Privacy Policies, Practices and Terms
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used.
“HIPAA” provides penalties for covered entities that misuse personal health information. As required by “HIPAA”, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes: treatment, payment, and health care operations.
Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include a physical examination.
firstname.lastname@example.org Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.
We may also create distribute de-identifiable information. We may contact you to provide appointment reminders or information about treatment alternatives or health-related benefits and services that may be of interest to you. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Office. The right to request restrictions on certain uses and disclosure of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction if we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. The right to inspect and copy your protected health information. The right to amend your protected health information. The right to receive an accounting of disclosure of protected health information.
The right to obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of July 1, 2012 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain.
We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated. You have the right to file written complaint with our office, or with the Department of Health and Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
TERMS and CONDITIONS
COLORADO MANDATORY DISCLOSURE STATEMENT
SYDNEY COOLEY 801 Florida Rd, Suite 12, Durango, CO 81301 • 970.426.8736
Education and Experience
Sydney Cooley earned her Masters of Oriental Medicine from the East West College of Natural Medicine in Sarasota, Florida in August 2005. The five year program consisted of 2908 hours of education, which includes 834 hours of clinical practice. She was certified as a Diplomat in Acupuncture by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) in December 2005. She has also been certified in Clean Needle Technique.
In addition to acupuncture, Sydney has been trained in herbal therapies, electrical stimulation techniques, ion pumping cord treatment, gua sha, tui na, cupping, auricular acupuncture, ear seeds, and nutritional and lifestyle counseling.
Sydney is a member of the Acupuncture Association of Colorado, the East West College Alumni Association and the American Association of Oriental Medicine. She is a licensed acupuncturist in the state of Colorado.
This license has never been revoked. (noted as of: July 01, 2012)
Sydney complies with the rules and regulations promulgated by the Colorado Department of Health, including the proper cleaning and sterilization of needles and the sanitation of acupuncture offices. Only single-use, disposable, factory-sterilized needles are used.
As applied and set forth between patient & practitioner (further set forth in the ‘Forms’ Section).
The patient is entitled to receive information about the methods of therapy, the techniques used, and the duration of therapy, if known.
The patient may seek a second opinion from another healthcare professional or may terminate therapy at any time.
In a professional relationship, sexual intimacy is never appropriate and should be reported to the Director of the Division of Registrations in the Department of Regulatory Agencies.
The practice of acupuncture is regulated by the Director of Registrations Colorado Department of Regulatory Agencies. If you have comments, questions, or complaints, contact the Acupuncturists Registration Office, 1560 Broadway, Suite 1350, Denver, Colorado, 80202, 303-894-7800.
TREATMENT AND ARBITRATION AGREEMENT
AS PROVIDED BY STATE CODE OF CIVIL PROCEDURE
With regard to medical care and services provided or to be provided, IT IS AGREED that: The ATTENDING PRACTITIONER will provide services to the patient, to the best of his skill and knowledge which medical care in the light of circumstance, is possible and practical. The Patient Client will cooperate fully with the ATTENDING PRACTITIONER by following the instructions of the ATTENDING PRACTITIONER, by adhering to such treatment plan or course of action as may be set forth. IT IS AGREED that: Because of differences in human constitution and response, it is in no way possible to warrant the outcome of such medical care and service.
It is understood that any dispute as to medical malpractice, that is as to whether any services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by state law, and not by lawsuit or resort to court process except as state law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional personal right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.
In the event of any controversy between the Patient Client or a dependent (whether or not a minor) or the heirs-at-law or personal representative of the Patient Client, as the case may be, and the ATTENDING PRACTITIONER (including its agents and employees), involving a claim in tort or contractual, the same shall be submitted to arbitrating. Within fifteen (15) days after the Patient Client or ATTENDING PRACTITIONER shall give notice to the order of demanding arbitration of such controversy, the parties to the controversy shall each appoint an arbitrator and give notice of such appointment to the other.
Within a reasonable amount of time after such notices have been given, the two arbitrators, so selected, shall select a neutral arbitrator and give notice of the selection thereof to the parties. The arbitrators shall hold a hearing within a reasonable time from the date of notice of selection of neutral arbitrator.
All papers or others papers required to be served shall be served by United States mail. Except as provided herein, the arbitration shall be conducted in accordance with and governed by the provisions of Title 9 of the State Code of Civil Procedure. The Patient Client may withdraw from the arbitration portion of this agreement within thirty (30) days from the date of this agreement by notification of his intent to do so to the ATTENDING PRACTITIONER by registered mail.
Sydney Cooley, L. Ac, Dipl OM
801 Florida Rd, Suite 12, Durango, CO 81301
Main: (970) 426-8736