NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES YOUR RIGHTS CONCERNING YOUR PROTECTED HEALTH INFORMATION (PHI), HOW YOUR PHI MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO YOUR PHI, AND OUR RESPONSIBILITIES TO PROTECT YOUR PHI
PLEASE REVIEW THIS NOTICE CAREFULLY
State and Federal laws require us to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this notice. We are required to abide by the terms of this Notice of Privacy Practices. This Notice will take effect on June 10th, 2015 and will remain in effect until it is amended or replaced by the Privacy Officer of PT Professionals.
We reserve the right to change our privacy practices provided the law permits the changes. Before we make a significant change, this Notice will be amended to reflect the changes and we will make the new Notice available upon request. We reserve the right to make any changes in our privacy practices and the terms of our Notice effective for all health information maintained, created, and/or received by us before the date changes were made.
You may request a copy of our Notice of Privacy Practices at any time by contacting our Privacy Officer. Information on contacting us can be found at the end of this notice. We will keep your health information confidential.
You have the following rights with respect to your PHI:
The Right To Inspect And Obtain A Paper Copy of your PHI: Upon written request, you have the right to inspect and get copies of your health information (and that of an individual whom you are a legal guardian). We will provide access to health information in a form/format requested by you. There will be some limited expectations. If you wish to examine or copy your PHI, you will need to inform the front office of your request so that it may be documented. You may request this information verbally our in writing. You may also request access by sending us a letter to the address found in the footer of this notice. If appropriate, an appointment can be made to review your records. Copying fees as allowed by Florida Statues will apply. If you prefer a summary or explanation of your health information, we can also provide this for a fee. If you want the copies mailed to you, postage will be charged. In light of the increasing use of Electronic Medical Record technology (EMR), the HITECH Act allows you the right to request a copy of your health information in electronic form if we store your information electronically. Access to your health information in electronic form, if readily producible, may be obtained with your request. A fee will be charged to cover the cost of staff to produce the electronic copy and the cost of the electronic media unto which the copy is saved. If for some reason we aren’t capable of an electronic format, a readable hardcopy will be provided. Please contact our Privacy Officer for an explanation of our fee structure.
The Right To Request A Restriction On Certain Uses And Disclosures Of Your PHI: You have the right to request additional restrictions on our use or disclosure of your PHI by completing a written request for restrictions which will be reviewed after completion. We are required to restrict disclosure of your PHI to a health plan if: (A) the disclosure is for carrying out payment or heath care operations and is not otherwise required by law; and (B) the PHI pertains solely to a health care item or service for which you, or a person on your half other than the health plan, has paid the covered entity out of pocket in full. Effective March 26, 2013, the Omnibus Rule restricts provider’s refusal of an individual’s request not to disclose PHI. We may not be required to agree to all other restriction requests and in certain cases, we may deny your request. If you are denied access to your PHI, you may request that this denial be reviewed.
The Right To Request Amendment Of Your PHI: You have the right to amend your healthcare information if you feel it is inaccurate or incomplete. You may request an amendment for as long as we maintain your PHI. Your request must be in writing and must include an explanation of why the information should be amended. Your request will be reviewed and if granted, the information will be amended. Under certain circumstances, your request may be denied. If we deny your request, you have the right to file a statement of disagreement with our denial and we may record a rebuttal to your statement.
The Right To Receive An Accounting Of Disclosures Of Your PHI: You have the right to receive an accounting of the disclosures we have made of your PHI. This accounting includes only those PHI disclosures required to be accounted for under HIPAA. This accounting is also limited for the time period that these disclosures need to be accounted for under HIPAA. Depending on the compliance date required by law for a particular record, an accounting of the disclosures from an EMR will include disclosures for treatment, payment, or health care operations. Records of these disclosures must be maintained for three years. We may use or disclose your health information when we are required to do so by law, (court or administrative orders, subpoena, discovery request, or other lawful process). To request an accounting, you must submit a written request to the privacy officer and include the specific time period, which may be no longer than the time period that these PHI disclosures need to be accounted for under HIPAA. You also have the right to receive a list of non routine disclosures we have made of your health care information. You can request non routine disclosures going back 6 years starting on April 14th, 2013.
The Right To Request Communications Of Your PHI By Alternative Means Or At Alternative Locations: You have the right to request to receive communications of PHI from our facility by alternative means or at alternative locations, if you feel that the disclosure of all or part of that information could endanger you. You may request confidential communications when appropriate
The Right To Receive Written Notification Of A Breach Of Your Unsecured PHI: It is presumed that any acquisition, access, use or disclosure of PHI not permitted under HIPAA regulations is a breach. We are required to complete a risk assessment, and if necessary, inform HHS and take any other steps required by law. You will be notified in writing of the situation and any steps you should take to protect yourself against harm due to a breach. Unless specified in writing by you to receive this breach notification by electronic mail, we will provide this notification by first-class mail, or if necessary, by such other substituted forms of communication allowed under law.
Examples Of How We May Use Your PHI:
The Following Are Descriptions And Examples Of Ways We May Use And Disclose Your PHI
Treatment: While we are providing you with health care services, we may share your protected health information (PHI) including electronic protected health information (ePHI) with other health care providers, business associates and their subcontractors or individuals who are involved in your treatment, billing, administrative support or data analysis. These business associates and subcontractors through signed contracts are required by Federal law to protect your health information. We have established “minimum necessary” or “need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.
Payment: We may use and disclose your health information to seek payment for services we provided to you. This disclosure involves our business office staff and may include insurance organizations, collections or other third parties that may be responsible for such costs, such as family members.
Healthcare Operations: We will use and disclose your health information to keep our practice operable. Examples of personnel who may have access to this information include, but are not limited to, our medical records staff, insurance operations, health care clearinghouses and individuals performing similar activities.
Disclosure To Other Healthcare Professionals: We may disclose and/or share protected health information (PHI) including electronic disclosure with other health care professionals who provide treatment and/or service to you. These professionals will have a privacy and confidentiality policy like this one. Health information about you may also be disclosed to your family, friends, and/or other persons only if you choose to involve them in your care. As of March 26, 2013 immunization records for students may be released without an authorization (as long as the PHI disclosed is limited to proof of immunization). If an individual is deceased we may disclose PHI to a family member or individual involved in care or payment prior to death. Psychotherapy notes will not be used or disclosed without your written authorization. The Genetic Information Nondiscrimination Act (GINA) prohibits health plans from using or disclosing genetic information for underwriting purposes. Uses and disclosures not described in this notice will be made only with your signed authorization.
Appointment Reminders: We may use your health records to remind you of recommended services, treatment or scheduled appointments.
Worker’s Compensation: We may disclose your PHI as authorized by, and as necessary to comply with laws relating to worker’s compensation or similar programs established by law.
National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.
Law Enforcement: We may use or disclose your PHI for law enforcement purposes as required by law in response to a valid subpoena or other legal process.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim or abuse, neglect, or domestic violence of the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent serious threat to your health or safety or that of others.
Public Health Responsibilities: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Marketing Health-Related Services: We will not use your health information for marking purposes unless we have your written authorization to do so. Effective March 23, 2013, we are required to obtain an authorization for marketing purposes if communication about a product or service is provided and we receive financial remuneration (getting paid in exchange for making the communication). No authorization is required if communication is made face-to-face or for promotional gifts.
Sale of PHI: We are prohibited to disclose PHI without an authorization if it constitutes remuneration (getting paid in exchange for PHI). “Sale of PHI” does not include disclosures for public health, certain research purposes, treatment and payment, and for any other purpose permitted by the Privacy Rule, where the only remuneration received is “a reasonable cost-based fee” to cover the cost to prepare and transmit the PHI for such a purpose or a fee otherwise expressly permitted by law. Corporate transactions (i.e., sale, transfer, merger, consolidation) are also excluded from the definition of “sale”.
For More Information Or To Report A Problem/Complaint: You have the right to file a complaint with us if you feel we have not complied with our Notice of Privacy Practices. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us in writing. Request a Complaint Form from our Privacy Officer. We support your right to the privacy of your information and 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.
HOW TO CONTACT US:
For General Questions:
Office Manger Contact: Jodi Bristol
8045 Spyglass Hill Road, Suite 103
Melbourne, FL 32940
Tel: (321)757-5515 Fax: (321)757-5514
PT Professionals Privacy Officer: Daryl Jacobs
Tel: (321)757-5515 Fax: (321) 757-5514