THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice tells you about the ways Four Rivers Naturopathic Clinic, PC, may collect, store, use and disclose your protected health information, and your rights concerning that information. “Protected Health Information” is information about you that can reasonably be used to identify you and that relates to your past, present or future physical or mental health or condition, the provision of health care to you, or the payment for that care.
Federal and state laws require us to provide you with this Notice about your rights and our legal duties and privacy practices with respect to your protected health information. We must follow the terms of this Notice while it is in effect. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
We may use and disclose your protected health information for different purposes. The examples below illustrate the types of uses and disclosures we may make without obtaining your authorization.
Payment. We may use and disclose your protected health information in connection with payment for health care services. For example, we may use your information to process lab orders or assist you in obtaining reimbursement from your insurance company.
Treatment. We may use and disclose your protected health information to assist your other health care providers in your diagnosis and treatment.
Health Care Operations. We may use and disclose your protected health information in order to perform various operational activities, such as quality assessment, training, and administration.
OTHER PERMITTED OR REQUIRED DISCLOSURES
As Required by Law. We must disclose protected health information about you when required to do so by law.
Public Health Activities. We may disclose your protected health information to public health agencies for reasons such as preventing or controlling disease, injury or disability.
Victims of Abuse, Neglect or Domestic Violence. We may disclose your protected health information to government agencies about abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose protected health information to government oversight agencies for activities authorized by law.
Judicial and Administrative Proceedings. We may disclose protected health information in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Law Enforcement. We may disclose protected health information under limited circumstances to a law enforcement official in response to a warrant or similar process; to identify or locate a suspect; or to provide information about the victim of a crime.
Coroners or Funeral Directors. We may release protected health information to coroners or funeral directors as necessary to allow them to carry out their duties.
Research. Under certain circumstances, we may disclose protected health information for research purposes, provided certain measures have been taken to protect your privacy.
To Avert a Serious Threat to Health or Safety. We may disclose protected health information about you, with some limitations, when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Special Government Functions. We may disclose information as required by military authorities or to authorized federal officials for national security and intelligence activities.
Workers’ Compensation. We may disclose protected health information to the extent necessary to comply with state law for workers’ compensation programs.
OTHER USES OR DISCLOSURES REQUIRING YOUR AUTHORIZATION
Other uses or disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent that we have already taken action in reliance on that authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Right to Access Your Protected Health Information. You have the right to review or obtain copies of your protected health information records, with some limited exceptions. Requests must be made in writing. We may charge a reasonable fee for the costs of producing, copying, or transmitting your requested information, but we will inform you of the cost in advance.
Right to Amend Your Protected Health Information. If you believe that your protected health information maintained by Four Rivers Naturopathic Clinic, PC, is incorrect or incomplete, you may request that we amend it. Your request must be made in writing and must include the reason you are seeking the change. We may deny your request if, for example, the information was not created by a doctor at Four Rivers Naturopathic Clinic, or the record is already accurate and complete. If we deny your request, we will notify you in writing, and you have the right to submit a written statement of disagreement.
Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures we have made of your protected health information. This list will not include disclosures related to your treatment, payment, or health care operations, or disclosures made to you or with your authorization. Your request must be made in writing and must state the time period for which you want an accounting, which may not exceed six years.
Right to Request Restrictions. You have the right to request that we restrict or limit how we use or disclose your protected health information for treatment, payment, or health care operations. We may not agree to your request. If we do agree, we will comply with your request unless the information is needed for an emergency. Requests must be made in writing and must specify what information you want to limit, whether you want to limit use, disclosure, or both, and to whom the restrictions should apply.
Right to Receive Confidential Communications. You have the right to request that we communicate with you in a specific way or at a specific location if standard communication could endanger you. Your request must be made in writing, must clearly state that the communication could endanger you, and must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right at any time to request a paper copy of this Notice, even if you previously agreed to receive it electronically.
HEALTH INFORMATION SECURITY
Four Rivers Naturopathic Clinic, PC maintains physical, administrative, and technical security measures to safeguard your protected health information. Patient health records are maintained electronically through our HIPAA-compliant electronic health records system (Charm Health). Access to your health information is limited to staff members who require it to perform their job responsibilities. Secure electronic communication with patients is conducted through the Charm patient portal.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time, effective for protected health information we already have about you as well as information we receive in the future. Any time we make a material change to this Notice, we will revise it and post the updated version with a new effective date. You may request a current copy at any time.
COMPLAINTS
If you believe we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may file a complaint by contacting us at the address below. You may also file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you or penalize you in any way for filing a complaint.
OUR LEGAL DUTY
We are required by law to protect the privacy of your protected health information, to provide this Notice about our information practices, and to follow the information practices described in this Notice.
CONTACT INFORMATION
To exercise any of the rights described above, or for any questions regarding this Notice, please contact us at: Four Rivers Naturopathic Clinic, PC 101 Orange Street, Suite B Auburn, CA 95603 530-823-1335, [email protected]
Notice of Privacy Practices — Effective June 1, 2026