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HIPAA
NOTICE OF PRIVACY PRACTICES
Fenton
Physical Therapy, Linden Physical Therapy,
Milford Physical Therapy
THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this
notice, please contact Barb O'Hara,
Administrator, Privacy Official at (810)
750-1996.
OUR PLEDGE REGARDING HEALTH
INFORMATION:
We understand that health information
about you and your health care is personal. We
are committed to protecting health information
about you. We create a record of the care and
services you receive from us. We 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 this health care practice,
whether made by your physical therapist or
others working in this office. This notice
will tell you about the ways in which we may
use and disclose health information about you.
We also describe your rights to the health
information we keep about you, and describe
certain obligations we have regarding the use
and disclosure of your health information.
We are required by law to:
·
make sure that health information that
identifies you is kept private;
·
give you this notice of our legal duties and
privacy practices with respect to health
information about you; and
·
follow the terms of the notice that is
currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
ABOUT YOU.
For Treatment. We
may use health information about you to
provide you with health care treatment or
services. We may disclose health information
about you to doctors, nurses, technicians,
health students, or other personnel who are
involved in taking care of you. They may work
at our offices or at another provider’s
office.
For Payment: We
may use and disclose health information about
you so that the treatment and services you
receive from us may be billed to and payment
collected from you, an insurance company, or a
third party. For example, we may need to give
your health plan information about your office
visit so your health plan will pay us or
reimburse you for the visit. We may also tell
your health plan about a treatment you are
going to receive to obtain prior approval or
to determine whether your plan will cover the
treatment.
For Health Care Operations: We
may use and disclose health information about
you for operations of our health care
practice. These uses and disclosures are
necessary to run our practice and make sure
that all of our patients receive quality care.
For example, we may use health information to
review our treatment and services and to
evaluate the performance of our staff in
caring for you. We may also combine health
information about many patients to decide what
additional services we should offer, what
services are not needed, whether certain new
treatments are effective, or to compare how we
are doing with others and to see where we can
make improvements. We may remove information
that identifies you from this set of health
information so others may use it to study
health care delivery without learning who our
specific patients are.
Other: We may also use or
disclose your protected health information in
the following situations without your
authorization:
These situations include: as Required
By Law, Public Health Issues as Required by
Law, Communicable Diseases, Health Oversight,
Abuse or Neglect, Food and Drug Administration
requirements, Legal Proceedings, Law
Enforcement, Coroners, Funeral Directors,
Organ Donation, Research, Criminal Activity,
Military Activity and National Security,
Workers’ Compensation, Inmates: Required
Uses and Disclosures.
We may use and disclose health
information to tell you about health-related
services or recommend possible treatment
options or alternatives that may be of
interest to you. Please let us know if you do
not wish us to send you this information, or
if you wish to have us use a different address
to send this information to you.
We may disclose health information
to a health oversight agency for activities
authorized by law. These oversight activities
include, for example, audits, investigations,
inspections, and licensure. These activities
are necessary for the government to monitor
the health care system, government programs,
and compliance with civil rights laws. If
you are involved in a lawsuit or a dispute, we
may disclose health information about you in
response to a court or administrative order.
We may also disclose health information about
you in response to a subpoena, discovery
request, or other lawful process by someone
else involved in the dispute, but only if
efforts have been made to tell you about the
request or to obtain an order protecting the
information requested.
YOUR RIGHTS REGARDING HEALTH
INFORMATION ABOUT YOU.
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 health
information that may be used to make decisions
about your care. Usually, this includes health
and billing records.
To inspect and copy health
information that may be used to make decisions
about you, you must submit your request in
writing to Barb O'Hara, Administrator, Privacy
Official. If you request a copy of the
information, we may charge a fee for the costs
of copying, mailing or other supplies and
services associated with your request. We may
deny your request to inspect and copy in
certain very limited circumstances. If you are
denied access to health information, you may
request that the denial be reviewed. Another
licensed health care professional chosen by
our practice will review your request and the
denial. The person conducting the review will
not be the person who denied your request. We
will comply with the outcome of the review.
Right to Amend. If
you feel that health information we have about
you is incorrect or incomplete, you may ask us
to amend the information. You have the right
to request an amendment for as long as we keep
the information. To request an amendment, your
request must be made in writing, submitted to
Barb O'Hara, Administrator, Privacy Official,
and must be contained on one page of paper
legibly handwritten or typed in at least 10
point font size. In addition, you must provide
a reason that supports your request for an
amendment. We may deny your request for an
amendment if it 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 amend information that:
- was not created by us, unless the person or entity that created the
information is no longer available to make
the amendment;
- is not part of the health information kept by or for
our practice;
- is not part of the information which you would be
permitted to inspect and copy; or
- is accurate and complete.
Any amendment we make to your health
information will be disclosed to those with
whom we disclose information as previously
specified.
Right to an Accounting of Disclosures. You
have the right to request a list accounting
for any disclosures of your health information
we have made, except for uses and disclosures
for treatment, payment, and health care
operations, as previously described. To
request this list of disclosures, you must
submit your request in writing to Barb O'Hara,
Administrator, Privacy Official. Your request
must state a time period which may not be
longer than six years and may not include
dates before April 14, 2003. 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
that time before any costs are incurred. We
will mail you a list of disclosures in paper
form within 30 days of your request, or notify
you if we are unable to supply the list within
that time period and by what date we can
supply the list; but this date will not exceed
a total of 60 days from the date you made the
request.
Right to Request Restrictions. You
have the right to request a restriction or
limitation on the health information we use or
disclose about you for treatment, payment, or
health care operations. You also have the
right to request a limit on the health
information we disclose about you to someone
who is involved in your care or the payment
for your care, such as a family member or
friend. We are not required to agree to
your request for restrictions if it is not
feasible for us to ensure our compliance or
believe it will negatively impact the care we
may provide you. If we do agree, we
will comply with your request unless the
information is needed to provide you emergency
treatment. To request a restriction, you must
make your request in writing to Barb O'Hara,
Administrator, Privacy Official. In your
request, you must tell us what information you
want to limit and to whom you want the limits
to apply. for example, use of any information
by a specified nurse, or disclosure of
specified surgery to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health
matters in a certain way or at a certain
location. For example, you can ask that we
only contact you at work or by mail to a post
office box. To request confidential
communications, you must make your request in
writing to Barb O'Hara, Administrator, Privacy
Official. 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.
Right to a Paper Copy of This Notice. You
have the right to obtain a paper copy of this
notice at any time. To obtain a copy, please
request it from Barb O'Hara, Administrator,
Privacy Official.
You
may also obtain a copy of this notice from our
website, www.fentonpt.com. Even if you have
received a notice electronically, you still
retain the right to receive a paper copy upon
request.
CHANGES TO THIS NOTICE
We reserve the right to change this
notice. We reserve the right to make the
revised or changed notice effective for health
information we already have about you as well
as any information we receive in the future.
We will post a copy of the current notice in
our facility. The notice will contain on the
first page, in the top right-hand corner, the
effective date. In addition, each time you
register for treatment or health care
services, we will offer you a copy of the
current notice in effect.
COMPLAINTS
If you believe your privacy rights
have been violated, you may file a complaint
with us or with the Secretary of the
Department of Health and Human Services. To
file a complaint with us, contact Barb O'Hara,
Administrator, Privacy Official. All
complaints must be submitted in writing. You
will not be penalized for filing a complaint.
OTHER USES OF HEALTH
INFORMATION.
Other uses and disclosures of health
information not covered by this notice or the
laws that apply to us will be made only with
your written permission. If you provide us
permission to use or disclose health
information about you, you may revoke that
permission, in writing, at any time. If you
revoke your permission, we will no longer use
or disclose health information about you for
the reasons covered by your written
authorization. You understand that we are
unable to take back any disclosures we have
already made with your permission, and that we
are required to retain our records of the care
that we provided to you.
Acknowledgement of Receipt of
this Notice
We
will request that you sign a separate form or
notice acknowledging you have received a copy
of this notice. If you choose, or are not able
to sign, a staff member will sign their name,
date. This acknowledgement will be filed with
your records.
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