Effective Date: January 1, 2024

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Spa by HorizonView is committed to protecting the privacy and security of your health information. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (“PHI”), your rights regarding your health information, and our legal responsibilities under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other applicable federal and state privacy laws.

Protected Health Information includes individually identifiable information relating to your past, present, or future physical or mental health or condition, healthcare services you receive, or payment for your healthcare.

We may use or disclose your PHI as permitted or required by law. Common uses and disclosures include:

We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This may include sharing information with physicians, nurse practitioners, nurses, medical assistants, pharmacies, laboratories, specialists, or other healthcare professionals involved in your care.

For example, information regarding medications, laboratory results, medical history, allergies, or previous treatments may be shared with a healthcare professional involved in determining or providing appropriate treatment.

We may use and disclose PHI as necessary to bill for and obtain payment for healthcare services, when applicable. This may include communications involving payment processors, health plans, or other parties responsible for payment.

We may use and disclose PHI for activities necessary to operate our practice and improve the quality of care we provide. These activities may include quality assessment, staff training, credentialing, compliance activities, audits, business planning, customer service, and administrative functions.

We may use your contact information to communicate with you regarding appointments, follow-up care, treatment instructions, laboratory results, medications, or other healthcare-related matters.

When appropriate and permitted by law, we may share relevant health information with a family member, friend, caregiver, or other person involved in your care or payment for your care.

You may tell us if you do not want us to share information with a particular individual.

We may disclose PHI to third-party service providers that perform services on our behalf when those services involve PHI. When required by HIPAA, these business associates must appropriately safeguard your health information.

We may disclose PHI when permitted or required by law for certain public health and safety purposes, including:

• Reporting certain diseases or adverse events;
• Preventing or reducing a serious threat to health or safety;
• Reporting suspected abuse, neglect, or domestic violence when required or permitted by law;
• Health oversight activities;
• Product recalls or safety notifications; and
• Other legally authorized public health activities.

We may disclose PHI when required or permitted by applicable law, including certain disclosures involving:

• Court or administrative proceedings;
• Law enforcement;
• Health oversight agencies;
• Workers' compensation programs;
• Coroners or medical examiners;
• Organ and tissue donation;
• Certain research activities;
• National security activities; and
• The U.S. Department of Health and Human Services for HIPAA compliance investigations or reviews.

Uses and disclosures of your PHI that are not otherwise permitted or required by law generally will be made only with your written authorization.

If you provide authorization, you may revoke that authorization in writing at any time, except to the extent that we have already acted in reliance upon it.

We will obtain your authorization before using or disclosing PHI for purposes for which HIPAA requires authorization, including certain marketing activities or the sale of PHI.

You have important rights concerning your Protected Health Information.

You have the right to request access to, inspect, and obtain a paper or electronic copy of PHI maintained in your designated record set, with limited exceptions provided by law.

To request your records, contact our office at 253-200-1400 or Office@TheSpabyHV.com.

We may charge a reasonable, cost-based fee when permitted by law.

If we deny your request in whole or in part, we will provide information regarding the denial and any applicable rights to review.

If you believe information in your medical or health record is incorrect or incomplete, you may request that we amend or correct the information.

Your request should identify the information you believe is incorrect or incomplete and explain the reason for the requested amendment.

We may deny a request under circumstances permitted by law. If the request is denied, we will provide you with information about the denial and applicable rights to submit a statement of disagreement.

You have the right to ask us to limit certain uses or disclosures of your PHI for treatment, payment, or healthcare operations.

We are generally not required to agree to all requested restrictions. However, when required by law, we will comply with applicable restrictions.

If you pay for a healthcare item or service completely out-of-pocket and request that we not disclose information about that item or service to your health plan for payment or healthcare operations, we will comply when required by HIPAA unless disclosure is otherwise required by law.

You have the right to request that we communicate with you about your health information in a particular manner or at an alternative location.

For example, you may request that we contact you only at a particular telephone number, email address, or mailing address.

We will accommodate reasonable requests as required by law.

You have the right to request a list, or “accounting,” of certain disclosures we have made of your PHI.

Not every disclosure is included in an accounting. For example, HIPAA generally excludes certain disclosures made for treatment, payment, and healthcare operations.

Contact our office to request an accounting of disclosures.

You have the right to obtain a paper or electronic copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Copies are available through our office and on our website.

If you have given someone medical power of attorney or if someone is otherwise legally authorized to act on your behalf, that individual may exercise your HIPAA rights as permitted by law.

We may verify that the person has the appropriate authority before taking action.

If you believe your privacy rights have been violated, you have the right to file a complaint with The Spa by HorizonView.

Complaints may be submitted to:

Privacy Officer
The Spa by HorizonView
201 15th Ave SW, Suite D
Puyallup, WA
Phone: 253-200-1400
Email: Office@TheSpabyHV.com

Please describe your privacy concern and provide sufficient information for us to investigate and respond.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).

Information regarding filing a HIPAA complaint is available through the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint or exercising any of your privacy rights.

The Spa by HorizonView is required by law to:

• Maintain the privacy and security of Protected Health Information;
• Provide you with this Notice describing our legal duties and privacy practices;
• Follow the duties and privacy practices described in the Notice currently in effect;
• Maintain appropriate administrative, technical, and physical safeguards to protect PHI;
• Limit uses and disclosures of PHI as required by applicable law;
• Notify affected individuals following a breach of unsecured PHI when notification is required by law; and
• Comply with applicable federal and Washington State privacy requirements.

We will not use or disclose your health information for purposes other than those described in this Notice unless permitted by law or you provide written authorization.

Washington State law may provide additional privacy protections for certain categories of health information. When Washington law provides greater privacy protection or imposes stricter requirements than HIPAA, we will comply with applicable Washington law.

Certain types of health information may be subject to additional confidentiality requirements and may require specific authorization before disclosure.

Electronic communication, including email and text messaging, may involve privacy and security considerations. We take reasonable measures to safeguard electronic PHI and comply with applicable privacy and security requirements.

Please contact our office if you would like to request an alternative or more confidential method of communication.

We reserve the right to change the terms of this Notice and our privacy practices as permitted by law. Changes may apply to PHI we already maintain as well as information we receive in the future.

If we materially change this Notice, the revised Notice will be made available upon request, posted at our office as required, and posted on our website.

The effective date appearing at the beginning of the Notice indicates when the current Notice became effective.

For questions about this Notice, to exercise your privacy rights, request medical records, request an amendment, request confidential communications, request restrictions, obtain an accounting of disclosures, or file a privacy complaint, contact:

Privacy Officer
The Spa by HorizonView
201 15th Ave SW, Suite D
Puyallup, WA
Phone: 253-200-1400
Email: Office@TheSpabyHV.com

Effective Date: January 1, 2024