Massage Salon

HIPAA Privacy Procedures and Policies

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

The privacy of your health information is important to this office.  Please review it carefully.

Legally Defined Duty of the Office
This office is required by legal statute to protect the privacy of your health information. This personal health information is defined as that health information that can be used to identify you, has been created by this office, or has been received from another office, or entity.  It applies to past, present, and future health or condition, you treatment, payment for services, and other health practices which will be explained to you.

This office has the duty to provide you with this NOTICE, which contains a description of how your health information will be used and disclosed for purposes of treatment, payment, and other health practices.  The use of this information applies to the sharing, utilization, examination, or analysis of this information within this treatment facility.  Your health information is disclosed when it is released or transferred out of this office to another party or entity.  These practices will be explained to you in this NOTICE.  This office has the legal duty, with some exceptions, to disclose or use only the necessary information to accomplish the task at hand.  Additionally, this office is legally required to apply and follow the practices described in this NOTICE.

This office has the right to change the privacy practices as described in this NOTICE at any time, as permitted by law.  The changes will apply to your health information held by this office.  You will receive an updated copy of this NOTICE and it will be posted in this office.  You can request a copy of this NOTICE at any time by notifying our CONTACT OFFICER at the address and telephone number located at the end of this NOTICE.

Use and Disclosure of Your Health Information
This office is permitted to use and disclose your health information for the purposes of providing treatment, payment for services rendered, and healthcare operations.  Some of these require your authorization and others do not.

Some Examples That Do Not Require Your Authorization Include:
Treatment
This office may use and disclose your health information to a physician, psychiatrist, or other mental health clinicians who provide treatment to you.  The purpose of this disclosure is for coordination of your treatment.
Payment
This office may use and disclose your health information to obtain payment for services provided to you.  The disclosure may be to your health insurance company or health plan.  If this office uses a third party for billing services, we will make sure they comply with the safe management of your health information.
Healthcare Operations
This office may disclose and use your health information for the purpose of maintaining and running this office.  This includes quality assessment protocols reviewing the competence of clinicians providing treatment, or conducting training, certification or licensing activities.
Emergency Situations
This office may use and disclose your health information to emergency personnel in case a situation warrants such treatment.
Federal, State, Local, or Administrative Law
This office may use or disclose your health information when mandated by law.  This includes reporting child and/or elder/dependent abuse, harm to self or others, when required by judicial or administrative actions, or when required by government agencies such as a county coroner or Worker’s Compensation Laws.
National Security
This office may disclose your health information to military authorities of the Armed Forces under specific situations.  For example, we may disclose to intelligence, counterintelligence, and other national security agencies information required by them.
Authorization
This office may obtain your written authorization for use or disclosure of your health information for situations not listed above.  You may give this office your written authorization for use of your health information or to disclose it to anyone for any purpose as defined by the written AUTHORIZED DOCUMENT.  You may revoke your authorization in writing at any time.
Family, Friends, or Others Involved in Your Healthcare
This office may provide your health information to a family member, friend, or other individual designated by you as being involved in your healthcare of for the payment of your healthcare, unless you object.
Appointment Reminders and Other Communications
This office, at times, my use or disclose your health information to provide you with appointment reminders, appointment changes, or other office communications.  These may include voicemail messages, letters, or E-mails.

Your Rights Regarding Your Health Information
Access To Your Health Information
You have the right to examine or obtain copies of your health information, with some limited exceptions.  This office will attempt to comply with the requested format, unless we are unable to do so.  The request must be made in writing and we will comply within 30 days of receiving your written request.  You will be charged $5.00 per page.  We may choose to provide you with a summary or synopsis of your health information if you agree.  Should this office deny your request, you will be provided a reason, in writing, and an explanation of your rights to initiate a review of the denial.
Requesting Limits on Uses and Disclosures of Your Health Information
You have the right to request limitation on the use and disclosure of your health information.  This office will review your request and may choose not to accept it.  If your request is accepted, a written format will be included in your records and this office will abide by the request.  The request may not interfere with the legally defined uses and disclosures of your health information. 
Receiving Health Information
You may request that health information be sent to you to a specific location and by specific means such as E-mail.  This office will attempt to comply as long as it is feasible.
Accounting for Disclosures
You have the right to request and receive a list of disclosures made on your behalf by this office for reasons other than treatment, payment, or healthcare operations.  The request is valid for the last six years to begin on April 14, 2003.  You may make one such request every year.  There will be a reasonable charge for additional requests made in one 12-month period.
The Right To Amend Your Health Information
You have the right to request an amendment or correction to your health information.  The request must be made in writing and a reason for your request must also be included.  This office must respond to your request within 60 days of the request.  The request will be granted or denied.  If your request is granted, the appropriate changes will be made, you will be informed of the changes made and third parties needing to know about the changes will be notified.
This office can deny your request if the information is complete and correct, it was not created by this office, not part of the office records, or cannot be disclosed.  You will receive a written statement stating the reason for a denial.  You will be provided with the format to file a written disagreement with the denial.  You also have the right to request that your original request and the denial be attached to all future disclosures of your health information.
Electronic Notification
You have the right to receive this NOTICE by E-mail or in written format.

Questions
Should you require additional information, please contact our CONTACT OFFICER at: (714) 957-8229.

Complaint Procedure
Should you believe that this office has violated your privacy rights, you disagree with a decision made about access to your health information, you disagree with a response to your request to amend or restrict the use or disclosure of your health information, or disagree with our decision to contact you via a specific method or location, you may complain to the CONTACT OFFICER at (714)957-8229, and/or submit a written complaint to the United States Department of Health and Human Services, 200 Independence Avenue, S.W., Washington D.C., 20201.  This office will not retaliate against you in any way should you choose to file a complaint.

CONTACT OFFICER: Linda Tesoro, MFT

Telephone: (714) 957-8229
Facsimile: (714) 957-0244
Email: BreakAwayhc@aol.com

Address: 3151 Airway Avenue, Suite D-1, Costa Mesa, Ca 92626

THIS EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2003