Patient Privacy Notice at Timeless4Health Spa

Effective 09/01/2021

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.

Your Rights

You have the following rights regarding your health information:

1. Right to Access Your Medical Records

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

2. Right to Correct Your Medical Records

You can ask us to correct health information about you that you think is incorrect or incomplete. We may deny your request, but we’ll tell you why in writing within 60 days.

3. Right to Request Confidential Communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will accommodate reasonable requests.

4. Right to Request Restrictions

You can ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are not required to agree to your request, and we may deny it if it would affect your care.

5. Right to an Accounting of Disclosures

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those made for treatment, payment, and healthcare operations, and certain other disclosures (such as those you asked us to make).

6. Right to Receive a Copy of this Notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.

7. Right to File a Complaint

If you feel we have violated your privacy rights, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services (HHS). Filing a complaint will not affect the quality of your care.

8. Right to Revoke Authorization

If you provide us with authorization to use or disclose health information about you, you may revoke it at any time, in writing. If you revoke your authorization, we will no longer use or disclose your health information for the reasons covered by your written authorization.

How We Use and Disclose Your Information

We typically use or share your health information in the following ways:

1. For Treatment

We can use your health information and share it with other professionals who are treating you. For example, a doctor treating you for an injury may share your medical history with another healthcare provider to determine the best course of treatment.

2. For Payment

We can use and share your health information to bill and get payment from health plans or other entities. For example, we may provide information about your treatment to your health insurance plan so it will pay for your care.

3. For Healthcare Operations

We can use and share your health information to run our clinic, improve your care, and contact you when necessary. For example, we use health information to manage the quality of care and evaluate the performance of our staff.

4. For Legal and Public Health Purposes

We may disclose your health information for legal and public health purposes when required by law, including:

• Public Health and Safety: Reporting certain health conditions (e.g., contagious diseases).

• Legal Compliance: For law enforcement, court orders, and other required disclosures.

• Abuse or Neglect: Reporting cases of abuse, neglect, or domestic violence.

5. Other Uses Require Authorization

We will not use or share your health information for purposes such as marketing or the sale of your information without your written authorization. If you have authorized us to use or disclose your information for any purpose, you may revoke that authorization in writing at any time.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and provide you with a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We reserve the right to change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Contact Information

If you have any questions about this notice, wish to file a complaint, or need further information, please contact:

Contact Information:

Dr Farshid T Namin, LAc

Acupuncture & Beauty Spa

Tel: (818) 960 3830

Address: 19509 Ventura Blvd, Tarzana, CA 91356