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NOTICE OF PRIVACY PRACTICES
Amityville Acupuncture & Wellness
Effective Date: March 3, 2026
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Amityville Acupuncture & Wellness is a Covered Entity under the Health Insurance Portability and Accountability Act (HIPAA) and complies with all applicable federal and New York State privacy laws.
OUR COMMITMENT TO YOUR PRIVACY
Amityville Acupuncture & Wellness is committed to protecting the privacy and security of your Protected Health Information (PHI). PHI includes information about your health condition, treatment, and payment for healthcare services that may identify you.
This Notice explains how we may use and disclose your PHI, your rights regarding your health information, and our legal duties to protect it.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your PHI for the following purposes:
Treatment
We may use and share your health information to provide, coordinate, or manage your healthcare and related services. This may include communication with physicians, acupuncturists, massage therapists, nurses, specialists, or other healthcare providers involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services provided. This includes submitting claims to insurance companies, verifying coverage, obtaining prior authorization, billing patients, and collecting outstanding balances.
Healthcare Operations
We may use and disclose your PHI for healthcare operations necessary to run our practice. These activities may include quality assessment, staff training, licensing, accreditation, compliance reviews, auditing, business planning, and administrative activities.
As Required by Law
We will disclose your PHI when required to do so by federal, state, or local law, including court orders, subpoenas, and mandatory reporting obligations.
Public Health and Safety
We may disclose PHI to public health authorities to prevent or control disease, report adverse reactions, report suspected abuse or neglect, or comply with government oversight activities.
Health Oversight Activities
We may disclose PHI to health oversight agencies for activities authorized by law, including audits, investigations, inspections, and licensure actions.
Law Enforcement
We may disclose PHI for certain law enforcement purposes as permitted or required by law.
Serious Threat to Health or Safety
We may use or disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Business Associates
We may share PHI with third-party service providers (such as billing services, electronic health record vendors, or IT providers) who perform services on our behalf. These Business Associates are required by law and contract to safeguard your information.
Electronic Communications
We may communicate with you via phone, email, text message, or electronic patient portals for appointment reminders, billing matters, treatment follow-up, and practice updates. While we use secure systems when possible, standard email and text messaging may not be fully secure. By providing your contact information, you consent to electronic communications related to your care.
Uses Requiring Your Written Authorization
We will not use or disclose your PHI for marketing, research, or the sale of PHI without your written authorization. You may revoke your authorization at any time in writing, except to the extent action has already been taken.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights under HIPAA:
Right to Access
You may request to inspect or obtain a copy of your health records in paper or electronic form. We may charge a reasonable, cost-based fee for copies.
Right to Request Amendment
If you believe your health record is incorrect or incomplete, you may request an amendment in writing. We may deny your request under certain circumstances but will provide a written explanation.
Right to Request Restrictions
You may request restrictions on certain uses or disclosures of your PHI. While we will consider your request, we are not required to agree to all restrictions unless required by law.
Right to Confidential Communications
You may request that we contact you in a specific way (for example, at a different phone number or mailing address). We will accommodate reasonable requests.
Right to an Accounting of Disclosures
You may request a list of certain disclosures we have made of your PHI, excluding those made for treatment, payment, healthcare operations, or certain other permitted purposes.
Right to Receive a Copy of This Notice
You may request a paper or electronic copy of this Notice at any time.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer. You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights:
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.
OUR LEGAL DUTIES
We are required by law to:
Maintain the privacy and security of your PHI.
Provide you with this Notice of our legal duties and privacy practices.
Abide by the terms of this Notice currently in effect.
Notify you without unreasonable delay and no later than 60 days following discovery of a breach of unsecured PHI, if such a breach occurs.
Limit the use, disclosure, and request of PHI to the minimum necessary to accomplish the intended purpose, except as permitted for treatment or as otherwise required by law.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice and to make the revised Notice effective for all PHI we maintain. Any updated Notice will be available in our office and on our website.
CONTACT INFORMATION
If you have questions about this Notice or wish to exercise your rights, please contact:
Privacy Officer
Amityville Acupuncture & Wellness
[Insert Full Street Address]
Amityville, NY [Zip Code]
Phone: 631.691.0200
Website: www.amityvillewellness.com
ACKNOWLEDGMENT
You will be asked to acknowledge receipt of this Notice of Privacy Practices. Your care will not be conditioned upon signing the acknowledgment form.
Amityville Acupuncture & Wellness
Effective Date: March 3, 2026
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Amityville Acupuncture & Wellness is a Covered Entity under the Health Insurance Portability and Accountability Act (HIPAA) and complies with all applicable federal and New York State privacy laws.
OUR COMMITMENT TO YOUR PRIVACY
Amityville Acupuncture & Wellness is committed to protecting the privacy and security of your Protected Health Information (PHI). PHI includes information about your health condition, treatment, and payment for healthcare services that may identify you.
This Notice explains how we may use and disclose your PHI, your rights regarding your health information, and our legal duties to protect it.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your PHI for the following purposes:
Treatment
We may use and share your health information to provide, coordinate, or manage your healthcare and related services. This may include communication with physicians, acupuncturists, massage therapists, nurses, specialists, or other healthcare providers involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services provided. This includes submitting claims to insurance companies, verifying coverage, obtaining prior authorization, billing patients, and collecting outstanding balances.
Healthcare Operations
We may use and disclose your PHI for healthcare operations necessary to run our practice. These activities may include quality assessment, staff training, licensing, accreditation, compliance reviews, auditing, business planning, and administrative activities.
As Required by Law
We will disclose your PHI when required to do so by federal, state, or local law, including court orders, subpoenas, and mandatory reporting obligations.
Public Health and Safety
We may disclose PHI to public health authorities to prevent or control disease, report adverse reactions, report suspected abuse or neglect, or comply with government oversight activities.
Health Oversight Activities
We may disclose PHI to health oversight agencies for activities authorized by law, including audits, investigations, inspections, and licensure actions.
Law Enforcement
We may disclose PHI for certain law enforcement purposes as permitted or required by law.
Serious Threat to Health or Safety
We may use or disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Business Associates
We may share PHI with third-party service providers (such as billing services, electronic health record vendors, or IT providers) who perform services on our behalf. These Business Associates are required by law and contract to safeguard your information.
Electronic Communications
We may communicate with you via phone, email, text message, or electronic patient portals for appointment reminders, billing matters, treatment follow-up, and practice updates. While we use secure systems when possible, standard email and text messaging may not be fully secure. By providing your contact information, you consent to electronic communications related to your care.
Uses Requiring Your Written Authorization
We will not use or disclose your PHI for marketing, research, or the sale of PHI without your written authorization. You may revoke your authorization at any time in writing, except to the extent action has already been taken.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights under HIPAA:
Right to Access
You may request to inspect or obtain a copy of your health records in paper or electronic form. We may charge a reasonable, cost-based fee for copies.
Right to Request Amendment
If you believe your health record is incorrect or incomplete, you may request an amendment in writing. We may deny your request under certain circumstances but will provide a written explanation.
Right to Request Restrictions
You may request restrictions on certain uses or disclosures of your PHI. While we will consider your request, we are not required to agree to all restrictions unless required by law.
Right to Confidential Communications
You may request that we contact you in a specific way (for example, at a different phone number or mailing address). We will accommodate reasonable requests.
Right to an Accounting of Disclosures
You may request a list of certain disclosures we have made of your PHI, excluding those made for treatment, payment, healthcare operations, or certain other permitted purposes.
Right to Receive a Copy of This Notice
You may request a paper or electronic copy of this Notice at any time.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer. You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights:
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.
OUR LEGAL DUTIES
We are required by law to:
Maintain the privacy and security of your PHI.
Provide you with this Notice of our legal duties and privacy practices.
Abide by the terms of this Notice currently in effect.
Notify you without unreasonable delay and no later than 60 days following discovery of a breach of unsecured PHI, if such a breach occurs.
Limit the use, disclosure, and request of PHI to the minimum necessary to accomplish the intended purpose, except as permitted for treatment or as otherwise required by law.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice and to make the revised Notice effective for all PHI we maintain. Any updated Notice will be available in our office and on our website.
CONTACT INFORMATION
If you have questions about this Notice or wish to exercise your rights, please contact:
Privacy Officer
Amityville Acupuncture & Wellness
[Insert Full Street Address]
Amityville, NY [Zip Code]
Phone: 631.691.0200
Website: www.amityvillewellness.com
ACKNOWLEDGMENT
You will be asked to acknowledge receipt of this Notice of Privacy Practices. Your care will not be conditioned upon signing the acknowledgment form.