Cancellation Policy/No Show Policy
We understand that sometimes you may need to cancel or reschedule your appointment and kindly request that you provide at least 24-hour notice. Thank you for understanding that our employees providing services rely on this income to support their families.
If you need to cancel or reschedule an appointment, please give 24 hours’ notice to avoid a cancellation fee. Cancellation with less than 24-hour notice will be charged 50% of the scheduled service(s) value. Exceptions are made for weather and emergency situations.
All no-show appointments will be charged 100% of the scheduled service(s) values. A no-show is considered not showing up for your scheduled appointment or arriving more than 15 minutes late. You will be billed the full amount of the service(s) scheduled, allowing for emergency exceptions.
Clients Arriving Late:
Clients who arrive less than 15 minutes late will receive the remainder of their session, which will end at the scheduled time. You will be required to pay the full price for the appointment. It is at the technician’s discretion whether to accept clients who arrive more than 15 minutes late.
Lengthy and Multiple Services:
Any bookings spanning longer than three hours, or group bookings of four or more clients must be secured by a valid credit card on your client account. In the event of late cancellation or no-show, the credit card on file will be charged as outlined in our above policies.
For clients who do not wish to leave a credit card on file, there is an option to prepay over the phone or come in and pay a 50% deposit on the appoints you wish to book.
Inclement Weather Policy:
If weather makes it unsafe for you to travel, we ask that you call to reschedule your appointment with as much notice as possible. If Acacia Spa closes due to weather conditions and you have an appointment scheduled, you will receive a call or text when the decision is made to close. There is no cancellation fee when an appointment must be rescheduled due to unsafe road conditions. We want everyone to remain as safe as possible throughout bad weather.
Children at The Spa:
While we love children, we ask that you find other arrangements for them during your spa time. We want you to get the most out of your session and we want to be respectful of other clients' quiet time. If you choose to bring your children and they are disruptive, you will be asked to leave and will be responsible for the full cost of the service no matter how
NOTICE OF PRIVACY PRACTICES ACACIA SPA
THIS NOTICE DESCRIBES HOW YOUR TREATMENT INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about our Privacy Practices, including your rights and ability to voice your concerns, please call Acacia’s Privacy Officer, Debra Arnold, at (417) 823-8318.
Dear Client:
The confidentiality of your Protected Health Information is important to us. We rely on you to provide us with complete and accurate information about your condition, symptoms and health history, which helps us provide appropriate care and safe treatment. We appreciate how you trust us with this personal information. We want you to know about the privacy practices in our office that are intended to safeguard the proper use and disclosure of your Protected Health Information.
Let’s Start with Some Important HIPAA Terms:
• “HIPAA” means the Health Insurance Portability and Accountability Act. On August 14, 2002, the Department of Health and Human Services issued the HIPAA Privacy Rule, which describes how Protected Health Information may be properly Used and Disclosed.
• “Protected Health Information” means information about your past, present and future treatment at Acacia Spa, including consultation notes, progress notes, and photographs.
• “Designated Record Set” means your treatment and billing/payment records, and any photographs taken by your care provider.
• “Disclose” means how Acacia may properly release, transfer, divulge or provide access to Protected Health Information to an outside person or entity, such as another medical spa.
• “Treatment” means the provision of medical care by physicians and staff within our office as well as the management and coordination of care and services between our office, other health care providers, or other medical spas, and the information and records related to that treatment and care.
• “Payment” means payment from you to Acacia at the time of service. We do not bill third party entities, such as health or auto insurance. If you have a claim for which you are receiving services at Acacia, we will provide you the necessary information to submit for reimbursement.
• “Health Care Operations” means certain internal functions, business management and administrative activities we perform in our office, such as quality assessment and improvement, evaluating our employees, performing risk management and compliance activities, and arranging for legal and accounting services. Some of these services are performed by Business Associates.
• “Business Associate” means a person who, when performing certain services (including specified Health Care Operations) on our behalf, may have access or Use of Protected Health Information. We have entered into agreements with our Business Associates to assure that they safeguard your Protected Health Information according to HIPAA’s Privacy Rule.
• “Authorization” means the written permission you give to Use or Disclose your Protected Health Information to persons and for purposes other than treatment and Health Care Operations. Authorization forms are available upon request.
• “Non-Covered Person or Entity” means a person or entity that is not required to comply with HIPAA’s Privacy Rule for the Use or Disclosure of Protected Health Information. For example, your employer (in its capacity as employer) is a Non-Covered Entity. Health information in your employee record is not considered Protected Health Information under HIPAA’s Privacy Rule.
• “Privacy Officer” means the person in our office who is in charge of assuring we follow our privacy practices to safeguard your Protected Health Information. Our Privacy Officer is also in charge of our Client Concern and Complaint Resolution Procedure. If you have a question about this Notice, our privacy practices, or your rights, or if you have a concern or complaint, please contact our Privacy Officer, Dr. Richard Kennedy.
How We Use and Disclose Protected Health Information for Treatment and Health Care Operations:
As permitted by HIPAA’s Privacy Rule, we will use and Disclose Protected Health Information for Treatment and Health Care Operations. There is no need for you to sign a Consent for us to Use and Disclose Protected Health Information for these purposes.
For example, our physician and staff will use Protected Health Information to provide treatment in our office. We will also Disclose Protected Health Information to other physicians, health care providers, or other medical spas involved in providing or coordinating your treatment. We will take reasonable precautions to protect against someone accidentally seeing confidential materials or overhearing confidential conversations.
An example of how we Use Protected Health Information for Health Care Operations is when we monitor our own performance quality in providing you treatment.
Use and Disclosure of Protected Health Information According to Your Written Authorization:
We will not Use or Disclose your Protected Health Information for purposes other than Treatment Operations unless we are required to do so by law without your signed, written Authorization.
For example, we will not Disclose Protected Health Information to a third party for marketing purposes without your written Authorization. Once information is obtained by a Non-Covered Entity, it is no longer considered Protected Health Information and is not covered under HIPAA’s Privacy Rule.
Photographs taken in reference to your treatment, such as before and after pictures, will be stored and protected within our electronic record system. You will be asked to sign a release form providing permission to take your photograph, and whether or not you agree to your pictures being shared on social media. If you cannot be identified in the picture, Acacia reserves the right to use these photographs on social media and for advertising/marketing purposes without an authorization from you.
It also is necessary for you to sign an Authorization before we can Use or Disclose Protected Health Information for research. Acacia may at some time enter into statistical research with a third-party entity, such as a product manufacturer, in which only non-identifiable data will be used. No Protected Health Information or personal data will be used in any research project in which Acacia may participate.
Your Right to Revoke in Writing that Authorization:
You may revoke the Authorization in writing at any time. Once we receive your written revocation, we will stop the Use or Disclosure of Protected Health Information according to the Authorization. However, we cannot be held responsible for any previous Use or Disclosure of Protected Health Information as permitted by the Authorization before we receive your written revocation.
USES AND DISCLOSURES:
•We may contact you via phone or text messaging to provide appointment reminders or information about your treatment or other treatment related information.
• We will use and disclose your Protected Health Information when we are required to do so by federal, state and local law.
• We may disclose your Protected Health Information to public health authorities that are authorized by law including but not limited to:
1. response to a health oversight agency for activities authorized by law such as a court or administrative order
2. if you are involved in a lawsuit or similar proceeding
3. response to a discovery request, subpoena, or other lawful process by another party involved in the dispute
This type of disclosure will only be made after we have made an effort to inform you of the request or when we receive an order from you protecting the information the party requested.
•We will release your Protected Health Information, if requested, to a law enforcement official for any circumstance required by law.
•We may release your Protected Health Information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.
•We may use and disclose your Protected Health Information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
•We may disclose your Protected Health Information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
•We may disclose your Protected Health Information to federal officials for intelligence and national security activities authorized by law.
•We may disclose Protected Health Information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
•We may disclose your Protected Health Information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals or the public.
•We may release your protected health information for workers’ compensation and similar programs.
Know Your Rights under the Privacy Rule and Our Privacy Practices:
You have the right to request and receive from us confidential communications of Protected Health Information by alternative means or at alternative locations.
Our general policy is to contact you by mail at your home address or by telephone to your home or mobile number. You have the right to request that we communicate with you confidentially by alternative means or at alternative locations. Our policy is to honor all reasonable requests. You will be informed if we are unable to honor your request.
For example, if you do not want to be contacted by telephone or at your home telephone, please fill out the written request that appears in the New Client Form. We will not require an explanation for why you are making this request.
Your Right to Request Restrictions on certain Uses and Disclosures of Protected Health Information:
You may request that we restrict certain Uses or Disclosures of your Protected Health Information by completing the Request for Restriction form available upon request at the front desk. You may present or mail the completed form to us. This request may involve certain restrictions in connection with Treatment or Health Care Operations. It also may involve a request that we do not discuss Protected Health Information with family members, friends or others who are involved in caring for you.
HIPAA’s Privacy Rule gives all covered entities the right to deny client requests for restricted Use or Disclosure of Protected Health Information.
While we will consider reasonable requests, it is our general policy and practice not to restrict the Use or Disclosure of Protected Health Information that is necessary for providing good treatment or important for protecting the health and safety of others providing treatment or taking care of you. For example, information that you provide when giving your medical history may necessarily be shared with another physician or provider of care. Restricting Disclosure could adversely affect the ability of that physician or provider to give you proper treatment.
If you are a Minor (less than 18 years old), you may request we not Disclose Protected Health Information to your parents. We will consider this request in connection with our obligations under Missouri law.
We will consider all other requests for restricted Use or Disclosure of Protected Health Information on a case-by-case basis, taking into account risks and benefits to you and others. You will be informed if we are unable to honor your request.
Your Right to Access, Inspect and Copy your own Protected Health Information Acacia maintains in a Designated Record Set:
You have the right generally to access, inspect and copy your own Protected Health Information that our office maintains in a Designated Record Set. There are some exceptions under the Privacy Rule. For example, you do not have the right to inspect notes or information compiled in anticipation of (or use in) civil, criminal or administrative proceedings. Your right also may not extend to information covered by other laws or information obtained from someone other than another health care provider, based on a promise of confidentiality.
We may also deny access if, in our judgment, it could endanger the life or safety of you or another.
You may request access to your Protected Health information by completing the Request for Access to Records form upon request at the front desk and present or send it to us.
Our practice will consider all requests according to our legal responsibilities under the Privacy Rule. We generally will act on your request within 30 days from the time we receive the completed form. The form will be returned to you if it is incomplete. In some circumstances, it may take more than 30 days, in which case we will notify you and will act on your request as soon thereafter as reasonably possible.
If we are able to grant your request, we will contact you to set up an appointment for you to inspect your Protected Health Information and request a copy of that information. You may not make changes in the original record.
Alternatively, with your permission, we may provide you with a summary or explanation of the Protected Health Information in lieu of you inspecting the record.
Under the Privacy Rule, we may charge you copying costs (supplies and labor) and postage.
If we are unable to grant your request, because of the reasons listed above, or because the information is not part of a Designated Record Set, we will notify you in writing of the basis for the denial and your rights for review of our denial.
Right to Amend Incorrect or Incomplete facts in your Protected Health Information maintained in a Designated Record Set:
You may make a request to amend your Protected Health Information by completing the Request to Amend form upon request at the front desk and present or mail it to us.
We will respond to your request within 60 days from the time we receive your completed form. The form will be returned to you if it is incomplete.
We will honor your request if Protected Health Information is incorrect or incomplete. We may not, under the HIPAA Privacy Rule, amend your Protected Health Information if it is not part of a Designated Record Set, if it would not be available for you to inspect (see Right to Inspect, above), or if the information is accurate and complete.
For example, if your record mistakenly indicates that you received Botox injections when, in fact, you received a facial, clearly that information should be amended. If, however, you want to delete a reference contained in the history that you told your treatment provider you were feeling “depressed,” it would not be appropriate to delete that reference from the Protected Health Information, because it accurately reflected the information you gave the provider.
If we accept the requested amendment, we will amend the Protected Health Information in the Designated Record Set, inform you that we have made the amendment, and notify persons who have received and may have relied on Protected Health Information that has been amended.
If we deny your request to amend Protected Health Information, we will:
(1) notify you in writing of the basis for that denial;
(2) inform you of your right to submit a written statement of disagreement and provide you with a form to submit your statement of disagreement, which we will maintain with your record and will include with future Disclosures, if requested; and
(3) inform you of your right to file a complaint.
If you file a statement of disagreement, we may prepare a written rebuttal statement.
If you have any questions about this right, please ask our Privacy Officer.
Right to Receive an Accounting of Disclosures of Protected Health Information:
You have a right to receive an Accounting of Disclosures of your Protected Health Information that we have made to others. This right is limited and does not require us to provide you with an Accounting of Disclosures made for:
(1) Treatment and Health Care Operations purposes;
(2) disclosures made to you or your legal representative on your behalf;
(3) disclosures made in accordance with a written Authorization that you signed; or
(4) disclosures made before April 14, 2003.
