Privacy

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.

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:

• Information obtained by Jing Gao L.Ac., will be recorded in your medical record and used to help decide what care might be right for you. Information may be provided to your referring Physician or others providing you care.

For payment:

• If you have health care coverage, we will request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to payor may include your diagnosis, procedures performed or recommended care.

For health care operations:

• We use your medical records to assess quality and improve services.

• We may use and disclose medical records to review qualifications and performance of our health care providers and to train our staff.

• We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.

• We may contact you to raise funds.

• We may use and disclose your information to conduct or arrange for services, including:

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:

• Receive, read and ask questions about this Notice;

• Request us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request, but we will comply with any request granted;

• Request that your health information be given to you by another means or at another location. Please sign, date and give us your request in writing;

• Request and receive from us a paper copy of the most current Notice of Private Practices for Protected Health Information ("Notice");

• Request that you be allowed to see and get a copy of your protected health information. You should make this request in writing. We have a form available for this type of request;

• Have us review a denial of access to your health information - except in certain circumstances;

• Request us to change your health information. You should make this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medic record, and included with any release of your records.

• When you request, we will give you a list of disclosures of your health information. The list will not include disclosures to third party payers. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.

• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes you cannot cancel an authorization if its purpose was to obtain insurance.

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

• Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.

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:

• With medical researchers - if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.

• To Comply With Workers Compensation Laws - if you make a workers compensation claim.

• For Public Health and Safety Purposes as Allowed or Required by Law:

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.

• To Report Suspected Abuse or Neglect to public authorities.

• For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victem of a crime.

• For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health.

• For Disaster Relief Purposes. For example, we may share health inforemation with disaster relief agencies to assisst in notification of your condition to family or others.

• For Work-Related Conditions That Could Affect Employee Health. For exmple, an employer may ask us to assess health risks on a job site.

• To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.

• In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.

• For Specialized Government Functions. For example, we may share information for national security purposes.

Other Uses and Disclosures of Protected Health Information

• Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.