Flexibly Fit     P.O. Box 1971, Orangevale, CA 95622

Notice of Privacy Practices

As a Certified Bowen Therapist and Health Care Practitioner, I am most dedicated to maintaining the privacy of your health information. In accordance with the privacy regulations created by the Health Insurance Portability and Accountability Act of 1996 (HIPPA), I am required to maintain the confidentiality of your health information and to provide you with a copy of this notice. I realize that these laws are complicated, but I must provide you with the following important information, which describes the use and possible disclosure of your protected health information: to carry out therapy, for payment or health care operations; and for other purposes that are permitted or required by law. It also describes your rights to access and control your "protected health information." This is information about you, that may identify you, and that relates to your past, present or future physical or mental health and related health care services.

Ongoing medical/therapy records will be maintained for all patients that request or are referred for therapy. A release to consider you strictly a "client" must be generated for medical records to be waived. Under this option, intake information, ongoing evaluations and treatment/therapist notes will be kept to a minimum.

Note:
All use of your protected health information will be accessed under your explicitt direction. The statements below reflect that restriction except in the case of law enforcement or other legal governmental authority.

Treatment:

I will use and disclose you're protected health information to provide, coordinate, or manage your health care, and any related services.

Payment:

I may use and disclose medical information about you in order to obtain payment for services rendered. Such disclosures may be made to you, an insurance company, or a third-party. As it relates, it may be necessary to tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment or therapy.

Operations:

I may use or disclose as needed your protected health information in order to support the business activities of this practice, which may include but are not limited to quality assessment activities, therapy reviews licensing, marketing and conducting or arranging for other business activities. In addition, I may use or disclose you're protected health information as necessary to contact you to remind you of your appointment or to confirm your consent to release your personal health information to your personal representative. I may also call you by your name in any waiting room used.

Others Involved in Your Health Care:

I may release medical information about you to a friend or family member, at your request who is involved in your medical care. I may also give information to someone who helps pay for your care, such as a parent or other related person.

Special Circumstances:

Health Oversight
Protected health information may be disclosed to a health oversight agency for activities authorized by law, such as audits, investigations and inspections.

Military Veterans
If you're a member of the Armed Forces, I may release medical information about you as required by military command authorities. Medical information may also be released about foreign military personnel to the appropriate foreign military authority.

Workers Compensation
Medical information may be released about you for workers compensation or similar programs. Such disclosures may be made to the workers compensation insurance carrier and or your employer.

Inmates
Your protected health information may be released to correctional institutions are law enforcement officials, if you are an inmate or under the custody of a law enforcement official.

Required by Law
The use of or disclosure of your protected health information may be done to the extent that the use national security disclosure is required by law.

Law Enforcement
Your protected health information may be disclosed if required to do so by a law enforcement official

National Security and Intelligence Activities
Your medical information may be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Legal Proceedings
It may be necessary to disclose protected health information in the course of any judicial or administrative proceeding; in response to an order of a court or administrative tribunal, or in response to a subpoena, discovery request or other lawful process.

Marketing
I may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Other Uses of Medical Information
Other uses in disclosures of medical information not covered by this notice or the laws that apply to this practice will only be made with your written permission. If you provide permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission, I will no longer use or disclose medical information about you for the reasons covered by your written authorization. At the time of revocation of your authorization, it is understood that I will be unable to take back any disclosures that have already been made with your permission, and that I am required to retain records of the care/ therapy that I have provided to you.

Your Rights

You have the right to inspect and copy or obtain a copy of the health information that may be used to make decisions about you, including medical records and billing records as they are maintained by this practice. If you request a copy information, you may be charged a fee for the cost of copying, mailing or other supplies associated with your request.

You have the right to amend or ask to be amended your health information if you believe it is incorrect or incomplete, provided the information is maintained by this practice. You must provide a reason that supports your request for any amendment. You may be denied the request for an amendment if it is not in writing or does not include a reason to support the request. Additionally, denial of your request is likely if you ask for information to be amended that: was not created by this practice, is not part of the normal medical information kept by the therapist or is that which is accurate and complete.

You have the right to request a restriction in our use or disclosure of your health information for treatment payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care such as family members and friends. Every attempt will be made to accommodate all reasonable requests for confidential communication restrictions promptly.

You have the right to request confidential communication, as it relates to this practice with you about your health and related issues in a particular manner or a certain location. For instance, you may ask to be contacted at home, rather than work. Reasonable requests will be of course accommodated.

You are entitled to receive a copy of this notice of privacy practices. A copy of this notice may be printed at any time from this web site www.flexiblyfit.org, by calling the our office and requesting a copy be mailed to you or by asking for one at the time of your next appointment.

To request an amendment of any medical/therapy records, limit a particular disclosure, except where allowable by law, or submit a complaint regarding the use of any protected health information, apply in writing to:

Judy Terwilliger, Bowen Therapist/ Flexibly Fit
P.O .Box 1971, Orangevale, CA 95622

(Please allow 30 days from the date of your written request for a reply)