Notice of Privacy Practices

Our Duties

We're required by law to protect the privacy of your health information, give you this notice, follow the notice currently in effect, and tell you if a breach compromises your unsecured health information. We protect your information under both federal law (HIPAA) and Washington law (Chapter 70.02 RCW) — where Washington law is more protective, we follow it.

How We May Use and Share Your Information

• Treatment — to provide and coordinate your care. For example, with your authorization, we may share information with your primary care provider.
• Payment — to collect payment and prepare superbills, receipts, or letters you request for insurance or HSA/FSA reimbursement.
• Operations — to run the clinic. We use secure scheduling, records, and messaging vendors that have signed Business Associate Agreements requiring them to protect your information.
• People involved in your care — unless you object, we may share information with a family member, friend, or other person involved in your care or in paying for it, using our professional judgment to share only what's directly relevant.

Other Uses Allowed or Required by Law

We may share information without your authorization only when both federal and Washington law require or allow it, including:

• To report suspected abuse or neglect of children or vulnerable adults
• To prevent a serious threat to health or safety
• For public health activities, health oversight, and workers' compensation
• In response to a court order, subpoena, or discovery request, as the law allows
• To coroners, medical examiners, funeral directors, and organ/tissue donation programs
• For research, subject to legal safeguards protecting your privacy
• When otherwise required by federal, state, or local law

Uses That Require Your Written Authorization

We will not use your information for marketing, sell it, or share it for any purpose not described in this notice without your written authorization. You may revoke an authorization in writing at any time, except to the extent we've already acted on it.

Substance Use Disorder Records

Records protected by federal substance use disorder confidentiality rules (42 C.F.R. Part 2) will not be used or shared in any civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order issued after notice and an opportunity to be heard.

Your Rights

You have the right to:

• See and get a paper or electronic copy of your health record
• Ask us to correct your record
• Ask us to contact you in a specific way or at a specific place — we'll agree to reasonable requests
• Ask us to limit what we use or share
• Get a list of certain disclosures we've made
• Get a paper copy of this notice at any time
• Choose someone to act for you, such as a legal guardian or person with power of attorney
• File a complaint (see below)

To exercise any of these rights, contact the Privacy Officer below in writing. We'll respond within 15 working days of receiving your written request, or within 21 working days if we notify you in writing of a delay and its reason.

Changes to This Notice

We may change this notice, and the changes will apply to all information we hold. The current notice, with its effective date, is posted at the clinic and on this page. A copy is available on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the clinic by writing to the Privacy Officer below, or with:

• U.S. Department of Health and Human Services, Office for Civil Rights — www.hhs.gov/ocr/complaints, 1-800-368-1019
• Washington State Department of Health, Health Systems Quality Assurance Complaint Intake — HSQAComplaintIntake@doh.wa.gov, (360) 236-4700

We will not retaliate against you for filing a complaint.

Contact (Privacy Officer)

Matthew Sabey Smith, DACM, LAc., Dipl.Ac.
82 Washougal River Rd, Suite 108
Washougal, WA 98671
(360) 208-7574
matt@livelyvibeacuherb.com