HIPAA Privacy Acknowledgment Form - Notice of Privacy Practices (NPP)

Indigo Wellness LLC – Practitioner: Ulrike Junker, L.Ac., Dipl. Acu.

We are committed to protecting your health information and respecting your privacy. This notice explains how we may use and disclose your Protected Health Information (PHI), and outlines your rights under the Health Insurance Portability and Accountability Act (HIPAA).

How We Use and Disclose Your Health Information

• Treatment: To provide, coordinate, or manage your healthcare.

• Payment: To bill and collect payment for healthcare services.

• Healthcare Operations: To improve the quality of care and the operations of our practice.

• We may also disclose your PHI when required by law or for public health purposes.

Your Rights Regarding Your Health Information

You have the right to:

• Access and obtain a copy of your health records

• Request addendums to your health information

• Request restrictions on certain uses and disclosures of your information

• Receive a list of disclosures we have made of your PHI

• Request confidential communications

• Obtain a paper copy of this notice

How to Exercise Your Rights

To exercise any of these rights, please contact:

Indigo Wellness LLC

208 Scott Street, Mount Pleasant, SC 29464

Phone: (704) 858-3815

Email: indigowellness@icloud.com