Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WE STORE YOUR PRIVATE HEALTH INFORMATION IN A SECURE FASHION AND SPACE, AS REQUIRED BY LAW AND COMMON COURTESY. WE DO NOT/ WILL NOT DISCUSS YOUR PRIVATE HEALTH INFORMATION WITH ANYONE ELSE (EXCEPT POSSIBLY AS DESCRIBED BELOW AND/OR REQUIRED BY LAW). AS A RULE, WE ALWAYS ERR ON THE SIDE OF CAUTION AND NOT SHARING INFORMATION.
About This Notice
This Notice will tell you about the ways we may use and disclose health information that identifies you. We also describe your rights and certain obligations we have regarding the use and disclosure of Health Information. We are required by law to maintain the privacy of Health Information that identifies you; give you this Notice of our legal duties and privacy practices with respect to your Health Information; and follow the terms of our Notice that are currently in effect.
The following categories describe different ways that we may use and disclose Health Information:
For purposes of treatment: I understand that Bardo Acupuncture & Ayurveda will use my health care information for purposes including diagnosis and treatment. Treatment may include acupuncture, dietary and lifestyle suggestions and herbs/supplements.
Friends and family: Bardo Acupuncture & Ayurveda will only disclose protected health information to friends or family (ex: your Emergency Contact) in the case of an emergency to the extent necessary to help with managing the emergency.
Abuse or neglect: Mandatory reporting rules require that we disclose protected health care information to appropriate authorities if we believe that an elderly individual or child may be a possible victim of abuse, domestic violence, neglect, or other crimes.
Serious threat to health or safety: We may disclose your protected health information if we believe that the disclosure is necessary to prevent a serious threat to your health or safety or the health and safety of the public or another person.
Public health and safety: Bardo Acupuncture & Ayurveda may release your protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. For example, we may use information in your health record to the Food and Drug Administration relative to adverse events regarding drugs, foods, supplements, and other health products or to post marketing surveillance to enable product recalls, or replacements.
Law enforcement: Bardo Acupuncture & Ayurveda may disclose your protected health information to law enforcement agencies in response to a court order, subpoena, discovery request, administrative order, or other lawful process by another person involved in a dispute involving a patient, but only if efforts have been made to tell the patient about the request or to obtain an order protecting the requested health information. We will always err on the side of protecting your information.
Reminder texts and emails: Bardo Acupuncture & Ayurveda’s appointment software will contact you to provide reminders of upcoming appointments or invoices due. Appointment software programs do not store your complete health records, only contact information, and billing/receipt information such as generic treatment information (ex: Acupuncture Treatment or Ayurvedic Consult).
For payment services: I understand that my health care information may be used to receive payment for services and products. The information on or accompanying a bill, invoice or receipt may include my identification (name), a treatment I received (example, itemized as a generic “acupuncture treatment”) and, potentially, herbs or supplements I have purchased, but will not include specific diagnostic/personal health information.
For health care operations: I understand that my protected health information may be disclosed for all activities that are included within the definition of “health care operations” as defined in the federal Privacy Regulations.
Other covered entities: Bardo Acupuncture & Ayurveda may disclose your protected health information to another covered entity to conduct health care operations in the area of quality assurance certification, licensing or credentialing.
Disclosure to the U.S. Department of Health and Human Services: When the U.S. Department of Health and Human Services is investigating or determining our compliance with the federal Privacy Regulations, Bardo Acupuncture & Ayurveda is required to disclose your protected health information to the DHHS.
Business Associates: We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Worker’s compensation: We may release your protected health information if you are involved in a workman’s compensation case and we are required to provide that information.
Other required or permitted disclosures: Bardo Acupuncture & Ayurveda may disclose your health care information under the following circumstances:
- Whenever required to do so by law;
- To a correctional institution or its agents, if a patient is or becomes an inmate of such an institution, when necessary for the patient’s health or the health and safety of others;
- To notify, or assist in notifying a family member, personal representative, or another person responsible for the patient’s care or the patient’s location, or general condition;
- To the military authorities under certain circumstances when the patient is a member of the Armed Forces;
- To authorized federal officials for intelligence, counterintelligence, and other national security activities; for compliance audits by regulatory bodies or payers.
Authorized Use and Disclosure
I understand that Bardo Acupuncture & Ayurveda will obtain my written Authorization before using or disclosing my protected health care information for purposes other than those listed above or otherwise permitted or required by law. I may revoke an Authorization in writing at any time. Upon receipt of this revocation Bardo Acupuncture & Ayurveda will stop using or disclosing my protected health care information except to the extent that Bardo Acupuncture & Ayurveda may have already taken action in reliance on previous authorization.
Guidelines around providing protected health information to Bardo Acupuncture & Ayurveda via e-mail
Information you submit through use of your own e-mail program (ex: Gmail, Hotmail, etc) is not secure by HIPPA standards. As effective as modern security practices are, no physical or electronic security system is impenetrable. We cannot guarantee the security of our electronic information systems, nor can we guarantee that information you supply won’t be intercepted while being transmitted over the Internet. If you choose to send confidential or protected information over the internet, you do so solely at your own risk. Patients who choose to use the Internet to send protected information must have signed documentation in their file stating they recognize their information is at risk of protected health information (PHI) breach.
Right to request restrictions: I understand that I have the right to request that Bardo Acupuncture & Ayurveda restrict how my protected health information is used or disclosed in carrying out treatment, payment, or health care operations. Requests must be made in writing to the Bardo Acupuncture & Ayurveda. The request must tell Bardo Acupuncture & Ayurveda: 1) the information to be limited and disclosed and 2) how I want Bardo Acupuncture & Ayurveda to limit and/or disclose the information. I understand that Bardo Acupuncture & Ayurveda is not required to agree to the requested restrictions, but if it does, Bardo Acupuncture & Ayurveda will abide by the agreement except in an emergency.
Right to access protected health information: I understand that have the right to look at or obtain a confidential copy of my protected health information or billing/payment information. Requests must be made in writing to the Bardo Acupuncture & Ayurveda. Bardo Acupuncture & Ayurveda may charge me a reasonable fee for copies and postage (if mailed). Bardo Acupuncture & Ayurveda may deny my request to inspect and copy my protected health information in certain limited circumstances. If denied access to my protected health information, I may request that the denial be reviewed.
Right to access to electronic medical records: At this time, patient medical records have not been stored electronically and therefore electronic medical records cannot be provided to Bardo Acupuncture & Ayurveda patients.
Accounting of Disclosures: I understand that I have the right to receive an accounting of the disclosures of my protected health information (PHI) Bardo Acupuncture & Ayurveda has made on or after January 1, 2019. Bardo Acupuncture & Ayurveda will provide the date of the disclosures, the name of the person or entity to which my PHI was disclosed, a description of the PHI disclosed, and the reason for the disclosure. Effective in September 2013, I have the right to restrict disclosures to an insurance company when I have paid for treatment out-of-pocket. Restriction requests must be made in writing and submitted to the Bardo Acupuncture & Ayurveda.
Amendments to Health Care Information: I understand that I have the right to request that Bardo Acupuncture & Ayurveda amend my protected health information if I feel that it is incomplete or incorrect. Requests must be made in writing to Bardo Acupuncture & Ayurveda and explain why the information should be amended. If Bardo Acupuncture & Ayurveda did not create the information I want amended or in certain other circumstances, Bardo Acupuncture & Ayurveda may deny the request. If the request is denied, a written explanation will be provided. I have the right to file a statement of disagreement with the decision.
How to Learn About Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information: Special privacy protections apply to HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. Some parts of this general Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, you may contact the us for more information about these protections.
Privacy Breach Notification: You have the right to be notified if a breach occurs that may have compromised the privacy or security of your Health Information.
For More Information or to Report a Problem
I understand that if I would like additional information or have questions the privacy practices, I may contact Bardo Acupuncture & Ayurveda. If I believe my privacy rights have been violated, I may file a complaint with Bardo Acupuncture & Ayurveda or with the Department of Health and Human Services. I understand that Bardo Acupuncture & Ayurveda supports my right to protect the privacy of my protected health and financial information and will not retaliate in any way if I choose to file a complaint with Bardo Acupuncture & Ayurveda or with the Department of Health and Human Services.
Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for Health Information we already have, as well as any information we receive in the future. We will post a copy of the current Notice at the Bardo Acupuncture & Ayurveda clinic office and on our website.