​NOTICE OF PRIVACY PRACTICES

 

Effective Date: January 1, 2026

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Bloom Acupuncture LLC is required by the Health Insurance Portability and Accountability Act (HIPAA) and Wisconsin law to maintain the privacy and security of your protected health information (PHI), provide you with this Notice, and abide by its terms.

 

Uses and Disclosures for Treatment, Payment, and Healthcare Operations

We may use and disclose your PHI without your written authorization for:

Treatment: Coordination of care, consultation, referrals, and related services.
Payment: Billing, claims management, insurance verification, and collection activities.
Healthcare Operations: Quality assessment, business planning, compliance review, credentialing, and administrative functions.

 

Other Permitted or Required Disclosures

We may disclose your PHI without authorization when required or permitted by law, including:

• Public health reporting

• Reporting abuse, neglect, or domestic violence

• Health oversight activities

• Judicial and administrative proceedings

• Law enforcement purposes

• Workers’ compensation

• To avert a serious threat to health or safety

• Specialized government functions

• As otherwise required by federal or Wisconsin law

 

Additional Protections Under Wisconsin Law

Certain categories of information receive heightened protection under Wisconsin law, including:

• Mental health treatment records (Wis. Stat. §51.30)

• Substance use disorder treatment information

• HIV test results and related information

• Records relating to minors who lawfully consent to care

We will disclose such information only as permitted by applicable state and federal law.

 

Uses and Disclosures Requiring Authorization

We will obtain your written authorization for:

• Marketing communications not related to your treatment

• Sale of protected health information

• Most uses and disclosures of psychotherapy notes

• Any use or disclosure not described in this Notice

You may revoke your authorization in writing at any time, except to the extent action has already been taken.

 

Your Individual Rights

You have the right to:

• Inspect and obtain a copy of your PHI (paper or electronic)

• Request an amendment to your PHI

• Request restrictions on certain uses or disclosures

• Request confidential communications

• Receive an accounting of disclosures

• Obtain a paper copy of this Notice

• Be notified following a breach of unsecured PHI

• Restrict disclosures to your health plan when services are paid in full out-of-pocket

Requests must be submitted in writing to Bloom Acupuncture LLC.

 

Our Legal Duties

We are required by law to:

• Maintain the privacy and security of your PHI

• Provide you with this Notice

• Notify you following a breach of unsecured PHI

• Follow the terms of this Notice

We reserve the right to change this Notice and make the revised version effective for all PHI we maintain. Revised notices will be posted in our office and on our website.

 

Complaints

If you believe your privacy rights have been violated, you may file a written complaint with:

Bloom Acupuncture LLC
4601 Camp Phillips Road
Weston, WI 54476
715-204-9202

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at www.hhs.gov/ocr. We will not retaliate against you for filing a complaint.

 

SMS Communications Policy

Patients may opt in to receive SMS communications for appointment reminders and administrative updates. We utilize secure systems designed to comply with HIPAA privacy and security standards.

• Message and data rates may apply.

• You may opt out at any time by replying STOP.

• SMS communications are not intended for emergency medical situations.

• SMS opt-in information is not sold or shared for marketing purposes.

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