those authorized health care providers who need it to perform their duties. The obligation to ensure patient privacy is also justified by the obligation of harm prevention. Sometimes maintaining patient privacy is a way of keeping the patient safe, for example, by minimizing the risk of identity theft. Confidentiality is mandated by HIPAA laws, specifically the Privacy Rule. The Privacy Rule protects all individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. This includes: • the individual’s past, present or future physical or mental health or condition, • the provision of health care to the individual, or • the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. • Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number). 7 All health care providers must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request. They must also develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. When the minimum necessary standard applies to a use or disclosure, a covered entity may not use, disclose, or request the entire medical record for a particular purpose, unless it can specifically justify the whole record as the amount reasonably needed for the purpose. Therapeutic Boundaries A boundary defines the difference between acceptable and unacceptable behavior. Establishing boundaries should begin with the therapist’s first client interaction on the phone or in the office. Creating professional boundaries can be achieved in many ways such as; • dressing appropriately • greeting the client by name • taking time to discuss medical history and session goals • offering clear directions in a professional tone • leaving the room as the client undresses • starting and ending massage services on time There are hundreds of small ways to establish “boundaries” through professional behavior and boundaries can be developed both verbally and non-verbally. Boundaries define personal comfort zones, the space in which individuals operate with a sense of safety and control. Boundaries define the professional relationship as fundamentally respectful and protective of the patient and as dedicated to the patient’s well-being. Professional boundaries are outlined in policy and procedure statements that are presented to the client at the beginning of the therapeutic relationship. These boundaries create a secure and a safe environment from which to work with client. An important aspect of a professional practice is to recognize, respect, and honor the client's personal boundaries. It is important to explore boundaries and constantly readjust limits to accommodate each individual. When boundaries are violated, respect may be lost in the relationship. There is three main types of boundaries we deal with include: professional boundaries, and personal boundaries and legal boundaries, Professional boundaries are determined by many things, such as your type of practice, your business rules and practices. Personal boundaries are everything that determines your safety zone. They may be 8 influenced by past experiences, beliefs and values. Legal boundaries are those that of course deal with the law and the rules and regulations that are set up by each state, city or county. Your scope of practice is defined legally. Your scope of practice is the limits or boundaries that apply to your practice. This may include areas you can work on and what you can or cannot do. This will determine if you can do things like make diagnosis's, do physical adjustments, work in the mouth or other body cavity and sell vitamins and other related items. The laws vary so much that it is impossible to discuss here. Make sure you contact your local authorities to determine what your legal boundaries are and that you work within the law. Boundaries are often difficult to determine. What may be good for one person may not be right for another. Boundaries are defined by our experiences, beliefs and expectations. Some determining factors in the formation of personal boundaries include family, school, or religious upbringing. Cultural and ethnic influences also shape attitudes about relationships, privacy, and touch. Everyone with whom we interact has different boundaries, and so we must be sensitive and able to respond with understanding. In some situations, we must hold strong boundaries, and at other appropriate times we must be flexible to merge or expand our experience. It is important to be aware of a client's concept of the boundaries in a variety of categories and how we can address related issues. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. Many small boundary errors occur with very little impact, depending on the level of trust in the relationship. When a boundary is severely invaded or violated, this might constitute a situation of neglect or even abuse. When a boundary has been crossed, we