Privacy

Notice of Privacy

NOTICE OF PRIVACY PRACTICES

Effective Date: 5/1/09

Revised: 5/1/09

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

Greensboro Acupuncture & Naturopathic Center is required by law to:

-Make sure that your medical information is protected

-Give you this Notice describing our legal duties and privacy practices with respect to your medical information

-Follow the terms of the Notice that is currently in effect.

Greensboro Acupuncture & Naturopathic Center (GANC) understands that your heath information is personal. We create and maintain a record with information about the care and services you receive here in order to provide you with quality care and to comply with the law. This Notice of Privacy Practices applies to all information about your care that GANC may create, maintain, or receive. This includes information that GANC receives from other doctors and medical facilities, but that GANC keeps to help give you better care.

The Notice tells you about the ways we may use and share your health information, as well as the legal duties we have about your health information.

Disclosure of your healthcare information

Treatment

We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations.

Payment

We may disclose your health information to your insurance provider for the purpose of payment or healthcare operations if and when we begin to become providers within an insurance network.

Workers’ Compensation

We may disclose your health information as necessary to comply with State Workers’ Compensation Laws. These programs provide benefits for work-related injuries or illness.

Emergencies

We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

-You have the right to have your 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 your request.

-You have the right to inspect and copy your health information.

-You have the right to request that Greensboro Acupuncture & Naturopathic Center amend your protected health information. Please be advised, however, that Greensboro Acupuncture & Naturopathic Center is not required to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.

-You have the right to receive an accounting disclosure of your protected health information made by Greensboro Acupuncture & Naturopathic Center

-You have the right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices

Greensboro Acupuncture & Naturopathic Center reserves the right to amend this Notice of Privacy Practices at anytime in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Greensboro Acupuncture & Naturopathic Center is required by law to comply with this Notice. Greensboro Acupuncture & Naturopathic Center is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have any questions about any part of this notice or if you want more information about your privacy rights please contact: Dr. Allison Scott by calling this office at . If Dr. Scott is not available, you may make an appointment for a conference in person or by telephone.

Complaints

Complaints about your Privacy rights or how Greensboro Acupuncture & Naturopathic Center has handled your health information should be directed to Dr. Allison Scott by calling this office at (336) 848-7539. If Dr. Scott is unavailable, you may make an appointment for a conference in person or by telephone. If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights

200 Independence Avenue, S.W.

Room 509F HHH building

Washington, D.C. 20201

I have read the Privacy Notice and understood my rights contained in this Notice.

By way of signature, I provide Greensboro Acupuncture & Naturopathic Center with my authorization and consent to use and disclose my protected health care information for the purpose of treatment, payment and healthcare operations as described in the Privacy Notice.