Notice of Privacy Practices

Effective Date: 05/01/2012

**Important Information about Your Health Information – Please Read Carefully**

This notice describes how your health information may be used and disclosed and how you can access this information. At Cascade Integrative Medicine (“CIM”), we are committed to maintaining the confidentiality and privacy of your health information. We are required by law to provide this notice and to follow its terms. The Health Insurance Portability and Accountability Act (HIPAA) permits us to use or disclose your health information for various purposes, as outlined below.

Uses and Disclosures of Health Information

1. Treatment: We may use or disclose your health information to those involved in your treatment. For example, a specialist doctor whom we may involve in your care may conduct a review of your file.

2. Payment: We may disclose your health information for the purpose of payment. For instance, we may be required to send a report of your progress to your insurance company.

3. Healthcare Operations: Your health information may be used for normal healthcare operations. For example, our staff may enter your information into our computer system.

4. Communication: We may use your health information to contact you. This includes sending you information via email or making phone calls. If you are not available, we may leave information on your voicemail or with the person who answers the phone.

5. Emergency Situations: In an emergency, we may disclose your health information to a family member or another person responsible for your care.

6. Legal Requirements: We may release some or all of your health information when required by law, including legal proceedings, cases of child or dependent adult abuse or neglect, and cases of imminent danger to yourself or others.

7. Prior Authorization: Except as described above, we will not use or disclose your health information without your prior written authorization. You have the right to request in writing that we do not use or disclose your health information as described above. We will inform you if we can fulfill your request.

8. Additional Uses and Disclosures: You have the right to be informed of any uses or disclosures we make with your health information beyond the normal uses outlined above.

9. Contact Information: As we may need to contact you from time to time, we will use the address or telephone number you prefer.

10. Transfer of Health Information: You have the right to request copies of your health information to be transferred to another practice. Please provide a written request specifying the information you want to have sent. A reasonable fee may be charged for copies of your records.

11. Request for Amendment: You have the right to request an amendment or change to your health information. Please submit your request in writing. If you wish to include a statement in your file, please provide it in writing. While we may or may not make the changes you request, we will include your statement in your file. If we agree to an amendment or change, we will not remove or alter earlier documents but will add new information.

12. Right to Receive a Copy: You have the right to receive a copy of this notice. If we make changes to the notice, we will notify you of the changes in writing.

Complaints and Contact Information

If you have any concerns or wish to file a complaint regarding the privacy of your health information, you may contact the Department of Health and Human Services at the following address:

Department of Health and Human Services
200 Independence Ave SW, Room 509F
Washington, DC 20201

Filing a complaint will not result in retaliation, and your rights will be protected. For further information or assistance concerning the privacy of your health information, please contact Cascade Integrative Medicine using the following information:

Cascade Integrative Medicine
Phone: (425) 391-5270
Mailing Address: 450 NW Gilman Blvd, Ste 201, Issaquah, WA 98027

At CIM, we value your privacy and are committed to safeguarding your health information. We encourage you to review this notice and reach out to us with any questions or concerns.