HIPAA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Effective Date: January 1, 2024
Please Review Carefully
This notice is required by law. Please review it carefully and ask us if you have any questions about your privacy rights or how we handle your health information.
Our Commitment to Your Privacy
Care Physical Therapy is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this notice of our legal duties and privacy practices.
How We May Use and Disclose Your Health Information
We may use and disclose your health information for the following purposes:
Treatment
We may use and disclose your health information to provide, coordinate, or manage your healthcare treatment and related services. Examples include:
- Sharing information with other healthcare providers involved in your care
- Coordinating treatment plans and referrals
- Consulting with specialists about your condition
- Providing information to family members or friends involved in your care (with your permission)
Payment
We may use and disclose your health information to obtain payment for services provided to you. Examples include:
- Submitting claims to your insurance company
- Verifying insurance coverage and benefits
- Collecting payment for services
- Responding to insurance company requests for additional information
Healthcare Operations
We may use and disclose your health information for healthcare operations. Examples include:
- Quality assessment and improvement activities
- Staff training and education
- Accreditation and licensing activities
- Business planning and management
- Legal and compliance activities
Other Uses and Disclosures
We may also use or disclose your health information in the following situations:
Required by Law
- When required by federal, state, or local law
- In response to court orders or legal proceedings
- To comply with workers' compensation laws
Public Health Activities
- Reporting communicable diseases
- Reporting suspected abuse or neglect
- Reporting adverse reactions to medications
- Public health investigations
Health and Safety
- To prevent or lessen a serious threat to health or safety
- To law enforcement in emergency situations
- To prevent harm to you or others
Your Rights Regarding Your Health Information
You have the following rights regarding your health information:
Right to Access
You have the right to inspect and obtain copies of your health information. To request access:
- Submit a written request to our Privacy Officer
- We will respond within 30 days
- We may charge a reasonable fee for copying costs
- In some cases, we may deny your request, but you may appeal the denial
Right to Request Amendment
You have the right to request that we amend your health information if you believe it is incorrect or incomplete:
- Submit a written request with the reason for the amendment
- We may deny your request if the information is accurate and complete
- If denied, you may submit a statement of disagreement
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your health information:
- We are not required to agree to your request
- If we agree, we will comply with the restriction unless emergency treatment is needed
- You may terminate the restriction at any time
Right to Request Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location:
- Request communications at an alternative address or phone number
- Request that we not leave messages with family members
- We will accommodate reasonable requests
Right to an Accounting of Disclosures
You have the right to receive an accounting of disclosures of your health information:
- Covers disclosures made in the six years prior to your request
- Does not include disclosures for treatment, payment, or healthcare operations
- First accounting in a 12-month period is free; additional requests may incur a fee
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Changes to This Notice
We reserve the right to change this notice and make the new notice apply to health information we already have as well as any information we receive in the future. We will post the current notice in our office and on our website. The notice will contain the effective date.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us:
File a Complaint
Privacy Officer
Care Physical Therapy
123 Main Street
Southfield, MI 48075
Phone: (248) 555-0100
Email: privacy@careptmi.com
You will not be retaliated against for filing a complaint. All complaints must be in writing.
Contact Information
If you have questions about this notice or need more information about our privacy practices, please contact our Privacy Officer using the information above.
Acknowledgment
By receiving services from Care Physical Therapy, you acknowledge that you have been provided with a copy of this Notice of Privacy Practices and have been informed of how we may use and disclose your health information.