Privacy Policy
Personal Health Information will be handled by the policies listed in our privacy policy and in this this form which abides by HIPAA guidelines. I understand and agree to these policies.This form is a friendly version. A more complete text is available in our office if asked for. What this is all about? Specifically, there are rules and restrictions on who may see or be notified of your Protected Health Information (PHI). These restrictions do not include the normal interchange of information necessary to provide you with office services. HIPAA provides certain rights and protections to you as the patient. We balance these needs with our goal of providing you with quality professional service and care. The personal health Information contained in this health intake form is confidential, and will only be used to facilitate your treatments both today and in the future, and in accordance with our privacy policy. I have been supplied a copy of the privacy policy and agree to the terms contained within it. As per the privacy policy, client health, treatment history and contact information will be shared between employees, contractors and independent therapists who assist in your treatments, billing, collections and scheduling as necessary. Your contact information will added to our databases for the purpose of feedback, follow up, scheduling, administration and/or to provide you with additional offers from Planet Massage. By notifying Planet Massage in writing, I understand I may opt out at any time of news and promotions which are typically sent out no more than once or twice a month to our preferred clients. Please note if you have any specific contact preference, or do NOT want to be contacted by us for any promotional purposes. Audio monitoring and or recording may be used on premises for the purpose of security, quality control and training. We have adopted the following polices: 1. Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately. This specifically includes sharing of information with other healthcare providers, health insurance payers, subcontractors, vendors and business associates as is necessary and appropriate for your care. The normal course of providing care means that such records may be left, at least temporarily, in administrative areas such as the front office, examination room, etc. Those records will not be available to persons other than office staff , support staff and therapists.
1) You agree to the normal procedures utilized within the office for handling of charts, patient records, PHI and other documents or information.
2) It is the policy of this office to remind patients of their appointments by text phone and email.
3) We may send you other communications informing you of changes to office policy and new technology that you might find valuable or informative.
3) The practice utilizes a number of vendors in the conduction of business. These vendors may have access to PHI but must agree to abide by the confidentiality rules of HIPAA
4) You agree to bring any concerns or complaints regarding privacy to the attention of the office manager.
5) We agree to provide patients with access to their records in accordance with state and federal laws.
6) We may change, add, delete or modify any of these provisions to better serve the needs of both the practice and patient at any time without notice.
7) You have the right to request restrictions in the use of your protected health information and to request change in certain policies used with the office concerning your PHI. However, we are not obligated to alter internal polices to conform to your request. I, do hereby consent and acknowledge my agreement to the terms set forth in the HIPAA INFORMATION FORM and any subsequent changes in office policy.
8) I understand that this consent shall remain in force from this time forward. As affixing my signature electronically on this form.
