HIPAA Notice of Privacy Practices

New City Acupuncture Pain Management PLLC. (DBA. Divine Acupuncture)
NOTICE OF PRIVACY PRACTICES
Effective Date: [March 10, 2017]
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.
1. Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your Protected Health Information (PHI). We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices described in this Notice while it is in effect.
2. Uses and Disclosures of Health Information
We may use and disclose your PHI for the following purposes without your explicit written authorization:
  • Treatment: We may use your PHI to provide you with acupuncture treatments, herbal consultations, or other therapeutic services. For example, we may disclose your information to another specialist or your primary care physician to coordinate your care.
  • Payment: We may use and disclose your PHI so that the services you receive may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about the acupuncture treatment you received so they will pay us or reimburse you.
  • Healthcare Operations: We may use and disclose your PHI in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
  • As Required by Law: We will disclose your PHI when required to do so by federal, state, or local law (e.g., reporting public health risks, responding to a lawsuit, or complying with a court order).
3. Uses and Disclosures Requiring Your Written Authorization
  • Marketing & Sale of PHI: We will never use or disclose your PHI for marketing purposes or sell your information without your explicit written authorization.
  • Psychotherapy/Session Notes: Most uses and disclosures of psychotherapy or extensive intake session notes require your authorization.
  • Other Uses: Any other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke such authorization at any time in writing.
4. Your Individual Rights Regarding Your PHI
  • Access to Records: You have the right to look at or get copies of your health and billing records, with limited exceptions. You must make a request in writing. We may charge a reasonable, cost-based fee for copies.
  • Alternative Communications: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations (e.g., calling your cell phone instead of a home phone).
  • Amendment: You have the right to request that we amend your health information if you feel it is incorrect or incomplete. Your request must be in writing and explain why the information should be amended. We may deny your request under certain circumstances.
  • Accounting of Disclosures: You have the right to receive a list of instances in which we disclosed your health information for purposes other than treatment, payment, healthcare operations, and certain other activities.
  • Restriction Requests: You have the right to request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to these additional restrictions, except if you pay for a service entirely out-of-pocket and ask us not to bill your insurance.
5. Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us. If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Contact Information:
Privacy Officer: Yiling Chua
Clinic Name: New City Acupuncture Pain Management PLLC. DBA Divine Acupuncture
Phone: (845) 377-5030
Email: [email protected]
Address: 120 N. Main St. Suite 204. New City, NY 10956