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Patient Medical Information Policies – Health Insurance Portability and Accountability Act

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

Changes To This Notice​

We reserve the right to change this notice at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. We will post a copy of our current notice within our facilities and we will post it on our website,

Privacy Concerns and Requests

If you have questions about this notice or want to talk to someone regarding our policies, please contact Erin Pass at the Acupuncture Clinic of Boulder, Inc. at 303-665-5515. If you believe your privacy has been violated, you may file a privacy complaint with the Acupuncture Clinic of Boulder, Inc. organization or with the Secretary of the Department of Health and Human Services. Privacy complaints or requests may be submitted in writing to:

Erin Pass, L.Ac., Dipl. C.H.
2500 Arapahoe Avenue, Suite 290
Boulder, CO  80302

Phone: 303-665-5515

4 Important Things to Know

1. Who Will Follow This Notice​

Health care practitioners who treat you at any of Acupuncture Clinic of Boulder, Inc. locations, including employees, volunteers, and members of other staff members at the Clinic,

All departments and operating units of our organization,

All medical practices operated by the Acupuncture Clinic of Boulder, Inc. (“ACoB”).

Rather than have you read and sign different notices for each health care practitioner that treats you at each of our operating locations, this Joint Notice of Privacy Practices describes the privacy practices followed by all our practitioners, other members of our workforce, and our business associates.

This notice does not apply to the use and disclosure of your medical information in connection with treatment you receive at your physician’s office. Your personal physician may have different policies regarding your medical information and may provide you with a separate notice

2) Our Pledge Regarding Medical Information

We understand that your medical information is personal and we are committed to its protection. We create a record of the care and services you receive to ensure that we are providing quality care and to comply with legal requirements. This notice applies to all your medical information that we maintain, whether created by our staff or others.

We are required by law to give you this notice of our legal duties and privacy practices with respect to your medical information, to follow the terms of this Privacy Notice, and to notify you following a breach of the privacy or security of your unsecured medical information.

3) How We May Use and Disclose Medical Information About You

For each category of use and disclosure, we will try to give some examples, although not every use or disclosure in the category will be listed.

For treatment: We may use your medical information so that we and other health care providers may provide you with medical treatment or services. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow your healing. Also, the doctor may need to provide information to the dietician so we can arrange for appropriate meals. Different health professionals may also share your medical information in order to coordinate the different services you need. We may disclose your medical information to people outside the hospital who may be involved in your medical care after you leave the clinic.

For payment: We may disclose your medical information so that treatment and services you receive may be billed by ACoB or other health care providers to a third party. For example, your health plan may need to know about procedures you received or diagnosis codes so they will pay us for the surgery. We may also disclose your medical insurance information to obtain prior approval from your health plan.

For Health Care Operations purposes: We may use and disclose your medical information for our internal operations, such as business management, and administrative activities, legal and auditing functions, and insurance-related activities. We may use medical information to make sure all of our patients receive quality care, such as reviewing our processes or to evaluate the performance of those caring for you. We may also disclose information to doctors, nurses, technicians, and other personnel for review and learning purposes. We may remove information that identifies you from this set of information so others may use it to study healthcare and healthcare delivery without learning a specific patient’s identity. Under certain circumstances, we may disclose your medical information for the health care operations of other health care providers.

Health Information Exchange: ACoB participates in the Colorado Regional Health Information Organization (“CORHIO”) which arranges for the electronic exchange of health information among health care providers in Colorado. ACoB may exchange your health information electronically through CORHIO for the purposes described in this Notice. You have the right to request that your information not be included in this exchange.

Individuals Involved in your Care or Payment of your Care: We may release your medical information to a friend or family member who is involved in your medical care, or to someone who helped pay for your care.

Notification: We may release your medical information to notify a family member, personal representative, or another person responsible for your care of your location, general condition, or death. We also may release your medical information for certain disaster relief purposes.

Contacts: We may contact you to provide appointment reminders, information about treatment alternatives, or other health related benefits and services that may be of interest to you.

Worker’s Compensation: We may release medical information about you for worker’s compensation or similar programs, which provide benefits for work related injuries or illnesses.

Mental Health Information: State laws create specific requirements for the release of mental health records. ACoB will obtain your specific authorization to release mental medical information when required by these laws.

Drug and Alcohol Treatment Records: Specific rules apply to the release of certain drug and alcohol program records, and ACoB will obtain your specific authorization to release those records as required by Federal regulation 42 CFR, Part 2.

Miscellaneous: We may use or disclose your medical information without your prior authorization for several other reasons. Subject to certain requirements, we may give out your medical information without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies, funeral arrangements, Coroner’s investigations, organ donation, and emergencies. We also may disclose medical information when required by law in response to a request from law enforcement in specific circumstances, for specialized government functions including correctional, military, or national security purposes, in response to valid judicial or administrative orders or to avoid a serious health threat. Additional specific rules may apply to mental health records.

4) Your Rights Regarding Medical Information About You

Right to Inspect and Copy: In most cases you have the right to inspect or receive a copy of your medical information (or have a copy provided to an individual whom you designate) when you submit a written request. If your medical record is maintained electronically in a designated record set, you have the right to request a copy of the information in an electronic form and format. We may deny your request in certain circumstances. If you are denied access to your medical information, you may appeal.

Right to Amend: If you believe the information in your record is incorrect or incomplete, you have the right to request an addendum be added to your record by submitting a written request giving your reason. We may deny your request under certain circumstances. If we deny it, we may advise you in writing of the reason or explain your rights to submit a statement of explanation.

Right to a Paper Copy of this Notice: If this joint notice was sent to you electronically you have a right to a paper copy of this notice.

Right to Request Restrictions: You may request in writing that we not use or disclose your medical information except when specifically authorized by you, when required by law, or in an emergency. Except in the case of certain requests related to disclosures to health plans, we are not required by law to agree to your request, but we will consider the request. We will inform you of our decision.

Right to Request Restrictions on Disclosures to Health Plans: You may request in writing that we restrict disclosures of your medical information to a health plan for purposes of carrying out payment or healthcare operations if the disclosure is not required by law and the medical information pertains solely to a health care item or service for which you (or a person other than the health plan who is acting on your behalf) have paid ACoB out of pocket and in full at the time of service. We must agree to a request that meets these requirements.