HIPPA and Email Policy

The federal government requires all medical offices to make patients aware that they have rights regarding the use of their personal health information.

You consent to our use and disclosure of protected health information according to the Notice of Privacy Practices available to you at our front desk. You have the right to revoke this consent at any time, in writing. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior consent. Matrix Wellness provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operation. This request must be done in writing. We will honor your request whenever possible.

The patient understands that:
• We will not release information to any future doctor, attorney, life insurance company, workman’s comp company without your written consent.
• Protected health information may be used for treatment through one of your current doctors, payment with your insurance company, or healthcare operations within our office.
• Matrix Wellness has a Notice of Privacy Practices that is available for review.
• Matrix Wellness reserves the right to change the Notice of Privacy Practices.
• The patient has the right to restrict the use of their information, but Matrix Wellness does not have to agree to these restrictions if, for example, it interferes with treatment, payment, or daily operations.
• The patient may revoke this consent in writing at any time and all future disclosures will then cease.
• Matrix Wellness may condition treatment upon the execution of this consent.
• You have the right to be notified of a protected health information breach.
• Matrix Wellness cannot sell your health information without your permission.
• Certain uses of your medical data, such as use of patient information in marketing, require prior disclosure and your authorization. Uses and disclosures not described in the Notice of Privacy Practice will only be made with your authorization.

E-mail offers a convenient and efficient way to communicate between doctor and patient. Unfortunately, due to the size of our clinic, we cannot afford a dedicated and encrypted e-mail server that would be 100% secure. If you choose to communicate with one of the providers via their professional email accounts, you should know that they are not a secure and HIPAA-compliant method of communication. It is possible that medical information, if sought by a third party, could be intercepted by hacking into email server hosts. The risk of this is very small but it is our duty to bring this to your attention. By acknowledging this policy, you are accepting the risks for that given form of communication and absolve any provider at Matrix Wellness from liability under medical privacy law for these communications.