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 are required to abide by the terms of this Notice of Privacy Practices. As permitted by law,  we reserve the right to amend or modify our privacy policies and practices. The new notice will be effective for all protected health information (PHI) that we maintain at that time.


We use and disclose your PHI in the following situations based upon your written consent:

  1. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services.
  2. Payment: Your protected health information will be used, as needed, to obtain insurance payment for your healthcare services.
  3. Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your acupuncturist’s practice.
  4. Others Involved in Your Healthcare: Base upon your written consent, we may disclose to a member of your family, a relative, or a close friend, your protected health information that directly relates to that person’s involvement in your health care.


We use and disclose your protected health information in the following situations without your written consent:

  1. Required by Law: Used as required by a law enforcement official for law purposes.
  2. Coroners, Funeral Directors: Used to help identify deceased or determine cause of death.
  3. Military Activity and National Security: Used as required by appropriate military command authorities.
  4. Inmates: Used if you are an inmate as required by law.
  5. Work Compensation: Used as required to support benefits for work related injury or illness.


Individual Rights:

  1. Right to Request Restrictions: You have the right to request restriction of limitation on use or disclosure of you PHI.
  2. Right to Request Confidential Communications: You may require that we communicate with you in a particular way. Your request must be in writing.
  3. Right to Inspect and Copy: You have the right to inspect and copy your PHI.
  4. Right to Amend: You have the right to request an amendment if your PHI is incorrect or incomplete. Your request must be in writing.
  5. Right to an accounting of disclosures: You have the right to request a list of disclosures of your PHI provided by us. Your request must be in writing.
  6. Right to receive a print copy of this notice: A copy will be available for you to read upon your first visit, a printed copy will only be provided at your request.


                                                                                                                                                        Effective 11/01/2018