THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS INFORMATION CAREFULLY
If you have any questions about this notice, please contact Rathjen Physical Therapy
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required
to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact Rathjen Physical Therapy.
USE AND DISCLOSURE OF HEALTH INFORMATION
We use and disclose health information about your for your treatment, payment and healthcare operations. For example:
For Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
For Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations
include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating
practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written
authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you maybe revoke it in
writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
To your Family and Friends: We must disclose your health information to you as described in the Patient Rights section of this notice. We may
disclose your health information to a family member, friend or other person to the extent necessary to help your healthcare or with payment
for your healthcare, but only if you agree that we may do so.
Persons Involved in Care: We may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use of disclosure of your health information, we will provide you with an opportunity to object to such uses or
disclosures. In an event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
Marketing Health-Related Services: We will not use your health information for marketing communications without your written permission.
Required by Law: We may use or disclose your health information when we are required to do so by Federal, State, or local law.
Military and Veterans: If you are a member of the armed forces or separated/discharged from military services, we may release health
information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also
release health information about foreign military personnel to the appropriate foreign military authorities.
Workers’ Compensation: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Lawsuits and Disputes: 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
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of
abuse, neglect, or domestic violence of the possible victim of other crimes. We may disclose your health information to the extent necessary to
avert a serious threat to your health or safety or the health or safety of others.
We may disclose to military authorities the health information of Armed Forces Personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutionor law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
Breach of Protected Information: You will be notified of any breach of protected health information in compliance with the guidelines outlined in the HIPPA Omnibus rules. Should a breach occur involving 5 or more patients, our office will notify the Secretary of Health
and Human Services as well.
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practically do so. You must make a request in writing to obtain access to your health information. Depending on the circumstances we may charge you a reasonable cost-based fee for expenses such as copies and staff time.
You may request a restriction of information to your insurance company if you pay for a service or item with no involvement by insurance. While you may use a medical savings account to pay for the service, you may not restrict the information to one insurance company but
submit a claim to another company for the same service or item.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices, or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or to alternative locations, you may complain to us at Rathjen Physical Therapy. You may also submit a written complaint to the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
ACKNOWLEDGEMENT AND 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 and date. This acknowledgement will be filed with your records