Notice of Privacy Practices
This notice describes how your health information may be used and disclosed, and how you can obtain access to it. Please review this notice carefully.
This notice of the Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out assessments and recommendations, payment, wellness-related operations, and other purposes permitted or required by law. It describes your rights to access and control your PHI. “Protected health information” is information about you, including demographic information, that may identify you as related to your past, present, or future physical or mental health or conditions and related wellness services.
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.
USES AND DISCLOSURES OF PHI
Your protected health information may be used and disclosed by your doctor, our office staff, and others outside of our office that are involved in care and treatment offered by this office for the purposes of providing wellness services to you, to pay your wellness care bills, to support the operation of the provider’s practice and any other use required by law.
We will use and disclose your PHI to provide, coordinate, or manage your wellness care and related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care for you. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the doctor/physician has the necessary information to diagnose or treat you.
Your PHI will be used as needed to obtain payment for your health care services. This is a pay-at-time-of-service practice. We may use and share PHI for services we provide to you and to collect payment for the service billed to you or a third party. We may also share PHI with another provider, for example, Ulta Labs, so that provider can bill and collect for services you receive.
We may use or disclose, as needed, your PHI in order to support the business activities of your provider’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, credentialing, and conducting or arranging for other business activities. In addition we may use a sign in sheet at the registration desk where you will be asked to sign your name and indicate the purpose of your visit. We may also call you by your name in the waiting room when your provider is ready to see you.
Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting. Child and elder abuse or neglect, or danger to self or others are examples of government-mandated reporting.
PUBLIC HEALTH REPORTING
Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
INFORMATION ABOUT TREATMENTS
Other uses and disclosures of your protected health information require your authorization. Disclosure of your protected health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
You have certain rights under federal privacy standards. These include:
The right to request restrictions on the use and disclosure of your protected health information
The right to receive confidential communications concerning your wellness status and progress
The right to inspect and copy your protected health information
The right to amend or submit corrections to your protected health information
The right to receive an accounting of how and to whom your protected health information has been disclosed
The right to receive a printed copy of this notice
RIGHT TO REVISE PRIVACY PRACTICES
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.
REQUESTS TO INSPECT PROTECTED HEALTH INFORMATION
You may generally inspect or obtain copies of your protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
HIPAA PRIVACY STANDARDS: COMPLAINTS
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:
Dr. ‘Lia R. Javadi Limited Liability Company
3260 W. Henderson Rd, Suite 100, Office B
Columbus, OH 43220
If you believe your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
Informed Consent for Treatment
I, the patient, hereby authorize ‘Lia R. Javadi, BCND, to perform the following specific procedures as necessary to facilitate my assessment and recommendations.
COMMON ASSESSMENT PROCEDURES
Collection and testing of body fluids, iridology, strong muscle testing, RBTI
Botanical substances may be recommended, such as teas, alcohol- or glycerite-based tinctures; capsules, supplements, tablets; creams, plasters, or suppositories; essential oils, flower remedies.
The use of highly dilute quantities of naturally occurring plants, animals, and minerals to gently stimulate the body’s healing responses may be recommended.
Recommendations for food and water, promotion of wellness including recommendations for exercise, sleep, stress reduction, weight management, and balancing of work and social activities will be made.
Acupressure, foot and hand hydrotherapy, Raindrops technique, reflexology and VitaFlex are part of this practice.
IMMUNE SUPPORT EDUCATION
Traditional Naturopathic Doctors do not offer vaccinations. Dr. Javadi is happy to discuss immune support recommendations. You should contact your primary physician or local pharmacist for vaccines.
Clients should recognize potential risks and benefits of these procedures as described below:
Although all preventative measures are taken, allergic reactions to and side effects of recommended herbs, supplements, essential oils, and subtle remedies can occur, as can aggravation of pre-existing symptoms, discomfort, pain, nausea, lightheadedness, inconvenience of lifestyle changes; and potential injury or infection from venipuncture or procedures. Notify the doctor if you experience any symptoms which may be secondary to the above procedures and/or go to an urgent care or emergency room.
Restoration of health and the body’s maximal functional capacity without the use of drugs or surgery, relief of pain and symptoms of discomfort, wellness optimization, and prevention of disease or its progression.
NOTICE TO PREGNANT WOMEN
All female patients must alert the doctor if they know or suspect that they are pregnant as some of the interventions could present a potential risk to pregnancy.
Dr Javadi utilizes specialty testing and standard laboratory tests to assess clients’ wellness and guide lifestyle change plans. Refusal to participate in specialty and laboratory tests can affect quality and results of recommendations. Also, lab results need to be interpreted by a professional trained in laboratory diagnostics. Dr. Javadi has access to the battery of Ulta Labs physicians for this purpose. Laboratory records belong to the client.
Dr. Javadi utilizes supplements from companies that manufacture very high quality products. Dr Javadi does profit from products purchased by clients. Clients are not required to buy products from Dr. Javadi. If products are bought elsewhere, the client is responsible for the content of those products and the therapeutic value of those products.
RELEASE OF RECORDS
Health-related records can be faxed to another health care provider as per medical release. Full chart copies are subject to $1/page copy fee, should a hard copy be requested.
Clients voluntarily consent to the above procedures, realizing that no guarantees have been given by Dr. Javadi regarding cure or improvement of condition. Clients are free to withdraw consent and to discontinue participation in these procedures at any time.
A record is kept of wellness services provided. This record will be kept confidential and will not be released to others unless so directed by the client, or the client’s legal representative, or unless it is required by law. Wellness records will be kept for a minimum of three, but no more than ten years after the date of the client’s last visit, or ten years after a minor client attains the age of majority. Information from wellness records may be analyzed for research purposes, and client identity will be protected and kept confidential. Dr. Javadi will answer any questions the client has to the best of her ability.