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:
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. Your record includes an Electronic Health Record. 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, treatments, 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.
- 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
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 and/or electronic 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.
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.
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. Effective July 1, 2015, through June 30, 2017 Washington State RCW 70.02.010 (37) allows $1.12 per page for the first 30 pages. Documents over 30 pages cannot be charged more than .84 per page for the remaining pages. There is a $25.00 clerical fee for searching and handling records, in addition to the per page cost. 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
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:
- to prevent or reduce serious, immediate threat to the safety of a person or the public
- to public health or legal authorities
- to protect public health and safely
- to prevent or control disease, injury, or disability
- 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.
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
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: