Notice of Privacy Practices

Our Commitment to Your Privacy

Jacob AcuBalance is required by law to maintain the privacy and security of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI. We must follow the terms of the Notice currently in effect. This Notice applies to care provided by Jacob AcuBalance at its Yorba Linda and Buena Park locations.

Your Rights

You have the rights described below. To exercise any of these rights, contact our Privacy Contact by phone, email, or mail using the information at the end of this Notice. We may ask you to submit certain requests in writing.

Get an electronic or paper copy of your medical record

You may ask to inspect or receive an electronic or paper copy of the medical and billing information we maintain about you. We will respond within the time required by applicable law and may charge a reasonable, cost-based fee where permitted.

Ask us to correct your record

You may ask us to amend health information that you believe is incorrect or incomplete. We may deny the request in some circumstances, but we will give you a written explanation when required and explain any right to submit a statement of disagreement.

Request confidential communications

You may ask us to contact you in a specific way, such as only at a certain phone number, or to send mail to a different address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are generally not required to agree. If you pay for a service in full out of pocket, you may ask us not to disclose information about that service to your health plan for payment or health care operations; we will agree unless a law requires the disclosure.

Get an accounting of disclosures

You may request a list of certain disclosures we made during the six years before your request. The accounting generally does not include disclosures for treatment, payment, or health care operations, disclosures made to you, or certain other disclosures excluded by law.

Get a copy of this Notice

You may request a paper copy at any time, even if you agreed to receive the Notice electronically.

Choose someone to act for you

A legally authorized personal representative may exercise your privacy rights. We will verify that person’s authority before acting.

File a complaint

You may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights were violated. We will not retaliate against you for filing a complaint.

Your Choices

For certain disclosures, you may tell us your preference. Tell us what you want us to do, and we will follow your instructions when required by law.

Family, friends, and others involved in your care

You may authorize us to share relevant information with family members, close friends, or others involved in your care or payment for your care. If you are unable to tell us your preference, we may share information when we determine in our professional judgment that doing so is in your best interest.

Disaster relief

We may share limited information with an authorized disaster relief organization to help notify family or others responsible for your care, unless you object or the law otherwise limits the disclosure.

Marketing, sale of PHI, and psychotherapy notes

We do not sell your PHI. We will obtain your written authorization before using or disclosing PHI for marketing or for most uses and disclosures of psychotherapy notes, if we maintain any.

Photographs and clinical images

Photographs or clinical images maintained for diagnosis, treatment, or progress documentation are part of your confidential medical record. We will obtain your separate written authorization before using or disclosing identifiable photographs or clinical images for education, research, promotion, marketing, or social media, unless another law expressly permits or requires the use or disclosure.

How We May Use and Disclose Your Health Information

We may use or disclose PHI without your written authorization for the purposes described below, subject to applicable federal and California law. Where required, we limit PHI to the minimum necessary for the purpose.

Treatment

We may use and share your PHI to provide, coordinate, or manage your acupuncture care and related services, including consulting with or referring you to other health care professionals.

Payment

We may use and share your PHI to bill and collect payment for services, including submitting claims and supporting information to an insurer or other third-party payer.

Health care operations

We may use and share PHI to run the practice, improve care, conduct quality review, manage appointments, comply with licensing obligations, and work with service providers that support our operations and are required to protect the information.

Public health and safety

We may disclose PHI for legally authorized public health activities, such as preventing disease, reporting certain injuries or adverse events, reporting suspected abuse or neglect, or preventing or reducing a serious and imminent threat to health or safety.

Research

We may use or disclose PHI for research only when the requirements of applicable law are satisfied, such as with your authorization or an approved waiver.

Required by law and health oversight

We may disclose PHI when federal, state, or local law requires it and to authorized health oversight agencies for audits, investigations, inspections, licensure, or other activities permitted by law.

Organ donation, coroners, and funeral directors

When applicable, we may share PHI with organ procurement organizations, coroners, medical examiners, or funeral directors as permitted by law.

Workers’ compensation and government requests

We may use or disclose PHI for workers’ compensation claims and for law enforcement, military, national security, protective service, or other government purposes only when permitted or required by law and when applicable conditions are met.

Lawsuits and legal proceedings

We may disclose PHI in response to a valid court or administrative order, subpoena, discovery request, or other lawful process, subject to all applicable protections.

Business associates

We may share PHI with vendors that perform services for us, such as electronic health record, billing, secure communications, or technology providers. When required, these vendors must enter into written agreements to safeguard PHI.

Substance Use Disorder Records

To the extent that we maintain or receive substance use disorder patient records protected by 42 CFR Part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you unless you provide written consent or the use or disclosure is authorized by a court order accompanied by a subpoena or other legal requirement compelling disclosure.

Uses and Disclosures Requiring Written Authorization

Other uses and disclosures not described in this Notice will be made only with your written authorization unless otherwise permitted or required by law. A valid authorization will identify the information, recipient, purpose, and expiration. You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it or as otherwise provided by law.

Additional California Privacy Protections

California’s Confidentiality of Medical Information Act (CMIA) and other state laws may provide protections that are more stringent than HIPAA. When a California law provides greater privacy protection or more individual rights, we will follow the more protective applicable requirement.

• We will maintain medical information in a manner that preserves its confidentiality and protects it against unauthorized access, use, alteration, or disclosure.
• We will obtain a valid written authorization before disclosing medical information when California law requires one. The authorization must identify the information, recipient, and purpose and must meet applicable form and signature requirements.
• Certain information may receive additional protection under California law, including, when applicable, records concerning mental health, HIV or other communicable disease testing, substance use disorder services, reproductive or sexual health services, genetic information, immigration status, and services to which a minor may legally consent.
• A minor who is legally permitted to consent to a particular health service may have independent privacy rights for information related to that service. We will follow the applicable California consent and access rules.
• You may have additional rights and remedies under California law if your medical information is used or disclosed unlawfully.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• We will notify you of a breach of unsecured PHI within the time and in the manner required by applicable federal and California law.
• We must follow the duties and privacy practices described in the Notice currently in effect.
• We will not use or disclose your information other than as described in this Notice unless you authorize us in writing or the law otherwise permits or requires it.

Changes to This Notice

We reserve the right to change this Notice and make the revised terms effective for PHI we already maintain as well as PHI we receive in the future. If we make a material change, we will revise the Notice. The current Notice will be available upon request, at our office locations, and on our website.

Questions or Complaints

If you have questions, want to exercise a privacy right, or believe your privacy rights have been violated, contact our Privacy Contact using the information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

U.S. Department of Health and Human Services, Office for Civil Rights: File a health information privacy complaint online · Phone: 1-877-696-6775

Privacy Contact and Practice Information

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