THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
White Dragon Healing Arts (WDHA) is committed to preserving and maintaining the privacy of your health information. We are also required by law to respect your confidentiality. It is our responsibility to inform you of how we can and cannot use your health information.
The purpose of this notice is to explain to you the privacy practices of WDHA and how we may use and disclose the health information that was learned from you when you were/are a patient at our clinic.
We may use and disclose your health information only for purposes of treatment, payment and health care operations.
Treatment: We may use your health information to provide, coordinate, or manage your health care. We may also disclose your health information to people outside of WDHA who may be involved in your health care, such as your family doctor or other treating physicians, home care providers, and family members.
Payment: We may use and disclose your health information so that we may bill and collect payment from you, your insurance company, or another third party.
Health Care Operations: We may use your health information in order to run the necessary administrative, quality assurance, and business functions at WDHA.
Appointment Reminders: We may use and disclose health information to contact you about appointments by way of phone, text, mail, or email. We may also contact you to provide information regarding possible treatment alternatives or other health related benefits and services that may be of interest to you.
Other Activities: We may use and disclose health information to create and distribute unidentifiable health information by removing all references to individually identifiable information.
Legal Matters: We may disclose your health information outside WDHA when required by law to do so by local, state, or federal law, or by the court process. We may disclose your health information to help control the spread of disease or to notify a person whose health or safety may be threatened; for public health reasons such as suspected abuse or neglect; and to a health oversight agency for audits, inspections and licensure.
We cannot use or disclose your health information for any other reasons than those identified above. Any other uses or disclosures of your health information will be made only with your written authorization. You may withdraw the authorization, in writing, at any time, but we cannot take back any previous uses or disclosures of your health information already made with your authorization.
You have certain rights regarding your health information listed below, which you can exercise with a written request to us, dated and signed.
Right to Request Restrictions: You have the right to request us to restrict or limit the health information we use or disclose about you for treatment, payment, or health care operations, or to someone who is involved in or the payment for your care, such as a family member, other relatives or friend. We are, however, not required to agree. If we do agree, we will comply with your request and it must be in writing and signed by the President of WDHA.
Right to Inspect and Copy: With certain restriction, you have the right to inspect and obtain a copy of your health information. We may charge a fee for processing your request.
Right to Amend: You have the right to amend your health record if you feel the information we have is inaccurate or incomplete. The records you wish to amend must be specified. We may deny your request; if we do, we will inform and explain to you our reason of denial.
Right to Accounting: You have the right to receive an accounting of disclosures of your health information. This does not include disclosures to you, for treatment, payment and health care operations purposes previously stated, or disclosures made with your written authorization.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your health in a certain way or an alternative place.
Right to a Paper Copy of This Notice: You have the right to request a paper copy of this notice from us.
If you believe your privacy protections have been violated, you may file a written complaint with Acupuncture Works, Inc. or with the Department of Health and Human Services. You will not be penalized for filing a complaint.
The U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Ave. SW, Washington D.C. 20202 1-877-696-6775
WDHA reserves the right to change this Notice at any time. Any provision made to the Notice will be effective for all health information we currently have about you and any future information we receive. We will post a copy of the current Notice of Privacy Practices at our facility and on our website. This Notice is effective as of March 1, 2004 and we are required by law to abide by the terms of the Notice currently in effect.
If you have questions or would like more information about this Notice, please contact Steve Bialon, L. Ac. at (612) 730-4336
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
