The Sacred Spine LLC
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. YOU MAY HAVE ADDITIONAL RIGHTS UNDER STATE AND LOCAL LAW.
This notice went into effect on September 1, 2025
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information (PHI).
I understand that health information about you and your wellness care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by The Sacred Spine LLC wellness practice.
This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.
I am required by law to:
I can change the terms of this Notice, and such changes will apply to all the information I have about you. The new Notice will be available upon request at my practice location and on my website.
The following categories describe different ways that I use and disclose health information. For each category I will explain what I mean and provide examples. Not every use or disclosure will be listed, but all permitted uses will fall within these categories.
For Treatment, Payment, or Health Care Operations
Federal privacy rules allow wellness providers who have direct treatment relationships with clients to use or disclose PHI without written authorization for treatment, payment, or health care operations.
Treatment Examples:
Payment Examples:
Operations Examples:
If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information in response to a subpoena or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information.
Any detailed notes about your wellness sessions, personal health goals, and coaching discussions require your written authorization for disclosure, unless the use is:
I will not use or disclose your PHI for marketing purposes without your prior written consent. If you provide a testimonial about my services, I will obtain proper authorization before using it for promotional purposes. You may withdraw this consent at any time in writing.
I will not sell your PHI under any circumstances.
Subject to certain limitations in the law, I can use and disclose your PHI without authorization for:
You have the right to tell me that I may share your PHI with family members, friends, or others involved in your care or payment for services. I will only share information directly relevant to their involvement. In emergency situations, I may share information necessary to mitigate serious threats to health or safety.
You may ask me not to use or disclose certain PHI for treatment, payment, or operations. I am not required to agree if I believe it would affect your care quality.
You may request restrictions on disclosure to health plans for services you have paid for in full out-of-pocket.
You may request that I contact you in specific ways (home/office phone, specific address) and I will accommodate reasonable requests.
You have the right to get electronic or paper copies of your wellness records. I will provide copies within 30 days of your written request and may charge a reasonable fee.
You may request a list of instances where I disclosed your PHI for purposes other than treatment, payment, or operations. I will respond within 60 days and provide the first list each year at no charge.
If you believe there are mistakes in your PHI or missing information, you may request corrections. I will respond in writing within 60 days.
You have the right to get paper or electronic copies of this notice at any time.
If you have given someone medical power of attorney or they are your legal guardian, they can make decisions about your health information.
You may file a complaint if you believe your rights have been violated by contacting:
The Sacred Spine LLC Email: admin@thesacredspine.com
Or by contacting: HHS Office for Civil Rights 200 Independence Avenue, S.W. Washington D.C. 20201 Phone: (877) 696-6775 Website: www.hhs.gov/ocr/privacy/hipaa/complaints
I will not retaliate against you for filing a complaint.
The Sacred Spine LLC provides wellness and integrative health services including:
These services are NOT medical treatment and are not intended to diagnose, treat, cure, or prevent any disease. You should always consult with qualified medical professionals for medical concerns and before making significant changes to your health routine.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request at my practice and on my website.
Contact Information: The Sacred Spine LLC Dripping Springs, Texas Email: admin@thesacredspine.com Website: thesacredspine.com Phone: 541-408-0058
Practitioner: Rachel Winkler
Certified Spinal Flow Technique Practitioner
Certified Health Coach Institute
Licensed Heal Your Life Coach
Certified Blood Type Diet Practitioner