Notice of Privacy Practices

Privacy practices and information

Effective Date: September 30, 2026

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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.

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This notice applies to protected health information maintained by Rose City Acupuncture, including electronic, paper, and verbal information about your health, treatment, and payment for care.

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Our Responsibilities

We are required by law to protect your health information, provide this notice, and follow the privacy practices described here. We must notify you as required by law following a breach of unsecured protected health information.

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We use a secure electronic medical records system and protect our computer and internet access with security controls. We do not retain credit card numbers or other financial account information. This does not mean that we do not maintain records of services, charges, or payments.

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How We May Use and Share Your Information

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Treatment. We may use your information to evaluate your health and provide acupuncture care. When permitted by law, we may share information with another healthcare provider involved in your treatment.

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Payment. We may use and disclose information to obtain payment for services, including submitting claims to a health insurer when applicable.

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Healthcare operations. We may use information to manage appointments, review care, maintain records, and operate our practice. Service providers handling protected health information on our behalf must have required privacy protections.

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Other legally permitted or required purposes. Subject to applicable safeguards, we may disclose information for:

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• Public health activities, product recalls, and adverse-event reporting

• Reporting abuse, neglect, or domestic violence

• Preventing a serious and imminent threat to health or safety

• Authorized healthcare oversight, audits, or investigations

• Workers’ compensation and qualifying law enforcement requests

• Court proceedings or other legal processes meeting applicable requirements

• Coroners, medical examiners, funeral directors, or organ donation organizations

• Research meeting applicable legal requirements

• Authorized military, national security, or other government functions

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We disclose information when legally required, including to the U.S. Department of Health and Human Services for HIPAA compliance review.

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Your Choices and Written Authorization

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We may share relevant information with people involved in your care or payment, or for disaster relief, when you agree or have an opportunity to object. If you cannot express a preference, we may share limited information when professional judgment indicates it is in your best interest.

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Uses or disclosures not otherwise permitted by law require your written authorization. This includes most uses or disclosures of psychotherapy notes, marketing requiring authorization, and sale of protected health information. We do not sell your personal information.

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You may revoke an authorization in writing, except to the extent we have already relied on it.

If we contact you for fundraising, you may opt out without affecting your treatment or payment.

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Specially Protected Records

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Additional federal or Oregon protections may apply to substance use disorder records, HIV-related information, mental health records, and genetic information. We follow those additional restrictions where applicable.

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If we receive substance use disorder patient records protected by 42 CFR Part 2, we will not use or disclose them in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or the required court order and subpoena.

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Before using Part 2 information for fundraising communications, we will provide clear advance notice and a choice about receiving those communications.

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Your Rights

Contact our privacy contact below to exercise these rights.

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Access your records. You may request inspection or an electronic or paper copy of your medical and billing records, subject to limited legal exceptions. We generally respond within 30 days. If a permitted extension is necessary, we will explain the delay and completion date in writing. A reasonable, cost-based copying fee may apply.

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Request corrections. You may request an amendment to information you believe is inaccurate or incomplete. We generally respond within 60 days. If we deny your request, we will explain why in writing and explain how you may submit a statement of disagreement.

Request confidential communications. You may ask us to contact you in a particular way or at a different address. We will accommodate reasonable requests.

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Request restrictions. You may ask us to limit information used or shared for treatment, payment, or healthcare operations. We generally are not required to agree.

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If you pay for a service entirely out of pocket and request that we not disclose information about that service to your health insurer for payment or healthcare operations, we must honor that request unless disclosure is required by law.

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Receive an accounting of disclosures. You may request a list of certain disclosures made during the preceding six years. The list excludes treatment, payment, healthcare operations, authorized disclosures, and other legally excluded disclosures. One accounting in a 12-month period is free; additional requests may involve a reasonable fee disclosed in advance.

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Receive this notice. You may request a paper copy at any time, even if you previously accepted an electronic copy.

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Use a personal representative. A person with verified legal authority to act for you may exercise your rights, subject to applicable exceptions.

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File a complaint. You may contact us or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

www.hhs.gov/hipaa/filing-a-complaint

We will not retaliate against you for filing a complaint.

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Changes to This Notice

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We may revise this notice and make revised practices apply to information we already maintain and information received later. The revised notice will display its effective date and be available in our office, on our website, and upon request.

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Privacy Contact

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For questions, requests, or complaints, contact:

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Sharon — Privacy Contact
Rose City Acupuncture
8249 SW Cirrus Drive
Beaverton, OR 97008

Phone: (503) 964-3422
Fax: (503) 388-7632
Email: sharon@rosecityacupuncture.com