Notice of Privacy Practices
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.
About this notice
This notice applies to the acupuncture and Chinese medicine practice of Dr. Riley Smith, LAc, DACM, [confirm legal business name: Smith Wellness Group], 2404 Broadway, 2nd Floor, San Diego, CA 92102.
It covers your health information. That means any information that identifies you and relates to your health, your care, or payment for your care. It does not cover general website visits or email newsletter signups; those are covered by the website Privacy Policy.
Your rights
You have the following rights regarding your health information. To use any of them, contact me using the information at the end of this notice.
- Get a copy of your records. You can ask to see or get a copy of your health and billing records, on paper or electronically. I will respond within the time the law allows (generally 15 days under California law) and may charge a reasonable, cost-based fee.
- Ask me to correct your records. You can ask me to correct information you think is wrong or incomplete. I may say no, but I will tell you why in writing within 60 days.
- Ask for confidential communications. You can ask me to contact you in a specific way (for example, a different phone number or mailing address). I will say yes to all reasonable requests.
- Ask me to limit what I use or share. You can ask me not to use or share certain information for your care, payment, or my operations. I am not required to agree if it would affect your care. If you pay for a service in full out of pocket, you can ask me not to share that information with your health insurer, and I will say yes unless the law requires me to share it.
- Get a list of those I have shared your information with. You can ask for a list (an “accounting”) of the times I have shared your information in the six years before your request, who I shared it with, and why. This list leaves out sharing for care, payment, and operations, and certain other disclosures. One list per year is free; I may charge a reasonable fee for more.
- Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to get it electronically.
- Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can use your rights for you. I will confirm they have this authority first.
- Be told about a breach. I will notify you if a breach occurs that may have compromised the privacy or security of your information.
- File a complaint. If you believe your privacy rights have been violated, you can complain to me, or to the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/privacy/hipaa/complaints. I will not retaliate against you for filing a complaint.
Your choices
For certain information, you can tell me your choices about what I share. Tell me what you want, and I will follow your instructions.
You have the right and the choice to tell me whether to:
- Share information with your family, close friends, or others involved in your care or in paying for your care.
- Share information in a disaster relief situation.
If you are not able to tell me your preference, for example if you are unconscious, I may share your information if I believe it is in your best interest. I may also share it when needed to lessen a serious and imminent threat to health or safety.
I will never share your information for these purposes unless you give me written permission:
- Marketing purposes, as the law defines them.
- Sale of your information. I do not sell your health information.
Appointment reminders and care messages. I may contact you by phone, text, or email with appointment reminders and messages related to your care. You can ask me to stop at any time.
How I typically use or share your information
I may use and share your health information without your written permission for three main purposes.
To provide your care (what the law calls “treatment”). I may use your information to provide care and share it with other professionals who are caring for you. Example: with your physician who referred you, or a provider coordinating your care.
To bill and get paid for your care (“payment”). I may use and share your information to bill and get payment from health plans or other payers. Example: I work with an outside billing company that submits claims to your health insurance plan, including Blue Shield of California. That company signs a written agreement to protect your information.
To run my practice (“health care operations”). I may use and share your information to run the practice, improve your care, and contact you when needed. Example: scheduling, record keeping, and quality review. Outside companies that help me run the practice, such as my scheduling, records, and billing services, must sign agreements to protect your information.
Other ways I may share your information
The law allows or requires me to share your information in certain other situations. I must meet specific legal conditions before sharing for these purposes. For more detail, see hhs.gov/hipaa/for-individuals.
Workers’ compensation. If you are receiving care for a work injury, I may share information with your employer’s workers’ compensation insurer or program as the law allows.
Public health and safety. For example, reporting suspected abuse, neglect, or domestic violence, reporting adverse reactions to products, or preventing a serious threat to someone’s health or safety.
When the law requires it. Including sharing with the Department of Health and Human Services if it wants to confirm I am following federal privacy law.
Health oversight. With agencies authorized by law to conduct audits, investigations, and licensing, such as the California Acupuncture Board.
Lawsuits and legal actions. In response to a court or administrative order, or a subpoena, as the law allows.
Law enforcement. For law enforcement purposes, as the law allows.
Government requests. For special government functions such as military, national security, and presidential protective services.
Research. For health research, only under strict legal conditions.
Coroners and organ donation. With a coroner or medical examiner, and with organ procurement organizations, as the law allows.
If you are a personal injury patient, I share records with your attorney only after you sign a written release.
California law, minors, and your written permission
California law. California’s Confidentiality of Medical Information Act and other state laws may give your information more protection than federal law. When state law is stricter, I follow state law.
Patients under 18. I see patients under 18 with a parent or guardian present. A parent or guardian can generally use the rights in this notice on the minor’s behalf, except where California law gives the minor control over certain information.
Your written permission. I will not use or share your information for any purpose not described in this notice unless you give me written permission (an “authorization”). You can take back that permission at any time by telling me in writing. Taking it back does not undo anything I already shared while your permission was in place.
My responsibilities
I am required by law to keep your health information private and secure, and to give you this notice of my legal duties and privacy practices. I must follow the terms of the notice currently in effect, and I will let you know promptly if a breach occurs that may have compromised your information.
Changes to this notice
I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available on request, in my office, and on my website.
Contact
Privacy contact: Dr. Riley Smith, LAc, DACM
2404 Broadway, 2nd Floor, San Diego, CA 92102
Email: hello@doctorrileysmith.com
Phone: [office phone]
Effective date: [date this notice takes effect]
© 2026 Dr. Riley Smith, LACDCM · All Rights Reserved
The information on this website is for educational purposes only and is not medical advice. See our Medical Disclaimer.