PRIVACY POLICIES
NOTICE OF PRIVACY POLICIES
Effective Date of Notice: October 19, 2019
Your Information. Your Rights. Our Responsibilities.
We understand that medical information about you and your health is personal, and we are
committed to protecting this information. When you receive treatment at our clinic, a treatment
record is created.
Typically, this record contains your treatment plan, history and physical, any other information
you provide to us, and billing records. In addition, this record serves as a:
1. The basis for planning your treatment.
2. Means of communication for or between our staff, the acupuncturists, and any health
care providers, if any, that you wish us to share such information with;
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your
rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record.
• You can ask to see or get an electronic or paper copy of your medical document and
other health information about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of
your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record.
• You can ask us to correct your health information that you think is incorrect or
incomplete. Just ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, by home or office phone)
or send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or
our operations. We are not required to agree to your request, and we may say “no” if it
would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to
share that information for payment or our operations with your health insurer. We will
say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information.
• You can ask for a list (accounting) of the times we’ve shared your health information for
six years before the date you ask, whom we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, health
care operations, and certain other disclosures (such as any you asked us to make).
We’ll provide one accounting a year for free but charge a reasonable, cost-based fee if
you request another one within 12 months.
Get a copy of this privacy notice.
• You can ask for a paper copy of this notice at any time, even if you have agreed to
receive the information electronically. We will provide you with a paper copy promptly.
Choose someone to act for you.
• If you have given someone medical power of attorney or your legal guardian, that
person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before taking any
action.
YOUR CHOICES
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations
described below, talk to us. Let us know what you want us to do, and we will follow
your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.
• If you are not physically able to tell us your preference, we may go ahead and share
your information if we believe it is in your best interest. We may also share your
information when needed to lessen a serious and imminent threat to health or safety.
Only if you give us written permission:
• Marketing purposes.
• Sale of your information.
OUR USES & DISCLOSURES
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat You
• We can use your health information and share it with other professionals who are
treating you.
Run Our Organization
• We can use and share your health information to run our practice, improve your care,
and contact you when necessary.
Bill For Your Services
• We can use and share your health information to bill and get payment from you or
another party.
Identification
• We may require you to provide us with certain information to verify your
identification. We may use different methods to confirm your identification, including
but not limited to photographs, fingerprints, or other biometrics.
• • This information will be stored in our system for identification purposes only and
will not be utilized for any other purposes.
Appointment Reminders
• If applicable, we may use and disclose medical information to remind you of an
appointment.
Comply With the Law
• We will share medical information about you when required to do so by federal or
state statutes or regulations.
Address Workers’ Compensation, Law Enforcement, And Other Government
Requests
We can use or share health information about you:
• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official.
• With health oversight agencies for activities authorized by law.
Respond To Lawsuits and Legal Actions
• We can share health information about you in response to a court or administrative
order or a subpoena.
OUR RESPONSIBILITIES
• We are required by law to maintain the privacy and security of your protected health
information.
• We will let you know promptly if a breach occurs that may have compromised the
privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give
you a copy of it.
• We will not use or share your information other than as described here unless you tell
us we can in writing. If you tell us we can, you may change your mind at any time.
Let us know in writing if you change your mind.
For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/
noticepp.html.
