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.

Acupuncture & Chinese Herb Center (ACHC) respects your privacy.

We understand that your personal health information is very sensitive.

We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnosis, treatment, health information from other providers and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment and Health Operations

For treatment:

For payment:

For health care operations:

medical quality review by your health plan;

accounting, legal, risk management and insurance services;

audit functions, including fraud, abuse detection and compliance programs.

Your Health Information Rights

The health and billing records we create and store are the property of ACHC. Your protected health information, however, generally belong to you. You have a right to:

For help with your rights and requests, during normal business hours, please contact: Jing Gao L.Ac., at (425) 861-6688

Our Responsibilities

We are required to:

      Keep your protected health information private;

      Give you this Notice;

      Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice of Privacy Practices. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our office.

To Ask for Help or Complain

If you have questions, want more information or want to report a problem about the handling of your protected health information, you may contact: Jing Gao L.Ac. at (425) 861-6688.

If you believe your privacy rights have been violated, you may discuss your concerns with Jing Gao. You may also deliver a written complaint to Jing Gao L.Ac. at our ACHC office. You may also file a complaint with the U.S. Secretary of Health and Human Services.

With respect to your right to file a complaint with ACHC or with the U.S. Secretary of Health and Human Services. If you complain, we will not retaliate against you.

Other Disclosures and Uses of Protected Health Information

Notification of Family and others

You have the right to object to this use or disclosure of your information. If you object we will not use or disclose it.

We may use and disclose your protected health information without your authorization as follows:

to prevent or reduce a serious , immediate threat to the health and safety of a person or public.

to public health or legal authorities

to protect public health and safety

to prevent or control disease, injury or disability

to report vital statistics such as births or deaths.

Other Uses and Disclosures of Protected Health Information