Permission to Treat/ Privacy Policy
Patient Consent to Treatment
I hereby consent to the following:
Treatment: Any and all health care and treatment during this introductory mini- treatment, which may include acupuncture, massage therapy, and/or nutritional and lifestyle counseling. I agree to inform the therapist of any experience of pain during the session. I agree to update the therapist as to any changes in health. I understand that the therapist holds no liability should I forget to do so. Any information obtained will not be shared with any third parties, as per HIPPA patient privacy laws described below.
Notice of Patient Privacy
Health Insurance Portability and Accountability Act (HIPAA)
Sunshine Healing Arts is dedicated to preserving your personal health information. We are required by law to protect your personal medical information and to provide you with a notice describing how your medical information may be used and disclosed and how you can access this information.
Required by law: We must have your written consent before we use or disclose to others your medical information for purposes of providing or arranging for your health care, the payment for or reimbursement of the care that we provide to you, and the relative administrative activities supporting your treatment. We may be required by law to use and disclose your medical information for other purposes without your consent or authorization. You are provided the right to request and receive a copy of your medical information that we maintain, amend or correct that information, obtain an accounting and/or disclosure of your medical information, request that we restrict certain uses and disclosures of your health information, and/or complain if you feel your rights have been violated in any way. You have the right to receive a copy of our most recent notice in effect. If you have any questions or concerns about the notice or your medical information, please contact Sunshine Healing Arts. You may also send a written complaint to the US Department of Health and Human Resources.