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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 is followed
by:
·
Any health care professional authorized to enter
information into your chart
·
All departments of the practice
· Any volunteer
or volunteer group we allow to help you while you are at
our practice
· All employees, staff, and other practice and billing
personnel
ProAction Physical
Therapy, PLLC respects your privacy.
We are committed to
protecting medical information about you. We create a
record of the care and services you receive at the
practice. 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 practice, whether made by
your physicians or others working in this office.
The law protects the
privacy of the health information we create and obtain
in providing our care and services to you. For example,
your protected health information includes your
symptoms, test results, diagnoses, treatment, health
information from other providers, and billing and
payment information relating to these services. Federal
and state law allows us to use and disclose your
protected health information for purpose of treatment
and health care operations.
Examples of Use and Disclosures of Protected Health
Information for Treatment, Payment, and Health
Operations
On behalf of ProAction
Physical Therapy, patients may receive written
correspondence (for example, billing statements,
appointment reminders, thank you and welcome letters,
and/or newsletters). We may also call patients to remind
them of their appointment date and time, as well as for
scheduling purposes, and to confirm/inquire about
information necessary to provide accurate and timely
billing services. We may also leave messages for you at
your provided contact numbers. We may also schedule,
change, modify, and/or cancel appointments for you that
are made by your spouse, immediate family member(s), or
designated personal representative(s). We will also send
electronic fax and email transmissions between our
clinic and billing office for billing purposes. Patients
may be announced when they arrive for their appointment.
The following categories
describe different ways that we use and disclose medical
information. For each category of uses or disclosures we
will explain what we mean and try to give some examples.
Not every use or disclosure in a category will be
listed. However, all of the ways we are permitted to use
and disclose information will fall within one of the
categories.
For
Treatment:
Information obtained by a
Physical Therapist, or other member of our health care
team will be recorded in your medical record and used to
help decide what care may be right for you. We may also
provide information to others providing you care. This
will help them stay informed about your care.
For
Payment:
We may use and disclose
medical information about you so that the treatment and
services you receive at our practice may be billed to
and payment may be collected from you or an insurance
company, including Medicare. For example, we may need
to give your health plan information about your care
received so your health plan will pay us or reimburse
you for the visit. Your health care plan may make a
request to review your medical record to determine that
your care was necessary. Information provided to health
plans may include your diagnoses, procedures performed,
or recommended care.
For
Health Care Operations:
We may use 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 medical
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 will remove information that identifies you from this
set of medical information so others may use it to study
healthcare delivery.
Your
Health Information Rights
You have the following
rights regarding medical information we maintain about
you:
1) Right to receive, read, and ask questions about this
Notice;
2) Ask us to restrict certain uses and disclosures. You
must deliver this request in writing to us. We are not
required to grant the request. But we will comply with
any request granted;
3) Request and receive from us a paper copy of the most
current Notice of Privacy Practices for Protected Health
Information (PHI).
4) Request that you be allowed to see and get a copy of
your protected health information. You may make this
request in writing. 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. ProAction Physical Therapy will also
charge a fee for copying PHI for our patients.
Washington State law allows .83 per page for the first
30 pages. Documents over 30 pages
cannot be charged more than .63 per page for the
remaining pages. The maximum fee for searching and
handling is $19.00, in addition to the per page cost.
Postage may not be
billed in addition to the maximum fee of $19.00. You
will receive your copy within 15 days of
receipt of your
request.
5) Have us review
a denial of access to your health information - except
in certain circumstances;
6) Ask us to change your health information. You must
give us this request in writing. You may write a
statement of disagreement if your request is denied. It
will be stored in your medical record, and included with
any release of your records.
7) Ask that your health information be given to you by
another means or at another location. Please sign,
date, and give us your request in writing.
8) Cancel prior authorizations to use or disclose
health information by giving us a written revocation.
Your revocation does not affect information that
has already been released. It also does not affect any
action taken before we have it. Sometimes, you cannot
cancel an authorization if its purpose was to obtain
payment.
Other Disclosures and Uses of Protected
Health Information
Notification
to Family and Others
Unless you object, we may
release health information about you to a friend or
family member who is involved in your medical care. We
may also give information to someone who helps pay for
your care. In addition, we may disclose health
information about you to assist in disaster relief
efforts. You have the right to object to this use or
disclosure of your information. If you object, we will
not use or disclose it. We may use and disclose your
protected health information without you authorization
as follows:
With Medical
Researchers
if the research
has been approved and has policies to protect the
privacy of your health information. We may also share
information with medical researchers preparing to
conduct a research project.
To Funeral
Directors/Coroners
consistent with
applicable law to allow them to carry out their duties.
To Organ
Procurement Organizations
(tissue donation
and transplant) or persons who obtain, store, or
transplant organs.
To the Food and
Drug Administration (FDA)
relating to
problems with food, supplements, and products.
To Comply With
Workers' Compensation Laws
if you make a
workers' compensation claim.
For
Public Health and Safety Purpose as Allowed or Required
by Law:
1) to prevent or reduce
serious, immediate threat to the safety of a person or
the public
2) to public health or legal
authorities
3) to protect public health and safely
4) to prevent or control disease,
injury, or disability
5) to report vital statistics such as
birth or deaths
To Report Suspected Abuse
or Neglect
to public
authorities.
To Correctional
Institutions
if you are in jail
or prison, as necessary for your health and the health
and safety of others.
For Law
Enforcement Purposes
such as when we
receive a subpoena, court order, or other legal process,
or you are the victim of a crime.
For Health and
Safety Oversight Activities.
For example, we
may share health information with the Department of
Health.
For Disaster
Relief Purposes.
For example, we may share
health information with disaster relief agencies to
assist in notification of your condition to family or
others.
For Work-Related
Conditions That Could Affect Employee Health.
For example, and
employer may ask us to assess health risks on a job
site.
To the Military
Authorities of U.S. and Foreign Military Personnel.
For example,
the law may require us to provide information necessary
to a military mission.
In the Course of
Judicial/Administrative Proceedings
at your request,
or as directed by a subpoena or court order.
For Specialized
Government Functions.
For example, we
may share information for national security purposes.
Other Uses and Disclosures of Protected
Health Information
Uses and disclosures not in this Notice will be made
only as allowed or required by law or with your written
authorization.
Our
Responsibilities
We are required to:
1) Keep your protected health
information private;
2) Give you this Notice;
3) Follow the terms of this Notice;
4) We have the right to change our
practices regarding the protected health information we
maintain. If we make changes, we will update this
Notice. You may receive the most recent copy of this
Notice by calling and asking for it or by visiting our
office to pick one up.
To Ask for Help or
Complain:
If you have
questions, want more information, or want to report a
problem about the handling of your protected health
information, you may contact:
Tamsie Aalbu, Privacy Officer
ProAction Physical Therapy, PLLC
6618 64th St NE, Suite D
Marysville, WA 98270
phone 360.653.5800 fax 360.653.5880
If you feel that your
privacy rights have been violated, you may discuss your
concerns with any staff member. You may also deliver a
written complaint to the Privacy Officer at ProAction
Physical Therapy, PLLC. We respect your right to file a
complaint with us without fear of retaliation. Your
complaint should contain enough specific information so
that we may adequately investigate and respond to your
concerns. If you are not satisfied with our response,
you may complain directly to the U.S. Secretary of
Health and Human Services.
ProAction Physical Therapy,
PLLC reserves the right to modify this Notice without
prior notification to our patients. (05/09)
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