NOTICE OF PRIVACY POLICY

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU

CAN GET ACCESS TO THIS INFORMATION.

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Uses and Disclosures

Treatment. Your health information may be used by staff members or disclosed to other health care

professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing

treatment. For example, result of laboratory tests and procedures will be available in your medical

record to all health professionals who may provide treatment or who may be consulted by staff

members.

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Payment. Your health information may be used to seek payment from your health plan, from other

sources of coverage such as an automobile insurer, or from credit card companies that you may use to

pay for services. For example, your health plan may request and receive information on dates of service,

the service provided, and the medical condition being treated.

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Health Care Operations. Your health information may be used as necessary to support the day-to-day

activities and management of The Healing Space Family and Integrative Medicine. For example,

information on the services you received may be used to support budgeting and financial reporting, and

activities to evaluate and promote quality.

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Law Enforcement. Your health information may be disclosed to law enforcement agencies who support

government audits and inspections, to facilitate law-enforcement investigations, and to comply with

government-mandated reporting.

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Public Health Reporting. Your health information may be disclosed to public health agencies as required

by law. For example, we are required to report certain communicable diseases to the state’s public

health department.

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Research. Provider may disclose your medical information to people preparing to conduct a research

project (for example, to help them look for patients with specific medical needs) so long as the medical

information they review is not removed from the premises of this practice. Provider may also disclose

the medical information of descendants for a research project, so long as the information is necessary

for the research.

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Other uses and disclosures require your authorization. Disclosure of your health information or its use

for any purpose other than those listed above requires your specific written authorization. If you change

your mind after authorizing a use or disclosure of your information you may submit a written revocation

or the authorization. However, your decision to revoke the authorization will not affect or undo any use

or disclosure of information that occurred before you notified us of your decision to revoke your

authorization.

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Additional Uses of Information

Appointment Reminders. Your health information may be used by our staff to send you appointment

reminders. If you would like this office to communicate your health information to you in a confidential

manner, please indicate your wishes on the “Acknowledgement of Receipt of HIPAA Notice of Privacy

Practices” Form.

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Information about treatments. Your health information may be used to send you information that you

may find interesting on the treatment and management of your medical condition. We may also send

you information describing other health-related products and services that we believe may interest you.

Individual Rights.

 

You have certain rights under the federal privacy standards. These include:

● The right to request restrictions on the use and disclosure of your protected health information;

● The right to request restrictions on disclosure to a health plan if you paid out of pocket, in full,

for items or services;

● The right to receive confidential communications concerning your medical condition and

treatment;

● The right to inspect and copy your protected health information;

● The right to amend or submit corrections to your protected health information;

● The right to receive an accounting of how and to whom your protected health information has

been disclosed; &

● The right to receive a printed copy of this notice.

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Practice Duties. We are required by law to maintain the privacy of your protected health information

and to provide you with this “Notice of Privacy Practices”. We are also required to abide by the privacy

policies and practices that are outlined in this notice.

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Right to Revise Privacy Practices. As permitted by law, we reserve the right to amend or modify our

privacy policies and practices. These changes in our policies and practices may be required by changes in

federal and state laws and regulations. Upon request, we will provide you with the most recently revised

notice on any office visit. The revised policies and practices will be applied to all protected health

information we maintain.

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Requests to Inspect Protected Health Information. You may generally inspect or copy the protected

health information that we maintain. You have the right to access your protected health information in

electronic format where it is available. As permitted by federal regulation, we require that requests to

inspect or copy protected health information be submitted in writing. You may obtain a form to request

access to your records by contacting this practice. Your request will be reviewed and will generally be

approved unless there are legal or medical reasons to deny the request.

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Complaints. If you would like to submit a comment or complaint about your privacy practices, please

contact our office and speak to the office manager. You may also submit complaints to the Secretary of

Health and Human Services. You will not be penalized or otherwise retaliated against for filing a

complaint.