Patient Notification of Privacy Practices Form
In accordance with HIPAA Privacy Regulation, this Notice describes how your practitioner may use and disclose your protected health information to carry out treatment, or health care operations and for other purposes that are permitted or required by law. The Notice also describes your rights, how you can get access to this information, and our requirements to protect your health information. Please review it carefully.
When you receive health-care services, state and federal law (HIPAA), protects your health information. In addition, HIPAA requires that we provide you this Notice of Privacy Rights. We maintain records of your name, address, telephone number, diagnosis, treatment, and other information supplied to us by you or others in connection with your healthcare.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the right to: a. Request restrictions on certain uses and disclosures, b. Receive communications of protected health information by alternative means or at alternative locations, c. Inspect, copy and amend your protected health information held by us if you believe it is inaccurate or incomplete, d. Receive an accounting of certain disclosures of your protected health information, e. Receive a paper copy of this notice even if you have received it electronically
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
We only use or disclose your health information as state and federal laws require or permit. In some cases, the law requires that you authorize the disclosure. In other cases, the law allows or requires us to disclose your health information without your authorization.
Use and Disclosure Not Requiring Your Authorization
Treatment: We will use your health care information to to help us diagnose and design a course of treatment for you within the Eastern Asian Medicine Practitioner’s scope of practice. We may also, for the purpose of treatment, disclose your protected health information to another health care provider when needed by the provider to render treatment to you.
To Contact You: We may use the information in your health records to contact you if necessary.
Other Permitted Uses and Disclosures
HIPAA specifically permits us to use or disclose your health information for other purposes without your consent or authorization. In our experience such disclosures are rare, and the limited information we maintain is generally not applicable. However, when authorized by law, and to the extent we may have the information, HIPAA permits us to disclose it to: a. Comply with the requirements of federal, state, or local laws, court orders or other lawful process and for administrative or court proceedings, b.Report to a public health authority for the purpose of preventing or controlling disease, injury, or disability, c. Report to the FDA for the quality, safety or effectiveness of FDA-regulated products or activities, d. Notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, e. Report abuse, neglect or domestic violence to a government authority, f. Provide necessary information to a health oversight agency for activities such as audits, investigations, inspections, licensure of the healthcare system, government benefit programs and regulated entities, g. A law enforcement official for specified law enforcement purposes, h. Coroners or medical examiners for identification or determining cause of death, i. Funeral directors to carry out their duties with respect to the decedent, j. Organ procurement organizations for facilitating donation and transplantation, k. Researchers conducting studies approved by an Institutional Review Board, l. Prevent or lessen a serious and imminent threat to the health of safety of a person or the public, m. Authorized federal officials for specialized government functions such as military and veterans activities; national security and intelligence activities; protective services for the president; medical suitability determinations; correctional institutions; government entities providing public benefits and, n. Comply with workers’ compensation laws
Uses and Disclosures with Your Authorization
Other uses and disclosures or your personal information require your written authorization. You may revoke your authorization at any time by doing so in writing.
Additional Protections for Certain Information
Confidential HIV related Information for which additional protections are provided by state law,
Substance Abuse Treatment Information for which additional protections are provided by state law,
Mental Health Treatment information for which additional protections are provided by state law.