Notice of Privacy Practices
Effective Date: September 16, 2025
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.
Our Responsibilities
Heart Folk Midwifery is required by law to:
Maintain the privacy of your protected health information (PHI).
Provide you with this Notice of our legal duties and privacy practices.
Notify you if there is a breach of your unsecured PHI.
Abide by the terms of this Notice.
How We May Use and Disclose Health Information
We may use and share your PHI for the following reasons:
Treatment: To provide, coordinate, or manage your care. For example, sharing information with another healthcare provider involved in your care.
Payment: To bill and receive payment for services. For example, sharing necessary information with your insurance company or with our biller for reimbursement purposes.
Healthcare Operations: To run our practice, improve services, and ensure quality care. For example, evaluating student or staff performance, clinical tracking and agreeing to allow students and apprentices of Heart Folk Midwifery who are involved in my care to use my records, with my name removed, as verification of skills.
.Other uses and disclosures permitted or required by law include:
Public health and safety purposes (such as reporting births, communicable diseases, or abuse).
Compliance with legal requirements (such as responding to a court order).
To medical examiners, coroners, or funeral directors when necessary.
For specialized government functions (such as military or national security).
We will not use or share your information for marketing or fundraising without your written permission.
Your Rights
You have the right to:
Access: Request to see or receive a copy of your medical record, usually within 30 days. A reasonable fee may apply.
Amend: Ask us to correct your medical record if you believe it is incomplete or incorrect.
Confidential Communication: Request that we contact you in a specific way (e.g., at work or by mail).
Restrictions: Request that we limit the use or disclosure of your PHI. We will honor reasonable requests, though we are not always required to agree.
Accounting of Disclosures: Ask for a list of times we shared your PHI (other than for treatment, payment, healthcare operations, or where you authorized).
Paper Copy: Request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
File a Complaint: If you believe your rights are violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS). We will not retaliate against you for filing a complaint.
Contact Information
For questions, requests, or complaints, please contact:
Heart Folk Midwifery
PO Box 290 South Main Street #2720
Sebastopol, CA 95472
Email: info@heartfolkmidwifery.com
Phone: 707-672-2654
Changes to This Notice
We reserve the right to change the terms of this Notice and make the new provisions effective for all PHI we maintain. If our practices change, we will update this Notice and make it available to you.