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 states
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 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, 2008.
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