Notice of Privacy Practices

This notice describes how Peninsula Family Acupuncture may use your protected health information, and how you can have access to it. Please review it carefully. Protecting your privacy is very important to me.

My Responsibilities Relating to Your Privacy

I am required by law to protect the privacy of your protected health information. Your protected information includes your name, your identifying information, and any information relating to your physical, mental, and emotional health. I am also required to give you a notice of my privacy practices if you choose. I can change my privacy policies at any time, without notice, but must then notify you of the change and make a copy of the revised policy available to you.

Ways I am Permitted to Use Your Protected Health Information Under the Law

For treatment: I may use your information for purposes of providing you treatment. This includes use of your information within my own office, as well as disclosures to your physician or other health care providers who are involved in your care, such as massage therapists, acupuncturists, and mental health counselors. It is the policy of Peninsula Family Acupuncture to communicate with your other health care providers on an as-needed basis. In most circumstances, I will notify you of my intention to contact one of your health providers. I will also keep a record of all such disclosures, which you may request at any time.

Payment: I may use your protected health information for purposes of securing payment for treatment provided. Some possibilities for this include sending bills to your insurance company, providing them with any chart notes they may request to process the claim, sending your checks to my bank and then your bank, or processing your credit card.

Healthcare operations: This involves the day to day running of the clinic and relates to how information is used internally. These kinds of activities include chart audits, quality improvement programs, and surveys. Occasionally, I am required to submit copies of charting to be admitted to an insurance panel, or to maintain some of my credentials. In these instances, any information that could be used to identify the client is blacked out from the pages.

If required by the law: Sometimes records are subpoenaed. In this case I am required to comply.

In an emergency: I will use and disclose your health information as determined by my professional judgement in case of an emergency. This include calling the emergency room or ambulance, notifying a family member that you are having an emergency, or notifying your family physician. If you are fit to make decisions at the time of the emergency, I will consider your preferences as to these disclosures.

Special communications: I occasionally do mailings to my past and present clients. If you want to be excluded from the mailing list, please let me know and your wishes will be respected. I do not sell my client list to outside parties.

Cases of abuse or neglect: I may disclose your protected health information to the appropriate authorities if I reasonably believe you are suffering abuse, neglect, or domestic violence, or are the victim of another crime. I may disclose your information to avert a serious threat to yourself or others.

Routine communications with you: I may disclose your protected information to communicate appointment reminders or attempts to schedule. This may be via voice mail, e-mail, or US post. You may express a preference as to how you would like me to communicate with you.

Your Rights

Access to your medical record: You may ask to receive a copy of your medical record. You must request the copy in writing. Contact the Privacy Officer at the number below to pursue this. Copies cost 25 cents per single sided page. Postage may be charged extra if you would like your copy mailed.

Receive a record of disclosures: I will maintain an record of all disclosures of your protected health information that are not related to treatment, payment, and operations. You can request a copy of this record. Again, contact the Privacy Officer.

Requesting restrictions on disclosures: You can request certain restrictions on disclosures of your health information. For instance, you may request that I not communicate with a particular health care provider. While I am not required to honor your request, if I agree to it, then I must honor it. You need to request such a restriction in writing. Such an agreement is void in an emergency or if records are subpoenaed. However, it is my strong desire to honor your requests for privacy, and if at all possible I will strive to do so.

Requesting alternative communication: You can request that I communicate with you in an alternative to the usual methods (phone calls, e-mails, or letters to your home or office). Please make such requests in writing. Such arrangements must not preclude the adequate provision of care or receipt of payment.

Requesting amendments to your medical record: You may request that I amend an entry in your medical record. Again, your request must be in writing, and you must explain why the amendment is warranted. I may deny your request. I will not falsify the record, nor will I deliberately misrepresent the facts.

Contact Information for Requests, Concerns and Complaints

The Privacy Officer handles all your questions regarding privacy practices, concerns, requests, and complaints. If you feel your privacy has been violated, please contact the Privacy Officer. You may also file a complaint with the U.S. Department of Health and Human Services. You are safe from retaliation if you choose to file a complaint.

Privacy is important to me, and protecting yours is something I take very seriously. I invite you to ask any questions you may have about how your information is used.

Privacy Officer: Donna Stewart, L.Ac., PT.
Telephone: 503-283-5518
email Donna