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.
Federal Law (the Health Insurance Portability and Accountability
Act (HIPAA)) requires that health care providers inform patients
of their rights regarding how the provider may use and disclose
your protected health information to carry out treatment, payment
or health care operations and for other purposes that are permitted
or required by law. This Privacy Notice describes our privacy practices
that relate to your protected health information. It also describes
your rights to access and control your protected health information
in some cases. Your "protected health information" means
any written and oral health information about you, including demographic
data that can be used to identify you. This is health information
that is created or received by your health care provider, and that
relates to your past, present or future physical or mental health
or condition.
Your Health Record and Protected Health Information
Each time you receive medical care from our practice, a record
of your visit is created. This record typically includes, but is
not limited to, information such as your name, age, address, a brief
medical history, symptoms, any test results, the treatment provided
to you, treatment plans devised for your care, and notes on follow-up
care to be performed. How your health care information may be used
and what control you may exercise over the use of your healthcare
information is described in this Privacy Notice.
Uses and Disclosures of Protected Health Information
Our Practice may use your protected health information for purposes
of providing treatment, obtaining payment for treatment, and conducting
health care operations. Your protected health information may be
used or disclosed only for these purposes unless the practice has
obtained your authorization or the use or disclosure is otherwise
permitted by the HIPAA privacy regulations or state law. Disclosures
of your protected health information for the purposes described
in this Privacy Notice may be made in writing, orally, or by facsimile.
Treatment: Your health information may be used by staff
members or disclosed to other health care professionals for the
purpose of evaluating your health, diagnosing medical conditions,
and providing treatment. For example, results of laboratory tests
and procedures will be available in your medical record to all health
professionals who may provide treatment or who may be consulted
by staff members.
Payment: Your protected health information may be used to
seek payment from your health plan, from other sources of coverage
such as an automobile insurer, or from credit card companies that
you may use to pay for services. For example, your health plan may
request and receive information on dates of service, the services
provided, and the medical condition being treated.
Health Care Operation: your health information my be used
as necessary to support the day-to-day activities and management
of Back to Action Physical Therapy. For example, information on
the services you received may be used to support budgeting and financial
reporting, and activities to evaluate and promote quality. Other
examples might include: employee review activities, training programs
including those in which students, trainees, or practitioners in
health care learn under supervision, accreditation, certification,
licensing or credentialing activities, review and auditing, including
compliance reviews, medical reviews, legal services and maintaining
compliance programs, and business management and general administrative
activities. In certain situations, we may also disclose patient
information to another provider or health plan for their health
care operations.
Law enforcement: Your health information may be disclosed
to law enforcement agencies to support government audits and inspections,
to facilitate law-enforcement investigations, and to comply with
government mandated reporting.
Public health reporting: Your health information may be
disclosed to public health agencies as required by law. For example,
we are required to report certain communicable diseases to the state’s
public health department.
Other uses and disclosures for health care operations may include:
Appointment Reminders: Your health information may be used
to contact you, a family member or friend involved in your health
care as authorized by you as a reminder that you have an appointment
for treatment or medical care at our facility. We may also leave
a message on your answering machine / voicemail system unless you
tell us not to.
Treatment Alternatives: We may use or disclose your protected
health information to tell you about or recommend possible treatment
options or alternatives that may be of interest to you.
Health Related Benefits and Services: We may use or disclose
your protected health information to tell you about health related
benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment of Your Care:
We may disclose your protected health information to a friend or
family member who is involved in your medical care. We may also
give information to someone assisting you in the payment for your
care. We may also tell your family or friends that you are in the
facility at the time of your care. If you want any of this information
restricted you must communicate that to us using the appropriate
procedure.
Worker's Compensation: The facility may release your health
information to comply with worker's compensation laws or similar
programs.
You may object to these disclosures. If you do not object to these
disclosures or we can infer from the circumstances that you do not
object or we determine, in the exercise of our professional judgment,
that it is in your best interests for us to make disclosure of information
that is directly relevant to the person’s involvement with
your care, we may disclose your protected health information as
described.
Uses and Disclosures which you authorize: Other than as
stated above, we will not disclose your health information other
than with your written authorization. You may revoke your authorization
in writing at any time except to the extent that we have taken action
in reliance upon the authorization.
Individual Rights
Although your health record is the physical property of the healthcare
practitioner or Facility that compiled it, the information belongs
to you. You have certain rights under the federal privacy standards.
These include:
· The right to request restrictions on the use and disclosure
of your protected health information
· The right to receive confidential communications concerning
your medical condition and treatment
· The right to inspect and copy your protected health information
· The right to amend or submit corrections to your protected
health information
· The right to receive an accounting of how and to whom your
protected health information has been disclosed
· The right to receive a printed copy of this notice
Please contact our HIPAA Privacy Officer if you have questions
about access to your medical record.
Back To Action Physical Therapy Duties
We are required by law to maintain the privacy of your protected
health information and to provide you with this notice of privacy
practices. We also are required to abide by the privacy policies
and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our
privacy policies and practices. These changes in our policies and
practices may be required by changes in federal and state laws and
regulations. Upon request, we will provide you with the most recently
revised notice on any office visit. The revised policies and practices
will be applied to all protected health information we maintain.
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information
that we maintain. As permitted by federal regulation, we require
that requests to inspect or copy protected health information be
submitted in writing. You may obtain a form to request access to
your records by contacting Robin Brackett or Joseph Grant. Your
request will be reviewed and will generally be approved unless there
are legal or medical reasons to deny the request.
Complaints
We encourage you to express any concerns you may have regarding
the privacy of your information. If you would like to submit a comment
or complaint about our privacy practices, you can do so by sending
a letter outlining your concerns to:
Joseph D. Grant, Owner
Back To Action Physical Therapy, PLC
4740 Main Street
Waitsfield, VT 05673
(802)-496-4292
You also have the right to express complaints to the Secretary
of Health and Human Services if you believe that your privacy rights
have been violated. You will not be penalized or otherwise retaliated
against for filing a complaint.
Contact Person
The name and address of the person you can contact for further information
concerning our privacy practices is:
HIPAA Privacy Officer
Joseph D. Grant
Back To Action Physical Therapy, PLC
4740 Main Street
Waitsfield, VT 05673
Effective Date
This Notice is effective on or after January 1, 2006.
BACK TO ACTION PHYSICAL THERAPY, PLC
4740 Main Street, Waitsfield, VT 05673
Clinic phone: 802-496-4292 Fax 802-496-4262 Billing phone 802-496-5340 |
