NOTICE OF PRIVACY PRACTICES
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
This notice describes the procedures and practices that this clinic and its professional, support and administrative staff follow to protect the privacy of your health information.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health, health status, and the health care and services you receive at this office. Your health information may include information created and received by this office, it may be in the form or written or electronic records or spoken words, and it may include information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.
We are required by law to maintain the privacy of your health information and to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information. We are required to abide by the terms of this notice, and to notify you of a breach of your unsecured health information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may use and disclose health information for the following purposes:
For example, the doctor who referred you for physical therapy may be treating you for medical or orthopedic condition and we may need to know about that and any other health problems that could complicate your treatment. We may use your medical history to decide what treatment is best for you. We will consult with your doctor and send reports about your treatment to the doctor. We do this to provide the most appropriate care for you.
Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as telephoning your doctor and getting needed information. Family members and other health care providers may be part of your physical therapy outside this office and that may require us to provide information about you.
For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain treatments are effective for certain problems.
We may also disclose your health information to your health plan and other health care providers that care for you in order to help these plans and providers evaluate or improve care, reduce cost, coordinate and manage health care and services, train staff and comply with the law.
We may use or disclose your health information about you for the following purposes, in accordance with the requirements and limitations of state and other law:
In situations where you are not capable of giving consent (due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care.
OTHER USES AND DISCLOSURES PURSUANT TO YOUR SIGNED AUTHORIZATION
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization. We will not sell your health information, use or disclose any psychotherapy notes about you, or use or disclose your health information for marketing purposes without your Authorization unless otherwise permitted under federal law. If you sign an Authorization for us to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy your health information, such as medical and billing records, that we keep and use to make decisions about your care. To request, you may complete and submit the “Patient Records Access Request Form” to our Front Office. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other associated supplies.
We may deny your request to inspect and/or copy records in certain limited circumstances. If you are denies copies of or access to, health information that we keep about you, you may ask that our denial be review. If the law gives you a right to have our denial reviewed, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denies your request, and we will comply with the outcome of the review.
To request a correction, complete and submit a “Request to Amend Records” form to our Front Office. We will provide you with one of these forms at your request. This request will be reviewed with the appropriate providers involved with your healthcare information. We may deny your request for an amendment if your request is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to correct information that:
To request, you may complete and submit the “Request for Accounting of Disclosures” form to our Front Office. We will provide you with one of these forms at your request. It must state the time period for which you want an accounting. The time period may not be longer than six years. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.
If you or someone on your behalf pays for a service in full and you request that we not disclose information about the service to your health plan for purposes or payment of health care operations, we are required to agree to your request unless the disclosure is required by law. For all other types or restriction requests, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide your emergency treatment or we are required by law to use or disclose the information.
To request restrictions, you may complete and submit the “Request to Restrict Disclosure” form to our Front Office. We will provide you with one of these forms at your request.
To request confidential communications, you may complete and submit the “Request for Alternative Communications” form to our Front Office. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
To obtain such a copy, contact the Front Office.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post the current notice or a summary of the current noticed in the office with its effective date in the top right hand corner. You are entitled to a copy of the noticed currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Office Manager by calling the office.