Notice of Privacy Practices (HIPAA) and Patients’ Rights:

Acupuncture practice of Jamie Paxton, L.Ac.

Please review the information below carefully

This notice describes how medical information about you may be used and disclosed, how you can get access to

this information, and how your privacy is protected by our office.

The Health Insurance Portability and Accountability Act of 1996 (HIPPA)

HIPPA is a federal program that requires all medical records and other individually identifiable health

information used or disclosed by us in any form are kept confidential. This act provides the patient rights to

understand and control how your health information is used. HIPPA provides penalties for covered entities that

misuse personal health information.

Our Legal Responsibility

We understand that information about you and your health is very personal.We value and respect your right to

privacy. As required by law, we strive to protect the privacy of your health information. We have prepared this

explanation of how we are legally required to maintain your privacy and how we may use and disclose your

health care information.

We respect our legal obligation to keep health information that identifies you private. We will only use and

disclose your Protected Health Information as allowed by applicable law. We will not use your health information

inside our office or outside without your written permission. In some limited cases, the law may require us to

disclose your health care information without either a written or verbal consent.

We gather personal information and health information in several ways:

· Information we receive from you

· Information we receive from other health care providers

Protected Health Information

is any information that includes information about health status, provision of health care, or payment for health

care that can be linked to a specific individual.

Safeguards in place at our office include

· Limited access to facilities where information is stored.

· Policies and procedures for handling information and medical records.

Use and Disclosure With Consent

We will ask you to sign a onetime general consent form, allowing us to use and disclose your health information

for purposes of treatment, payment, and health care operations in this office. This general written consent is

obtained the first time we provide you with treatment or services. This general written consent is a broad

permission that does not need to be repeated each time we provide treatment or services to you. We are allowed

to refuse to treat you if you do not sign the consent form.

We will use your Protected Health Information for the purposes of treatment, payment and health care

operations.Treatment, payment and health care operations

For purposes of treatment: We will use your health care information to treat you. For example, we will use your

information to help us diagnose and design a course of treatment for you. Your treatment may include

acupuncture, massage and herbs. We may disclose patient health care information to other health care

professionals within our practice for the purpose of treatment, payment or health care operations. For example,

on occasion, it may be necessary to seek consultation regarding a patient's condition from other health care

providers. We may also, for the purpose of treatment, disclose your Protected Health Information to another

health care provider outside this clinic in order to coordinate your care such as scheduling lab work.

For payment services: We will use your health care information to receive payment for services and products. We

will bill you for the cost of treatment and herbs provided to you. The information on or accompanying the bill

may include your identification, as well as the herbs you are taking.

For health care operations: We may use and disclose your Protected Health Information for all activities that are

included within the definition of ‘health care operations’ as defined in the Federal Privacy Regulations.

Other uses and disclosures of Protected Health Information permitted or required by regulation

Friends and family: Unless you request otherwise, we may use or disclose health information to a family member

or other personal representative to the extent necessary to help with your health care or with payment for your

health care.

Reminders: We may call a patient's home to confirm a scheduled appointment or may send an appointment

reminder by email. We may leave a reminder message on the answering machine or with the person answering

the phone. No personal health information will be disclosed during this recording or message other than the

date and time of the scheduled appointment along with a request to call our office if there is a need to cancel or

reschedule the appointment.

Other covered entities: We may disclose Protected Health Information to another covered entity to conduct

health care operations in the area of quality assurance activities, certification, licensing or credentialing.

We will obtain your written authorization before using or disclosing your protected health care information for

purposes other than those listed above or otherwise permitted or required by law.

You may specifically authorize us to use Protected Health Information for any purpose or to disclose (share) your

Protected Health Information by submitting an authorization in writing. Such disclosures will be made to any

personal representative to whom you choose to make your Protected Health Information available.

You may revoke authorization in writing at any time. Upon receipt of this revocation we will stop using or

disclosing your protected health care information except to the extent that we have already taken action in

reliance on the authorization.

Use and Disclosure Without Consent

In some limited situations, the law requires us to use and disclose your health information without your

permission. These examples include:

· When state or federal law mandates certain health information be reported for a specific purpose.· For public health purposes, such as contagious disease reporting and notices to and from the FDA

regarding drugs and medical devices.

· Disclosure to government authorities about victims or suspected abuse, neglect, or domestic violence.

· Uses and disclosures for health oversight activities, such as for the audits by Medicare, or for investigation

of possible violations of health care laws.

· Disclosures in response to subpoenas of orders of the court.

· Disclosures for law enforcement purposes, such as to provide information about someone who is suspected

to be a victim of a crime, or to provide information about a crime in our office.

· Disclosure related to worker’s compensation programs.

Patient Rights

As a patient you have the following rights:

1. 2. 3. 4. RIGHT TO INSPECT AND COPY. Upon written request you have the right to access, review or receive

copies of your health care records.

RIGHT TO AN ACCOUNTING OF DISCLOSURES. Upon written request you have the right to receive a

list of items this office has disclosed about your Protected Health Information.

RIGHT TO REQUEST RESTRICTIONS. You have the right to request that this office place additional

restrictions on the disclosure of your Protected Health Information.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS Patients have the right to have their

Protected Health Information received or communicated through an alternative method or sent to an

alternative location other than the usual method of communication or delivery, upon their request. For

example, patients can ask that we only contact them at work or by mail.

5. RIGHT TO AMEND. You have the right to request that we amend your Protected Health Information, in

the event that you believe the health information we have is incorrect or incomplete. This request must be

in writing. Please be advised, however, that we are not required to agree to amend Protected Health

Information. We may deny the request for an amendment if it is not in writing or does not include a

reason to support the request. In addition, we may deny the request if the patient asks us to amend

information that:

A. We did not create, unless the person or entity that created the information is no longer available to

make the amendment.

B. Is not part of the health information that we keep.

C. You would not be permitted to inspect and copy.

D. Is accurate and complete.

If the patient request to amend health information has been denied, the patient will be provided with a

explanation of our denial reason(s) and information about how to disagree with the denial.

6. RIGHT TO A PAPER COPY. You have the right to receive a paper copy of this Notice of Privacy Practices

at any time upon request.

Questions and Complaints

If you have any questions, complaints, or want more information, contact this office. If you believe that your

privacy rights have been violated, you may file a complaint with us.

Jamie Paxton L.Ac., Olapidous Acupuncture, 1008 E. Jefferson St., Charlottesville, VA 22902If you are not satisfied with the manner in which this office handles your complaint, you also have the right to file

a formal, written complaint with the Secretary of the US Department of Public Health and Human Services.

US Dept. of Health and Human Services (DHHS), Office of Civil Rights, 200 Independence Ave SW, Room 509

F HHH Building, Washington, DC 20201

We support your right to protect the privacy of your protected health and financial information. We will not

retaliate in any way if you choose to file a complaint with us or the Department of Health and Human Services.

Effective Date: February 1, 2020