Privacy Notice and Authorization

As you are no doubt aware, Federal privacy requirements known as HIPAA privacy regulations, obligate most physician practices to provide notice about privacy rights and detailed policies designed to protect your privacy. These requirements were put in place because so much personal health information is now being shared in digital format over computer networks. Because Dr. Lonsdorf does not bill electronically or otherwise share personal health information in digital format this office is not subject to the detailed provisions of the HIPAA privacy regulations.

Nonetheless, you should be assured that Dr. Lonsdorf remains committed to protecting personal health information confidentiality. You should understand the following with regard to how we treat your personal health information, which includes medical and mental health information:

1)If you wish records sent to a health provider you have not yet seen, a family member, an attorney, or other party outside of this list, you must first sign a release of information before we can forward your information. We do not provide personal health information directly to your insurance company without your additional written consent. Under certain conditions, we may provide you with a receipt for services that is submittable to private insurers.We cannot provide submittable receipts to Medicare recipients, however we can provide general receipts suitable for tax or other personal purposes.

2) We cannot release information to family members, other than parents or legal guardians, even if they are involved in your care, without your written permission.

3) In order to ensure quality of care, Dr. Lonsdorf’s records are occasionally reviewed both internally and by outside consultants in legal, clinical, record keeping and other concerns that affect the quality of the services we provide. Only necessary information is accessed, and any such review is performed by professional staff working under the condition of confidentiality.

4) If you wish to limit the nature of information that is released, or the parties noted above to whom information may be provided, please ask to meet with Dr. Lonsdorf office manager to discuss these limitations. In some instances, Dr. Lonsdorf may not be in a legal position to honor requested limitations, or there may be consequences that you need to be aware of, such as limitations upon the coordination or quality of care delivered. It is best to discuss any such concerns in advance.

5) You may revoke authorization for the future release of information in writing. We may in that event, however, decline to provide further treatment.

6) We may be required by law, in some cases, to make disclosures of your record that you have not authorized. Examples are subpoenas in criminal or civil litigation, or requests/surveys by licensure or other regulatory agencies.

7) While the records of the care we provide are the practice’s property, we will make them available for your inspection and provide copies at a reasonable fee. If you have any concerns about your health records, please discuss this with Dr. Lonsdorf’s medical records personnel. Dr. Lonsdorf reserves the right to charge for the copying and forwarding of your health records.

Dr. Lonsdorf will provide appointment reminders, as well as other scheduling issues, by email.She will notify you of your lab results through your private “myupdox” portal, a method that ensures privacy and is HIPAA compliant.

Forms of Communication, Patient or Client Election

Important Notices: E-mail is not a secure and confidential method of communicating health information. E-mail services may scan terms for advertising opportunities, third-party “hackers” may attempt to access your account or family and friends may have access to your e-mail. If you e-mail us you thereby accept the risk of the lack of security for your own e-mail and our answers. Patients are responsible for securing their part of the communication and are strongly encouraged to use your “myupdox” message portal for all communications other than scheduling.For scheduling issues, the fastest response will come by emailing healthoffice@drlonsdorf.com or calling the office phone number.

Coaching clients only— Coaching clients who do not have a “myupdox” portal account are encouraged to call the office phone number or text Dr. Lonsdorf directly if they have medical information to convey.Intake forms are through a HIPAA-compliant platform and secured to acceptable standards for electronic health records.For added comfort, you may also use only your first name or initials when filling out personal health information solely for coaching purposes.

E-mail communication is appropriate to to confirm or request scheduling, to ask simple questions that don’t require discussion, to clarify instructions or ask a question about recommendations made during your office visit (preferably, use “myupdox” for complete privacy regarding any personal health information, explicit or implied.) E-mail communication is not appropriate for communicating urgent or emergency information or discussing personal health information.

E-mail and “Myupdox” communications do not take the place of an office consultation. If you think you need to be seen, please book an appointment. Staff other than Dr. Lonsdorf may check the inbox to handle routine matters and may read your communications. It is important to keep in mind that there may be a delay before staff can check and read the message you sent. Messages are generally not checked over the weekend or holidays.

E-Mail: I have read the notice above and understand the security limitations with electronic communication. I agree to use e-mail communication in accordance with the above policies. I understand that even if I do not show agreement to the use of e-mail on this form, if at some time I initiate e-mail communication I signal my acceptance of these terms and for return communication via e-mail.

Telephone Communication: I give permission for Dr. Lonsdorf practitioners or staff to contact me via telephone at the number I have provided and leave a message that may contain appointment information if I am not available.

Notice of Information/Privacy Practices

This "Notice of Information/Privacy Practices" is used to inform website visitors regarding our policies with the collection, use, and disclosure of Personal Information if anyone decided to use our Service.

If you choose to use our Service, then you agree to the collection and use of information in relation with this policy. The Personal Information that we collect are used for providing and improving the Service. We will not use or share your information with anyone except as described in this Privacy Policy.

Information Collection and Use

For a better experience while using our Service, we may require you to provide us with certain personally identifiable information, including but not limited to your name, phone number, and postal address. The information that we collect will be used to contact or identify you.

Log Data

We want to inform you that whenever you visit our Service, we collect information that your browser sends to us that is called Log Data. This Log Data may include information such as your computer’s Internet Protocol ("IP") address, browser version, pages of our Service that you visit, the time and date of your visit, the time spent on those pages, and other statistics.

Cookies

Cookies are files with small amount of data that is commonly used an anonymous unique identifier. These are sent to your browser from the website that you visit and are stored on your computer’s hard drive.

Our website uses these "cookies" to collection information and to improve our Service. You have the option to either accept or refuse these cookies, and know when a cookie is being sent to your computer. If you choose to refuse our cookies, you may not be able to use some portions of our Service.

Service Providers

We may employ third-party companies and individuals due to the following reasons:

To facilitate our Service;
To provide the Service on our behalf;
To perform Service-related services; or
To assist us in analyzing how our Service is used.

We want to inform our Service users that these third parties have access to your Personal Information. The reason is to perform the tasks assigned to them on our behalf. However, they are obligated not to disclose or use the information for any other purpose.

Security

We value your trust in providing us your Personal Information, thus we are striving to use commercially acceptable means of protecting it. But remember that no method of transmission over the internet, or method of electronic storage is 100% secure and reliable, and we cannot guarantee its absolute security.

Links to Other Sites

Our Service may contain links to other sites. If you click on a third-party link, you will be directed to that site. Note that these external sites are not operated by us. Therefore, we strongly advise you to review the Privacy Policy of these websites. We have no control over, and assume no responsibility for the content, privacy policies, or practices of any third-party sites or services.

Changes to This Privacy Policy

We may update our Privacy Policy from time to time. Thus, we advise you to review this page periodically for any changes. We will notify you of any changes by posting the new Privacy Policy on this page. These changes are effective immediately, after they are posted on this page.

Coaching for Mind-Body Balance – Personal Profile

Coaching for Mind-Body Balance

Personal Profile

Section 1: Contact Information

Section 2: Vital Statistics