations, please call our front desk at 770-992-2002.
CHRONIC AND ACUTE PAIN RELIEF If you have been injured in the car, on the job, at home, or play, or just have a discomfort unrelated to injury and just simply feel like your body needs an overall tune up, we can help. Dr. Batchelor has successfully treated over 100,000 patients over the past 23 years using a variety of techniques for a variety of conditions. After Dr. Batchelor graduated with honors and received his doctorate in 1980, he continued to excel as a doctor and as an athlete. He is presently the #1 ranked mountain bike masters duathlete in Atlanta. Winner of over 350 roadraces, Dr. Batchelor has run over 60,000 miles. He has been a guest lecturer at many major marathons and universities. At the Batchelor Clinic, we understand your desire to have pain eliminated from your life. That's why we take special care to treat the cause of your pain, rather than just its symptoms. Be the best you can, Let the doctor who practices what he preaches show you how.
Putting off care may prevent proper healing from taking place. There are many alternatives to surgery and it is our goal to seek the cause, treat the cause and prevent the cause of your symptoms from returning.
Our goal is to provide care in an efficient and timely manner. We pride ourselves in keeping patient waiting time to an extreme minimum. Please do not rush or become stressed in trying to keep your appointment. If you cannot make your scheduled appointment time we will be happy to see you the day of your appointment with no problem. If you cannot make your appointment the day it is scheduled, please call the day before or the day of to prevent a missed appointment charge. Due to the public demands upon the office and our time, it is our policy to release from care all patients who miss 2 appointments without notifying the office beforehand. If you do not have an appointment and with to visit us that day please call before you come. Staff and Doctor may be out of town at educational seminars etc. so if you need immediate care we can accomodate you but please make sure the doctor is in before traveling. Our fee schedule is in keeping with the reasonable and customary fees of Georgia insurance companies. We are members of many managed care groups ( PPO, HMO )(usually only a $10 copay) throughout the country. Our office offers a number of payment plans for families, and well patient care. Personal injury cases are accepted. New Patients are accepted daily Dr. Dan Batchelor also has a brother that is a Doctor of Chiropractic. Dr. Brad Batchelor has an office in Boone, N.C. Dr. Brad Batchelor has 25 years of experience in the area of acupuncture. The greatest compliment is for our patients to refer their friends and relatives. As you experience the benefits of Chiropractic you will want to share this knowledge with your friends. Our office is full of research and pamphlets and holds a Patient Workshop (class) twice per month. We welcome your interest.
Seen above are "before and after" X-rays of a professional golfer that we treated for lower back pain. As a result of the correction, he has no lower back pain and is able to reach his athletic potential without restrictions. We accept referrals from many medical doctors, allied health practitioners, and other Doctors of Chiropractic. If possible, bring x-rays, physical reports and any information pertaining to your problem. It is not required, but helpful.
Dr. Dan Batchelor's other accomplishments: Winner of over three hundred and fifty 5k and 10k roadraces 5k PR 14:59 10k PR 32:28 Half Marathon PR 1:13 Marathon PR 2:39 Triathlete and the #1 overall ranked mountain bike masters duathlete(run, bike, run) in Atlanta from 1996-2003.. Consulted for Runners World, Running in Georgia, Run and See Georgia, Running Journal, and The Georgia Runner magazines. Monthly columnist on Sports Medicine for several fitness magazines and has spoken to dozens of clubs and lectured to many medical colleges on Sports Medicine. Expert witness for testifying in court in regards to "injuries sustained in automobile injuries" Performed as a dancer in the Opening Ceremonies of the 1996 Olympic Games in Atlanta. Race Director- 2000 Willie Nelson 5k Roadrace
Dr Batchelor races a 2003 Trek Fuel 100 Carbon full suspension mountain bike. He was a member of the Eco-Challenge Adventure Racing Team that competed in the Santa Monica Mountains of California. The 5 day "extreme" event involved running, hiking, mountain biking, climbing, rapelling, and kayaking with only 2 hours of sleep allowed each night.
Dr. Batchelor has run over 60,000 miles and has treated over 100,000 patients including many beginning as well as Olympic athletes from all over the world. Patients include John Tuttle-Olympic Marathoner, Keith Brantley-Olympic Marathoner, World Class runners- Katie Schilly and Linda Mclennan, Marcos Barreto-World Class 5k runner from Mexico, Craig Virgin- World Cross Country Champion and winner of the Peachtree Roadrace several times, Kelly Jenson-Olympic Steeplechaser, including Falcon football players, members of the World Softball Championship team, professional hockey players, Olympic Soccer players, etc, etc Recent invited quest speaker for the Huntsville Rocket City Marathon(voted as one of the top 10 marathons in the USA by Runners World). Guest speaker for the Chattahoochee Road Runners, Joints in Motion training team, Macon Track Club, Rome Track Club, Roswell Track Club, Mercer College of Medicine, Americus Track Club, etc etc. Member Atlanta Track Club Top 20 Masters runners at Peachtree Roadrace DrBatch@aol.com <--click here to send Dr. Batchelor an e-mail.
Below are a few of the over 850 articles written by Dr. Batchelor for various fitness magazines and medical journals: Articles: A GOOD BEATING By Dr Daniel C. Batchelor I dont know about you but I need a good beating at least once per day. A good beating keeps me feeling in tip top shape. If it werent for my beatings, I would feel stagnant and less than whole. I get a good beating by pushing my body moderate to hard. When my heart beats 60%-80% of its max. heart rate is when I feel my best. That means that according to my age and fitness level, my training heart rate should beat 106-142 times per minute. Long after that beating, I continue to feel the benefits of increased circulation, increased energy and that not so fresh feeling is a a thing of the past. I get my beatings everyday either at noon or after work. These beatings have become a part of me and if I dont receive them, I feel less than I could be. A good beating is recommended by the surgeon general. I get a good beating while riding a bike, swimming in a pool, and/or running. The only great beating that I get, however, is when I run. Everyone needs a good beating. Some need it more than others. Computer programmers, secretarys, CPAs, fitness magzine publishers, and even Doctors of Chiropractic need these beatings. Even my German Shephard and his unrelated Shoberwieller(shephard, doberman, rottweiller) brother needs a good beating. If they dont get a good heart beating at least once per day, I can see the tenseness in their faces and sense it in their mood. After a good beating, their faces are relaxed, they are happier and they sleep like logs. The same with humans. Many people live a life never appreciating what a good beating can do. I know several people that do not appreciate a good beating either because they tried it once or twice but disliked it because it made them tired and sore afterwards. They did not realize that frequent gentle beatings were necessary in the beginning before anyone can reap the benefits of a really good hard beating. What do these beatings actually do physiologically and why do we like these beatings so? Beatings increase the number of capillaries that supply your muscles. A good beating produces endorphins that dull pain, combat mental and physical stress, and allow you to receive that runners high occasionally. Several good beatings over a period of time improves your ability to take in oxygen and with more oxygen present, you will not be forced to produce lactic acid which inhibitis muscular contraction. Several long beatings at moderate effort trains your body to burn fat instead of carbos. This is good because the fewer carbos you burn, the less lactic acid you produce. When the heart beats strong and hard, like any other muscle of the body, it becomes stronger and more efficient. More blood volume is pumped per stoke and you dont have to strain yourself any longer performing tasks that would otherwise wear you out. If you are similar to me, you can tell when its time for a good beating. When I have been motionless while sitting in front of a computer or sitting on an airplane or sitting in a meeting or taking a long road trip, I feel the need for a really good beating. Have you had your beating today?
CHIROPRACTIC SPORTS MEDICINE QUESTIONS AND ANSWERS
To Dr. Batchelor from Robert Mosher,, I am 53 years old, and in pretty good shape except for the fact that I have suffered from sciatica for the past 4 years. The pain starts at the center of my lower back and radiates down my left leg to my toes. It feels similar to an electrical current in addition to pain. I can run but cannot stride out very far without the pain hurting me while I run. I would not even think about trying to run intervals very fast. The hamstring muscle feels like it would probably rip if I tried running fast. I want to run the Atlanta Marathon this year but unless my sciatica gets better I dont think I will be able to do it. I have taken a host of pain killers, muscle relaxants, and anti-inflammatory drugs and have had no benefit from any of them. I have never been one to take drugs but I used them as a last resort hoping they would do the trick. I have been to a physical therapist, orthopedic surgeon, and massage therapist. Two of them, after failing to help me, suggested that I go to a chiropractor. Since you have been around the running community more than any other doctor that I know of, I thought you might be able to help. You may not remember but I met you at Hearttrek last year. I was the guy that asked you if you made orthotics for my size 14 1/2 shoe. Because I am in Covington and I work over 60 hours a week, I am not able to come to your clinic. Do you feel that chiropractic can help this condition and do you have any suggestions on what my next step should be? Robert Mosher Covington, Georgia To Robert from Dr. Batchelor, Lower back pain sends more people to doctors offices than any other ailment. One kind of back disorder that may strike, especially in middle age, is sciatica, so called because it involves the sciatic nerve. This is actually a group of nerves(the bodys longest) bound in one nerve sheath, which runs from the lower back through the buttock and thigh to the knee(where it branches) on down into the foot. Thus, besides pain deep in the buttock, an irritated sciatic nerve may also produce pain in the thigh that may radiate all the way down to the feet. Weakness and numbness in the legs are other common symptoms. The end of the spinal cord, called the cauda equina, branches into nerve roots along the lower backbone. Four of these roots thread through the pelvis and merge to form the sciatic nerves that extend down each leg. Runners with sciatica have great difficulty trying to take long strides when they run. This is because extending the leg stretches the sciatic nerve. When the nerve is irritated or swollen, any action that compresses or stretches it will cause great pain. Though sciatica often affects people in their fifties, its not age that causes it but a complex of other factors: work that requires repetitive lifting, or constant exposure to mechanical vibrations(for example, long hours behind the wheel of a car or truck), running on concrete or asphalt, etc., etc. The pain of sciatica has various causes. Herniated disks can cause sciatica. Disks are the fibrous padding between the vertebrae; when a disk herniates, it bulges and can press on the sciatic nerve. The piriformis muscle in the buttocks-the muscle that allows you to lift your leg sideways can press on the sciatic nerve. Vertebrae rotated out of their normal position can compress or irritate the sciatic nerve. Degeneration of discs can reduce the normal spacing between two vertebrae and allow the nerve that exits between the vertebrae to become compressed or irritated. The most effective treatment for sciatica involves chiropractic adjusting, manipulation, physiotherapy, specific exercise, and modification of activities. I suggest that you contact a sports injuries chiropractor if you want relief and correction of your condition. Chiropractic does not involve surgery or drugs.
MAKING FRIENDS WITH PAIN By Dr Daniel C. Batchelor My father is 75 years old and he travels the country competing in softball tournaments designed for those over 65 of age. Last year his team won the world championship that involved hundreds of leagues from the entire planet. Over the past 63 years my father has had every softball injury imaginable including shoulder pain, neck pain, lower back pain, knee pain, foot pain, etc etc. During the game, however, all of his pain mysteriously vanishes. His mind becomes so enthralled with the game that he feels as though his body has been replaced with a younger newer version that functions with efficiency and precision. After the game, however, on the way home, all of his pain once again returns and he must modiy his range of motion to prevent the discomfort. Last year during a softball tournament in Fort Meyers Florida my father was running from first base to second base at a high rate of speed. As he slid into second base, the second basement and he collided and my father was knocked unconscious. After 3 minutes of lying on the ground and appearing dead, my father woke from the state of unconsciousness. Without hesitation, he stoodup while maintaining his keen interest in the present game and immediatley prepared for his next run to third base. A cheer from the crowd gave his teammates goosebumps. What type of commercial pain killer does my father use during the game of softall. The answer is none.The mind provides us many powerful natural painkillers. Endorphins are naturally produced opiates known as endogenous opoid peptides. They are produced by the pituatary gland and act similiar to morphine dulling our central nervous systems response to pain. What about the mental aspect of pain, not just physical pain from injury but the pain of exertion. What can we do to become friends with the pain of the effort associated with a hard 10 mile run. One world class Triathlete female was asked what techniques she used during her hard training days to deal with the pain of effort, I think of sex and Haagan Daaz ice cream, was her response. Once you realize that the pain of effort is not going to kill you, the urge to slow down or stop becomes less urgent. Becoming familiar with pain will cause a gradual acclimatization with it. On a hot day in Atlanta during a hot hilly long hard workout, I let my mind take a trip to a cool place in the mountains. I let my body run on autopilot while my mind goes somewhere else. Another technique is to let your mind and body relax during a long hard run. I try to gently concentrate on form and efficiency. Where are my arms, where are my feet, how can i achieve maximum alignment and efficiency by altering their positions so slightly. If you do not practice dealing with pain while training then do not expect to learn to deal with pain when the next race comes to town. If you would like Dr. Batchelor to speak to your club or race, feel free to call or write. Call Dr. Batchelor at 770-992-2002 or write with questions on sports medicine. Dr Daniel C. Batchelor 270 South Atlanta st, Roswell, GA 30075
Golf and Running By Dr. Daniel C. Batchelor Question submitted To Dr Batchelor from Howard Royer via E-mail, I have been a runner and a golfer for the past 21 years. I believe that either running or golf has caused my back to become weakened recently but I am not sure. I have had lower back pain for several years but lately I have increased my weekly mileage and have been playing more golf. The recent symptoms that I have involve pain at the bottom of my lower back and pain down my right leg. My family doctor said to stop running and playing golf but that is not something that I am willing to accept. I have seen you for many years at local races and on the dog hikes at Red Top mountain and I thought that you would be the best man to consult with. I wanted to send an e-mail and then I will call to make an appointment.
To Howard Royer From Dr. Batchelor, Golf is considered a relatively safe sport with few exceptions. One exception, however, occured when a friend of mine, who is also my automobile insurance salesman, was running on the fairway of a local golf course. He did not see the golfer far off on the green as they were preparing to drive the ball as far and as straight as they could. One of the golf balls, after it was hit, bounced one time on the fairway and then smashed directly into his front teeth. The ball knocked one of his teeth out right out of his mouth. He required emergency treatment. The other effects of golf, though not as traumatic as having your teeth smashed out, can be painful and even debilitating. Research shows that amateurs generate up to 80% more peak torque around the lumbar spine than professionals do. Technique is everything. Most injuries occur in the lower back at the L5-S1 area. Amateurs tend to have poor technique in their backswing, resulting in ncreased shearing forces in the low back. Imagine going to the fitness center and only working out one side of your body everyday for years and neglecting the opposite side. Golf tends to create this same type of imbalance. The real problem with the golf swing is that it can compress, rotate and laterally bend the lower spine at the same time are forced into each other and damage can occur. When the golfer uses improper form and arches his back while at the same time sticking out his rear during the swing phase, increased forces are exerted at the lower spine area. Before playing golf, it is mandatory to gently swing the golf club in the opposite direction many times to strengthen the non-dominant muscle groups. Specific exercises designed by the Doctor of Chiropractic are used to strengthen the weak side and to stretch the tight side of the lower back. Physical examination combined with x-ray examination will determine which specific exercises to perform. I would doubt that the running is the sole cause of your back pain. Golf commonly causes the primary imbalance and then running irritates it. Chiropractic is the most effective means of diagnosing and correcting golf related imbalance. My brother Dr Brad Batchelor, a Boone, N.C. chiropractor, corrected my golf related imbalance when I was a caddy several decades ago.
RESTORING FUNCTION By Dr. Daniel C. Batchelor (submitted to DrBatch@aol.com via email), Dear Dr. Batchelor, I am a 51 year old female that has been running consistently for the past 25 years. I am happy with my running and have no major injuries but I do have a few minor ailments that I dont want to become major one day. Here is my first minor ailment. I cannot take as deep of a breath while running as I did a decade ago. It seems like I have to take many smaller breathes compared to one large one. It feels as though my lungs and spine just cannot move as well as they once did. If I could just expand the lungs more, I think I could run much faster and further with less effort. I know something just isnt right with my lung power. Also, I have a minor pain in my right heel under the arch that has been getting progressively worse. It does not hurt that bad but I think if something isnt done, in time, it will affect my runnning style. I asked my family doctor who does not run and he said that I should not be running. Needless to say, I am looking for a new family doctor. I heard about you from some running friends and one of them gave me a magazine with an article in it that you wrote. Can you help me? From Susan Farris-Atlanta To Susan from Dr. Batchelor A loss of maximum lung capacity or the ability to expand your lungs to their maximum capacity can be caused by a thoracic spine(mid back) that has become less flexible over the years. This loss of elasticity or flexibility, decreases the ability of the thoracic spine and rib cage to move properly or fully expand. The thoracic spine just simpy doesnt flex and extend as much as it once did. Simply put, you cant suck in as much air, similar to blowing up a large balloon inside of a small paper bag. Research suggests that between the age of 25-55, there is a 15-20% loss of rib expansion as a result of fibrosis in the area. Thats all fine and dandy but what if you dont want to accept this loss of expansion? Lets first talk about the anatomy of the intervertebral disc. At the age of 25, the nerves and arteries that supply the discs of the spine die off at around the age of 25.. Researchers do not know why this happens, but nevertheless, it does. After the age of 25, it is vital to move the spine as much as possible through all its ranges of motion so as to squeeze out the waste products from the discs between the vertebra and to allow them to absorb in new nutrients. This allows the disc to remain flexible and elastic. If very little motion occurs between the vertebra after age of 25, the disc becomes fibrotic resulting in less flexiblity of the spine. Swimming, yoga, stretching, deep breathing exercises, aerobics, running, walking, etc are things that will enhance the ability of your thoracic spine to remain youthful. If you are over the age of 25, then take this test. Right now as you are sitting there reading this article, take a maximum breath and hold the breath. Do you feel a slight pressure or restriction in the your thoracic(mid back) spine? If you feel this restriction or pressure, then you probably hve some loss of lung capacity and seeking care from a sports medicine chirorpractor is your next logical step. Chiropractic manipulation aimed at improving this elasticity and flexibility is the recommended treatment of choice. Its common for a patient over the age of 25 to come into my clinic with some type of ache or pain and then after a week or so of treatment ask, Does what you are doing make it easier for me to breath, because I have noticed that it is much easier to breath when I run now? Manipulation of the thoracic spine can improve flexibility of the spine and increase the ability of the ribs to expand. Now lets talk about the other end of your body. You mentioned heel pain. The most common condition involving heel pain is a microscopic tearing of the plantar fascia(fibrous band of the arch) where it attaches to your calcaneous(heel) bone. There is a very simply taping procedure to eliminate the pain. This will allow you to train with no discomfort. If the condition has become chronic and you now have a spur, then non-surgical physiotherapy is used by a sports medicine chirorpactor to reduce the sharp spur into a dull spur that doesnt cause pain. In the past, heel pain caused by heel spurs was a difficult thing to treat but now with new recent advances in technology, it is really no big deal. Allowing the body to function at 100% from head to toe without interference is really what health is all about. Adding or taking things away from the body surgically or filling the body with unnatural substances is not the definition of health.
Services Offered: electrical acupuncture prescription custom made lightweight orthotics chiropractic spinal manipulation specific exercise instruction ultrasound massage traction x-ray diagnosis body fat % analysis muscle imbalance correction computerized nutritional evaluation stress fracture diagnosis galvanic current biomechanics evaluation heel spur reduction scoliosis correction back braces and supplies Conditions treated: back and neck pain heel spurs tennis elbow sciatica hamstring pain shoulder and arm pain muscle spasm headaches bunions ankle sprains shin splints groin pain mortons toe TMJ syndrome numbness, tingling chondromalacia-knee pain carpal tunnel syndrome achilles tendonitis plantar fasciitis-arch pain sacro-illiac pain rotator cuff injuries
DrBatch@aol.com---click to send
e-mail
Dr. Batchelor founded D.H.O.G. in December of 1993. Dr. Batchelor founded the Dog Hikers of Georgia in December of 1993. The club meets every Sunday morning at 10am near Red Top Mountain at a special secluded area perfect for dog hiking. (See specific directions to the hike below)..Seen above, Gator and Cameron Batchelor mellow out during a recent dog hike. Gator is a former Seeing Eye Dog and also a former winner of the Atlanta Dog Jog( 1000 dog running race at Piedmont Park in Atlanta where dog runs with owner). Cameron and Dr. Dan are recent winners of the Atlanta Dog Jog. On our dog hikes, we meet on Sunday at 10am near red top mountain at a trail not listed on a map or in a book. The trails are the best around since they follow Lake Allatoona for almost the entire distance. Its a secluded area and the dogs are able to hike, swim, and play for 2 hours without intruding upon other humans. Many dogs come to the hikes including Jack Russels, Dobermans, Whippets, Rottweillers, Golden Retrievers, Collies, Beagles, Pekineese, Labs, Greyhounds, Portugeese Water Dogs, Australian Cattle Herders, etc etc. We have had as many as 67 dogs come on our hikes at one time. Usually, however, there are from 20-30 dogs on each hike. There have been articles on the Dog Hikers with photographs of our members in action in the Atlanta Journal, Marietta Daily Journal, Creative Loafing, Neighbor Papers, Atlanta Sports and Fitness Magazine, Running Journal, Dog Fancy Magazine, and we have been interviewed on local television and local radio stations. Cameron Batchelor was recently on the nationally televised "America's funniest videos" program as he barked and smiled while running on a treadmill. There are absolutely no fees and no dues in any way, shape or form related to the hikes. All that is required is a strong heart and strong legs. Occasionally, we rent a Pontoon boat and take all of the dogs to a secluded island at Lake Lanier or Lake Hartwell for a picnic. We are the only club in the South specifically designed for dog hiking, however, you do not need a dog to hike with us. Many people come and hike without a dog since it is a safe, social way to exercise with other people that enjoy animals..All you need to bring with you during the hike is a water bottle. The hikes involve many hills, therefore you should be in a state of good physical fitness to join us. No children are allowed on the hikes. The pace is moderate(15 minutes per mile walking pace). Directions to the hike- 10am Sunday morning ongoing year long dog hikes near Lake Allatoona Dam: take I-75 north from Marietta and go 20 minutes or so and then turn onto exit 285, Red Top Mountain exit. Follow the signs to the dam and park in the dam parking lot near the Batchelor Clinic van as pictured above. 24 Hour Dog Hiker hotline 770-992-2362 LEGAL NOTICE: Hike at your own risk. We are not responsible for injuries sustained during the hike.
Mountain Bikers of Georgia The Mountain Bikers of Georgia (MBOG) was formed in 1993 by Dr. Dan Batchelor. Every Saturday, Dr. Batchelor meets with local mountain bikers in either the Sope Creek area near the Chattahoochee river or at the Silver Comet trail for 1-2 hours of mountain biking. There are no fees, no dues, and no rules. Call 770-992-2362 for information. Come and join us!!
Call the Batchelor Clinic 24 hours/day 770-992-2002 Insurance Accepted with Little or No Cost to YouHMO/PPO Member 1/2 mile north of the Chattahoochee river on Roswell rd Roswell, Georgia 270 South Atlanta st, Roswell, Georgia 30075DrBatch@aol.com ---click to send e-mail Hope to see you soon!
*Optional: Below is our case history form. Print it out, then fill it out, and when you enter the clinic, present it to our office manager. The doctor will be able to see you immediately. ------------------------------------------------------------------------ Date ____ ____ ____ Name _____________________________________________ Address___________________________________________ City ______________________ State _____Zip______ Home telephone #_______________________________ Birth date_____ ____ ______ Age______ Sex-M/F Marital Status S/M/D/W S. S. # __________ _______ __________ Height__________" Weight__________ Referred by_______________________________Employer_______________________________________________ Occupation___________________________ Office telephone#___________________________________________ Name/Telephone # of nearest relative_______________________________________________________________ Spouses name_______________ __________________________ Spouses S.S # __________ ______ __________ How will you pay today? Cash/Credit card/Check/Insurance co-pay/Workers comp. /Other_______________ **Please give us your insurance card so that we may make a copy of it What is the purpose of todays appointment?__________________________________________________________ If accident, what type? Home/ Auto / Work / Sport / Other___________________________________________ Explain what happened____________________________________________________________________________ If Auto Accident- List name/phone # of attorney_____________________________________________________ Date of Accident____ ____ ____ How did it happen?___________________________________________________ Have you visited our office in the past? Yes/No Date __________ Circle the appropriate location below of your problem areas: Neck/Arm/Elbow/Wrist/Head/MidBack/Rib/Chest/Stomach/LowerBack/Leg/Hip/Knee/Ankle/Foot/Toe Notice of privacy practices. This notice describes how medical info about you may be used and disclosed and how you can get access to this info. Please read carefully. This Notice explains how our office may collect, use and disclose your protected health information. It also explains your rights regarding your protected health information and the steps we take to keep your protected health information secure. "Protected health information" is information about you, including demographic information, that can reasonably be used to identify you and that relates to your past, present or future physical or mental health condition, the provision of care to you or the payment for that care. Our office is required to provide you with this Notice by state and federal law. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards. Our office is legally required to maintain the privacy of protected health information and to follow the privacy practices that are described in this Notice. However, we reserve the right to change the terms of this Notice and our privacy policies at any time. Any changes will apply to all of the protected health information that we maintain, including any information we have created or received prior to issuing any new Notice. When we make an important change to our privacy policies, we will promptly change this Notice and post a new Notice in the office. You may also obtain any new Notice by asking for one at any time. This Notice goes into effect April 14, 2003. Uses And Disclosures Our office uses and discloses your protected health information for different reasons. We may collect and disclose protected health information from you and your other healthcare providers for the purposes of coordinating treatment, payment or operating your health care plan. Treatment: We may use and disclose your protected health information to assist in your diagnosis and treatment. For example, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Payment: We may use and disclose your protected health information in order to bill and collect payment for the treatment and services provided to you. For example, we may provide your protected health information to our billing department and your health plan to get reimbursed for health care services. We may also provide your protected health information to our business associates, such as billing companies, claims processing companies, and others that participate in claims payment process. Health Care Operations: We may use and disclose your protected health information for activities necessary to operate your health care plan including quality management, utilization review, anti-fraud and claims payment, provider credentialing activities, underwriting or determining premiums. We may also collect and disclose your protected health information as required by industry or government regulators such as the state licensing boards and insurance regulatory agencies. Our office may not use or disclose any more of your protected health information than is necessary to accomplish the purpose of the use or disclosure, except for treatment purposes. Signature of patient X____________________________________________________________date___________________ Witness signature_______________________________________________________________date___________________ Doctors signature_______________________________________________________________date___________________
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