NOTICE OF PRIVACY PRACTICES

Anjuna Sports Acupuncture
656 Charnelton Street, Eugene, OR 97401 | 541-653-8692

Effective Date: 5/16/2025

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.

Our Commitment

Anjuna Sports Acupuncture is required by law to maintain the privacy of your protected health information ("PHI"), to provide you this Notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI. We are required to follow the terms of the Notice currently in effect.

How We May Use and Disclose Your PHI Without Your Authorization

Treatment. To provide, coordinate, or manage your care. Example: we may share your treatment notes with your referring physician or physical therapist.

Payment. To bill and collect payment for services. Example: we may submit your diagnosis and treatment information to your insurer to obtain authorization or payment for a session.

Health Care Operations. For quality assessment, provider review, training, and business management. Example: we may review treatment records to evaluate clinical outcomes.

Business Associates. We may disclose PHI to vendors who perform services for us, such as billing and revenue cycle management. Each is bound by a written agreement requiring them to safeguard your PHI.

Appointment Reminders and Health Services. We may contact you by phone, text, email, or mail regarding appointments or treatment alternatives.

As Required or Permitted by Law. Including public health activities, reporting abuse or neglect, health oversight, judicial and administrative proceedings, law enforcement, coroners and medical examiners, organ donation, research, serious threats to health or safety, specialized government functions, and workers' compensation.

Uses and Disclosures Requiring Your Written Authorization

Your written authorization is required for: 

(1) most uses and disclosures of clinical notes; 

(2) uses and disclosures for marketing purposes; 

(3) disclosures constituting a sale of PHI; and 

(4) any other use or disclosure not described in this Notice. 

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your Rights

Right to Request Restrictions (§ 164.522). You may request restrictions on our use or disclosure of your PHI. We are not required to agree, except that we must agree to your request to restrict disclosure to a health plan for a service you have paid for in full, out of pocket, where the disclosure is for payment or health care operations and is not otherwise required by law.

Right to Confidential Communications. You may request that we communicate with you at an alternative address or by alternative means.

Right to Access and Obtain Copies (§ 164.524). You may inspect and obtain a copy of your PHI in a designated record set, including an electronic copy where we maintain it electronically. We will respond within 30 days and may charge a reasonable, cost-based fee.

Right to Amend (§ 164.526). You may request an amendment to PHI you believe is inaccurate or incomplete. We may deny the request and will explain why in writing; you may submit a statement of disagreement.

Right to an Accounting of Disclosures (§ 164.528). You may request a list of certain disclosures made in the six years prior to your request. The first accounting in any 12-month period is free.

Right to Breach Notification. You will be notified in the event of a breach of your unsecured PHI.

Right to a Paper Copy. You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Our Duties

We are required by law to maintain the privacy and security of your PHI, provide this Notice, abide by its terms, and notify you of breaches. We reserve the right to change this Notice and to make revised terms effective for all PHI we maintain. Revised notices will be posted at our clinic and on our website, and a copy will be available upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201; 1-877-696-6775; 

www.hhs.gov/ocr/privacy/hipaa/complaints/. 

You will not be retaliated against for filing a complaint.

Contact

Privacy Officer, Anjuna Sports Acupuncture
656 Charnelton Street, Eugene, OR 97401
541-653-8692 | info@anjunasportsacupuncture.com