Privacy Policy
Roots to Blooms Acupuncture &Wellness, LLC
921 Park Drive, Suite D
Lake Geneva, WI 53147
262.475.9661
Effective Date: 2 March, 2026
Previous Version issued on: 1 May, 2020
HIPAA Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities.
This Notice is effective as of the date stated above and supersedes any prior notices. We reserve the right to revise this Notice and make the new provisions effective for all protected health information we maintain, including information created or received prior to the effective date of the revised Notice.
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.
Your Rights
You have certain rights under the federal privacy standards. These include:
The right to inspect and copy your PHI; you can ask to see or get an electronic or paper copy of your health record
The right to request a restriction on the use and disclosure of your PHI
The right to receive confidential communications concerning your medical condition and treatment
The right to amend or submit corrections to your PHI
The right to choose someone to act for you: legal guardian or someone with power of attorney for your care
The right to receive an account of how and to whom your PHI has been disclosed
The right to receive a printed copy of this notice
Uses and Disclosures
Treatment: Your protected health information (PHI) may be used by staff members to disclose to other healthcare professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, we may consult with your primary care physician regarding your case.
Payment: Your PHI may be used to seek payment for services provided to you. For example, we may send a report of progress to your insurance company.
Health Care Operations: Your PHI may be used as necessary for normal healthcare operations. For example, your address will be stored on our computer, and we may contact you via your address or telephone number.
Law Enforcement, Public Health and Safety We can share health information about you for certain situations, such as:
Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
Other situations as permitted or required by law
Fundraising: We will not contact you for fundraising efforts.
Other Uses and Disclosures: Except as above, your PHI will be made available only with your written consent via a HIPAA Authorization Form, authorization, or opportunity to object, unless required by law. If you change your mind after authorizing a use or disclosure of your PHI you may submit a written revocation of that 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.
In these cases, you have both the right and choice to tell us to limit how we may:
Share information with your family, close friends, or others involved in your care or payment for your care, including following your death.
Share information in a disaster relief situation.
Include your information in a facility directory (if applicable to our practice). If you are not able to tell us your preference, for example, if you are unconscious or in an emergency situation, we may share your information if we determine, in our professional judgment, that doing so is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission (in the form of a HIPAA-compliant authorization):
Marketing purposes
Sale of your information
Most sharing of psychotherapy notes
Other instances that require written permission
Roots to Blooms Acupuncture & Wellness, LLC Duties
We are required by law to maintain the privacy of your PHI and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices that are outlined in this notice. 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 the federal and state laws and regulations. We will provide you with the most recently revised notice via our website, with an email, or on your next office visit after the date of the policy change. The revised policies and practices will be applied to all PHI we maintain. For the latest on privacy policy requirements, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
SUD Treatment Information
If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.
In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
If we create or maintain records subject to 42 CFR Part 2 and intend to use or disclose those records for fundraising for our benefit, we will first provide you a clear and conspicuous opportunity to opt out of receiving fundraising communications.
Notice Regarding Additional State and Federal Law Protections
There are certain types of highly confidential information that are specifically addressed in certain federal and state laws and regulations, which further restrict the use and disclosure of this type of highly confidential information. This highly confidential information, including alcohol and substance abuse treatment information (including but not limited to SUD records protected under 42 C.F.R. Part 2), HIV and sexually transmitted disease-related information, mental health information, psychotherapy information, genetic information, and pregnancy of minors, as well as some other sensitive information, is considered so sensitive that some federal and applicable state laws provide special protections for it. All uses or disclosures of such highly sensitive information must meet the requirements of such applicable law. Therefore, there may be greater protections under applicable law for such highly sensitive information. As mentioned above, please note that State confidentiality laws may impose additional or different requirements beyond HIPAA and Part 2.
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:
Privacy Officer/Administrator
Roots to Blooms Acupuncture & Wellness, LLC
921 Park Drive, Suite D
Lake Geneva, WI 53147
You also have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (OCR) if you believe your privacy rights have been violated. OCR complaints can be filed online at www.hhs.gov/ocr/privacy/hipaa/complaints/, by mail, or by phone at 1-800-368-1019. You will not be retaliated against for filing a complaint.