Notice of Privacy Practices
This notice describes how your protected health information (PHI) may be used and disclosed and how you can get access to this information. Please review this document carefully. Managing the privacy of your PHI is extremely important.
Legal Responsibilities of the Acupuncturist: As mandated by Federal and State legal requirements, your health information must be protected. As part of these regulations, the acupuncturist is required to ensure that you are aware of privacy policies, legal duties, and your rights to your PHI. This notice of privacy policies, outlined below, will be in effect for the duration during the course of practice and will be in effect until it is replaced.
Changes to this Notice of Privacy Practices: Sonoma Acupuncture reserves the right to modify privacy policies and the terms of this notice at any time and will make the new provisions effective for all information that it maintains, including PHI created or received before the changes were made. Any such modifications will be made within the guidelines of the law. Until such amendment is made, Sonoma Acupuncture is required by law to comply with this Notice.
PHI Use and Disclosure: Information regarding your health may be used and disclosed for the purpose of treatment, payment, and other healthcare operations.
Treatment: We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment, or healthcare operations. Your PHI may be provided to a healthcare provider outside of our practice, however, this information will not be provided unless you have authorized it in writing.
Payment: Your PHI may be used and disclosed to obtain payment for services provided to you. We may disclose your health information to your insurance provider for the purpose of payment or healthcare operations. If payment is not made as arranged, our office may utilize an outside collection agency, credit reporting agency, or other means of collecting outstanding debt. The designated collection agency or authority may review your file containing protected heath care information.
Healthcare Processes: The acupuncturist may use and disclose your protected healthcare information in relation to our healthcare process. These processes include an assessment, improvement activities, reviewing the competence or qualifications of healthcare professionals, provider performances and evaluating practitioner, conducting training programs, accreditation, certification, licensing, or credentialing activities.
Your Authorization: At any time, you may provide in writing your authorization for use and disclosure of your PHI for any purpose. You may choose to revoke your written permission at any time. The revocation must be in writing. If you revoke your written authorization, it will not affect any use or disclosure prior to the revocation. Your protected healthcare information may be disclosed to you, as described in the patient rights section of this notice. In addition, your PHI may be disclosed to a family member, friend, or other person to the extent necessary to assist you with your healthcare, but only with your authorization.
Person Involved in Care: In order to accommodate the notification of your location, your general condition, or death, your PHI may be used or disclosed to a family member, your personal representative, or another person responsible for your care. If you are present and wish to object to such disclosures of your protected health information, you may do so. To the extent you are incapacitated or emergency circumstances exist, the acupuncturist will disclose PHI using her professional judgment, disclosing only PHI that is directly relevant to the person’s involvement in your healthcare. The acupuncturist will use professional judgment and our experience with common practices to make reasonable inferences of your best interest in allowing a person to pick up filled herbal prescriptions.
Marketing Health-Related Services: The use of your PHI for the purpose of marketing is prohibited without your written authorization.
Required By Law: Your PHI may be used or disclosed if required by law.
Abuse or Neglect: As required by law, if the acupuncturist has reason to believe that you are the victim of possible abuse, neglect, domestic violence, or other possible crimes, your PHI may be disclosed to the appropriate authorities. If the acupuncturist has reason to believe the use or disclosure of your PHI will prevent a serious threat to your health or safety or the health or safety of others, the acupuncturist may have to provide the necessary protected health information.
National Security: Under some circumstances, the military may require disclosure of healthcare information for armed forces personnel. For the purpose of national security activities, counter intelligence, and lawful intelligence, authorized federal authorities may require disclosure of protected health information. Protected healthcare information disclosure may be made to correctional facilities or law enforcement authorities with the lawful authority requiring custody of such information.
Appointment Reminders: Your protected healthcare information may be used to assist you with appointment reminders in the form of voicemail messages, text messages, emails, postcards, or letters. The acupuncturist may also write a thank you card to whomever referred you to the practice.
Patient Rights Access: With limited exception, you have the right to review your protected health information.
Disclosure Accounting: You have a right to receive an accounting of disclosures of your PHI made by the acupuncturist for reasons other than treatment, payment, healthcare information, and certain other activities for the last six years.
Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI. However, please be advised that Sonoma Acupuncture is not required to agree to the restriction that you requested. If Sonoma Acupuncture agrees to follow your request regarding additional restrictions, Sonoma Acupuncture will follow the agreed restrictions unless an emergency situation dictates otherwise.
Alternative Communication: You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request. Your request must be in writing and agreed upon with the practice.
Electronic Notice: If you receive a notice electronically, you are entitled to receive the notice in writing as well.
Complaints about your privacy rights or how Sonoma Acupuncture has handled your health information should be directed to:
Attn: Privacy Officer
5755 Mountain Hawk Dr Suite 201
Santa Rosa, CA 95409
If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue SW
Room 509F HHH Building
Washington, DC 20201
For additional information about your privacy, please visit: www.hcfa.gov/medicaid/hipaa