Privacy Policy – Harvest of Peace

Policy Highlights

All massage must be scheduled online through Jane App. It is a safe, HIPAA compliant site to manage your health information and make communication easier. All consent and health history forms must be completed online (some injury cases may have additional paper requirements). If you are unable to complete your online forms, please reach out to me for assistance prior to your appointment. Health forms are a vital part of your treatment and are required for all massage treatments.
A credit card on file is required for all appointments. You may choose to pay with card on file, HSA card or cash. Cash is greatly appreciated however, we don’t keep change in the office.
Appointments may be rescheduled or cancelled online up to 24 hours in advance of your appointment with out penalty by logging in to your Jane account.
No shows will be charged for the entire scheduled visit.
Your appointment will begin and end on time. Please come prepared.
Please do not come to your appointment if you have fever, chills, nausea, active contagious skin conditions or have been exposed to someone who exhibits these symptoms. Massage will very likely make your condition worse, not better.
We are currently not requiring masks but are happy to wear one upon request. Please know, very few people are in and out of our office on a daily basis. Your risk of exposure to illness is very low here.

Policy in Detail

Privacy Policy

Confidential Records:

We are committed to protecting the privacy and confidentiality of your personal and health information. All records, including treatment notes and personal information, are kept confidential and are only accessible to authorized personnel.
Your records will not be disclosed to anyone without your written consent, except as required by law.

Use of Information:

Personal information collected from you, such as your name, contact information, and health history, is used solely for the purpose of providing you with quality massage therapy services.
Information about you may be used by the personnel affiliated with Harvest of Peace for diagnosis, treatment, continuity of care, and billing. We may disclose it to practitioners at Harvest of Peace or employees and business associates affiliated with this clinic such as billing, quality enhancement, training, audits, and accreditation.
We may use your information to communicate with you about your appointments, treatment plans, and other relevant information related to your care.
We do not sell, rent, or share your personal information with third parties for marketing purposes.
If you elect to have us bill your insurance company, we are required to submit your chart notes and physicians order along with our invoice.
If you issue a charge back or legal claim against us, we may release your chart notes or other information in order to defend ourselves.

Patient Rights:

You have the right to review and request a copy of your records at any time. If you believe that any information in your records is inaccurate or incomplete, you may request that it be corrected. We may assess reasonable fees for copies and our research time.
You have the right to request restrictions on how your information is used and disclosed. However, we may not be able to accommodate all requests, especially if they affect our ability to provide you with quality care or violate other laws we may be subject to.
You have the right to request confidential communication of your information, such as contacting you only at a specific phone number or address.
All requests must be in writing.

Compliance with Laws:

We comply with all applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA) and the Washington State laws regarding patient privacy and confidentiality.
We reserve the right to update or modify this Privacy Policy at any time. Any changes will be posted on our website and will be effective immediately upon posting.

If you have any questions or concerns about our Privacy Policy, please email therese@harvestofpeace.com with your request.

Office Policy Regarding Fees and Payments

1. Private Pay – Full payment is expected at time of each visit. We accept cash or MC/Visa/AMEX. If payment is not received at the time of your visit, you will not be eligible for a Time-of-Service discount. 2. Health Insurance – For patients who have private health plans covering our services: We do not bill your insurance company. However, as a courtesy, we will submit bills on your behalf. Your insurance company may reimburse you or apply balance paid toward your deductible. Insurance coverage is NOT a guarantee of payment and you are fully responsible for any fee your insurance does not cover, and for checking your benefits and confirming coverage for all services. To initiate this service please be sure to fill out the information requested on the intake form. There is no additional fee for this service. Please be aware, we will need to submit your health information to complete this process.

3. Personal Injury/Car Accidents –As a courtesy, we will bill and collect from your car insurance company if you have an active PIP claim, however if your insurance company does not pay your balance in full, you are responsible for any unpaid portion within 90 days of treatment. If we are submitting your claim for billing, you do not qualify for a Time-of-Service discount.

4. Worker’s Compensation – If you have been injured on the job, you are required by law to report to your employer first and open a claim. The first provider you see following your injury will be considered your ‘primary provider’ for this case. If we are not your primary provider on the case, it will require a referral from that provider. If a denial occurs, you will be fully responsible for the balance of your account. We do not bill L&I directly but can provide you with a superbill for reimbursement. L& I claims must be paid a Time-of-Service.

Massage and bodywork requires close contact. Massage increases circulation which can exacerbate symptoms of illness. Illness can lay dormant in your system for many days prior to onset of symptoms. Please do not come to your appointment if you have any of the following symptoms: fever, chills, nausea, cough, sinus infection/pain, unexplained rash or skin conditions or have been exposed to any one with these conditions in the last 7 days. Please contact us immediately to reschedule your appointment at anytime with out penalty.

I understand that I may ask questions and request changes to the treatment plan at anytime. I understand that at any time during the massage, I or the massage therapist, may withdraw consent and the treatment will be stopped.

I understand that massage is entirely therapeutic and non-sexual in nature. If any sexual advances are made, the session will be terminated immediately and client will be charged for the full session. Draping will be used if you have chosen to remove clothing for your session. Removing clothing is required for some techniques but is not necessary to receive an excellent massage. Please discuss this with your therapist if you have questions or concerns.

Informed written consent must be provided by a parent or legal guardian for any client under the age of 17. Please indicate the minor/guardian relationship when signing below.

It is my choice to receive massage therapy and bodywork provided by Therese Livella, LMT. I understand that the scheduled appointment is for me alone. Bringing children, pets, or guests is not appropriate. Please refrain from wearing strong scents to your appointment as your therapist may be allergic. I understand there is no guarantee of success with this treatment and that it is not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness. I understand and am informed that, in the practice of massage therapy there are some risks to treatment, including but not limited to sore muscles and joints, increased risk of embolism from varicose veins, and increased blood pressure from hypertension. I do not expect the massage therapist to be able to anticipate and explain all risks and complications, and I wish to rely on the massage therapist to exercise judgment during the course of the procedure which the massage therapist feels at the time, and based upon the facts then known, is in my best interest. I understand that no guarantee has been made to me as to the result or cures that may be obtained from treatment in this clinic. I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I may seek treatment.

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Health information shared with Harvest of Peace is retained according to federal and Washington state law.