Benicia Wellness Center's Privacy Practices

Effective April 24, 2003
Updated to include HITECH requirements on September 1, 2013

To our patients
This notice describes how health information about you, as a patient of this practice, may be used and disclosed, and how you can gain access to your health information. This is required by the Privacy Regulations created as a result of the Health Information Portability and Accountability Act of 1996 (HIPAA).

Our commitment to your privacy
Benicia Wellness Center (BWC) is dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information. Our office realizes that these laws are complicated, but we must provide you with the following important information.

Use and disclosure of your health information is allowed in certain special circumstances:

Your Authorization
Except as outlined below, we will not use or disclose your Protected Health Information (PHI) unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing except to the extent that we have taken action in reliance upon the authorization or that the authorization was obtained as a condition of obtaining coverage under a group health plan, and we have the right, under other law, to contest a claim under the coverage or the coverage itself.

BWC must notify you in case of a breach of unsecured PHI.

Uses and Disclosures for Payment
We may make requests, uses, and disclosures of your PHI as necessary for payment purposes. For example, we may use information regarding your medical procedures and treatment to process and pay claims. We may also disclose your PHI for the payment purposes of a health care provider or a health plan.

Uses and Disclosures for Health Care Operations
We may use and disclose your PHI as necessary for our health care operations. Examples of health care operations include activities relating to the creation, renewal, or replacement of your health insurance coverage, reinsurance, compliance, auditing, rating, business management, quality improvement, and assurance.

Family and Friends Involved in your Care
If you are available and do not object, we may disclose your PHI to your family, friends, and others who are involved in your care or payment of a claim. If you are unavailable or incapacitated, and we determine that a limited disclosure is in your best interest, we may share limited PHI with such individuals. For example, we may use our professional judgment to disclose PHI to your spouse concerning the processing a claim.

Business Associates
At times, we use outside persons or organizations to help us provide you with the best services available. Examples of these outside persons include massage therapists and radiology consultants.

Other Products and Services
We may contact you to provide information about other health-related products and services that may be of interest to you. For example, we may use and disclose your PHI for the purpose of communicating to you about your health and health-related products we have available to you.

Other Uses and Disclosures
We may make certain other uses and disclosures of your PHI without your authorization. We may disclose your PHI:

»For any purpose required by law. For example, we may be required by law to use or disclose your PHI to respond to a court order.

»For public health activities, such as the reporting of a disease, injury, birth & death, and for public health investigations.

»To the proper authorities if we suspect child abuse or neglect; we may also disclose your PHI if we believe you to be the victim of abuse, neglect, or domestic violence.

»If authorized by law to a government oversight agency (e.g. a state insurance department) conducting audits, investigations, or civil criminal proceedings.

»In the course of a judicial or administrative proceeding (e.g. to respond to a subpoena or discovery request).

»To coroners, medical examiners, and/or funeral directors, as consistent with the law.

»For cadaveric organ, eye, or tissue donation.

»For research purpose, but only as permitted by law.

»To avert a serious threat to health or safety.

»If you are a member of the military as required by armed forces services, and we may also disclose your PHI for other specialized government functions such as national security or other intelligence.

»To worker’s compensation agencies for your workers’ compensation benefit determination.

We will, if required by law, release your PHI to the Secretary of the Department of Health and Human Services for enforcement of HIPAA. In the event that applicable law, other than HIPAA, prohibits or materially limits our uses and disclosures of Protected Health Information as described above, we will restrict our uses or disclosure of your PHI in accordance with the more stringent standard.

Your rights regarding your health information:

1. Right to Request Restrictions: You have the right to request disclosure restrictions of PHI to a health plan with respect to healthcare for which you have paid out of pocket in full, where not elsewhere restricted by law.

  1. BWC is required by law to provide to you a timely notification of all demonstrated breaches of your PHI.

  2. Communications: You can request that BWC communicates with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that Benicia Wellness Center contact you at home, rather than work. BWC will accommodate reasonable requests.

  3. You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations. Additionally, you have the right to request that BWC restrict our disclosure of your health information only to certain individuals involved in your care or the payment of your care, such as family members and friends. BWC are not required to accommodate your request; however, if your request is granted, we are bound by the stipulations of our agreement, except where otherwise required by law, in emergencies, or when the information in necessary to treat you.

  4. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you and your health care, including electronic or paper patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to our Privacy Official.

  5. You may ask us to amend your health information if you believe it to be incorrect or incomplete, and as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Official. You must provide us with a reason that supports your request for the amendment.

  6. Right to a copy of this notice: You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, contact our Privacy Official.

  7. Right to File a Complaint: If you believe your privacy rights have been violated, you may file a formal complaint with our practice or with the Regional Office for Civil Rights, US Department of Health and Human Services. Regional Office information may be found on their website,, or you may ask the Privacy Official for this information. To file a complaint with our practice, contact our Privacy Official. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

  8. Right to provide an authorization for other uses and disclosures: Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

Benicia Wellness Center’s Policy:

In accordance with the standards of implementation specifications of 45 C.F.R. § 164.524, Benicia Wellness Center may grant an individual access to inspect and obtain a copy of Protected Health Information about the individual in a designated record set.

1. The designated record set that is subject to access by an individual is as follows:

a. Medical Records

b. Billing Records

c. List of all those requesting copies of designated record set

2. The Privacy Official is responsible for receiving and processing requests for access by individuals.

3. In compliance with federal and state law, our practice destroys medical and billing records (both in paper and electronic form) 5 years from the patient’s last date of service.

            a. If the patient was a minor at the time of treatment, their medical and billing records will be kept until the patient turns 19, or 5 years from the last date of service, whichever comes later.

           b. BWC only uses methods of record destruction that will ensure that no identifiable information will be at risk of disclosure during the process of destruction. All methods of destruction used by our office are compliant with state and federal law.

4. All medical and billing records processed for destruction will be entered into the Health Record Destruction Log, which is maintained by the Privacy Official for tracking purposes. A copy of BFC’s and BFM’s full Destruction of Health Records Protocol can be made available upon request.

If you have any questions regarding this notice or our health information privacy policies, would like to request to view your private health information, or would like a copy of this and other office policies please contact:

Benicia Wellness Center
Attn: Privacy Official
1075 First Street Suite 3
Benicia, CA 94510

Messages may be left for our Privacy Official at any time the office is open and your call will be returned within 7 business days. Messages can also be left after hours; upon receipt of your message, your call will be returned in 7 business days. Please contact: 707-745-2345.