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.
I. Who We Are
This Notice describes the privacy practices of professional corporation doing business as AposTherapy("we" or "us" or "our"), including all healthcare professionals allowed to enter or access information in your patient record and all employees or other personnel with access to your medical, personal or billing records or health information about you.
II. Our Commitment
We are dedicated to maintaining the privacy of your individually identifiable health information (also called "protected health information " or "PHI"). We will promptly let you know if a breach occurs that may have compromised the privacy and security of your PHI. In conducting our business, we will create records about you and the services we provide to you, and we are required by law to maintain the privacy of health information that identifies you. We are providing you with this legal notice of our duties and privacy practices that we maintain in our practice concerning your PHI. When we use or disclose your PHI, we abide by the terms of this Notice. We will not use or disclose your PHI other than described here, unless you tell us we can in writing. You can change your mind at any time, and inform us in writing of any changes
III. Permissible Uses and Disclosures without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must obtain your written authorization in order to use and/or disclose your PHI. However, we do not need any type of authorization from you for the following uses and disclosures:
A. Treatment.We may use and disclose your PHI to provide treatment and other services to you – for example, to develop treatment plans or to consult with your physician about your treatment plan and progress. We may also disclose PHI to other providers involved in your treatment.
B. Payment. We may use and disclose your PHI to obtain payment for services that we provide to you - for example, disclosures to claim and obtain payment from your health insurer, HMO, or other company or program that arranges or pays the cost of some or all of your care ("Your Payor"), or to verify that Your Payor will pay for the care. We may also disclose PHI to your other providers when such PHI is required for them to receive payment for services they render to you.
C. Health CareOperations. We may use and disclose your PHI for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use PHI to evaluate the quality and competence of our physical therapists and other workers, measuring systems we use (such as the gait mat and the questionnaires) and of the patient journey through which you became our patient. We may disclose PHI to our Customer Relations Center in order to resolve any complaints you may have and ensure that you are satisfied with our services.
D. Disclosure to Relatives, Close Friends and Other Caregivers. We may use or disclose your PHI to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to the disclosure. If you object to such uses or disclosures, please notify the Privacy Officer.
If you are not present for or unavailable prior to a disclosure (e.g., when we receive a telephone call from a family member or other caregiver) or there is an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure to a family member, close friend or other caregiver is in your best interests. If we disclose information under such circumstances, we would disclose only information that is directly relevant to the person's involvement with your care.
E. Alternative Treatments; Appointment Reminders. We may use your information to direct or recommend alternative treatments, therapies, health care providers, or settings of care to you or to describe a health-related product or service. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
F. As Required by Law. We may use and disclose your PHI when required to do so by any applicable federal, state or local law.
G. Special Circumstances. The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
(1) Public Health Activities. We may disclose your PHI: (a) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (b) to report child abuse, neglect, or domestic violence to a government authority authorized by law to receive such reports; (c) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (d) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (e) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
(2) Health Oversight Activities. We may disclose your PHI to an agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
(3) Law Enforcement, Health and Safety.
(a) Victims of Abuse, Neglect or Domestic Violence. We may disclose your PHI if we reasonably believe you are a victim of abuse, neglect or domestic violence to a government authority authorized by law to receive reports of such abuse, neglect, or domestic violence.
(b) Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
(c) Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required by law or in compliance with a court order. We may release information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
(d) Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent threat to a person's or the public's health or safety.
(4) Decedents; Organ and Tissue Procurement. We may disclose your PHI to a coroner or medical examiner as authorized by law. We may also disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
(5) Specialized Government Functions. We may use and disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.
(6) Workers' Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with state law relating to workers' compensation or other similar programs.
(7) Clinical Trials and Other Research Activities. We may use and disclose your PHI for research purposes. For example, a research project may involve comparing the health and recovery of patients who received one treatment plan versus another for the same condition. All research projects, however, are subject to a special approval process before your PHI may be used or disclosed. When legally required, we will ask for your special written permission (authorization). Under certain circumstances, your PHI may be disclosed without your authorization to researchers preparing to conduct a research project, for research or decedents or as part of a data set that omits your name and other information that can directly identify you.
IV. Uses and Disclosures Requiring Your Written Authorization
For any purpose other than the ones described above in Section III, we only use or disclose your PHI when you give us your written authorization.
A. Marketing.We must obtain your written authorization prior to using your PHI to send you certain marketing materials. For example, we will not accept any payments from other organizations or individuals in exchange for making communications to you about treatments, therapies, health care providers, settings of care, case management, care coordination, products or services unless you have given us your authorization to do so or the communication is permitted by law.
We can, however, provide you with marketing materials in a face-to-face encounter without authorization. We may also provide a promotional gift of nominal value, if we so choose. We may provide reminders or communicate with you about your treatment plan or relevant treatment plans so long as any payment we receive for making the communication is reasonably related to our cost of making the communication.
B. Sale of PHI.We will not make any disclosure of PHI that is a sale of PHI without your written authorization.
C. Revocation of Your Authorization. You may revoke your authorization, except to the extent that we have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Officer identified below.
D.Fundraising. We may contact you for fundraising efforts, but you can tell us not to contact you again.
VI. Your Individual Rights
A. For Further Information; Complaints. If you desire further information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your PHI, you may contact our Privacy Officer. Name and contact information for Privacy Office can be found in Section VIII. of this notice. You may also file written complaints with the Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint.
B. Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. All requests for restrictions must be made in writing. While we will consider all requests for additional restrictions carefully, we-are-not-required to-agree to a-requested -restriction unless-the request is to restrict our disclosure to a health plan for purposes of carrying out payment or health care operations, the disclosure is not required by law and the information pertains solely to a health care item or service for which you (or someone on your behalf other than the health plan) have paid us out of pocket in full. If you wish to request additional restrictions, please obtain a request form from our Privacy Officer and submit the completed form to the Privacy Officer. We will send you a written response.
C. Right to Receive Confidential Communications by Alternative Means or at Alternative Locations. You may request, and we will accommodate, any reasonable written request for you to receive communications by alternative means of communication (example – home or office phone), or at alternative locations (example, different mailing address.
D. Right to Inspect and Get an Electronic or Paper Copy of Your Health Information. You may request access to your patient record file and billing records maintained by us in order to inspect and request electronic or paper copies of the records. All requests for access must be made in writing. Under limited circumstances, we may deny you access to a portion of your records. If you are denied access to medical information, you may request a review of the denial under New York State law. If you desire access to your records, please obtain a record request form from the Privacy Officer and submit the completed form to the Privacy Officer. If you request copies, we may charge you a reasonable copy fee. We will also charge you for our postage costs if you request we mail the copies to you.
You should take note that, under New York State law, if you are a parent or a legal guardian of a minor, certain portions of the minor's record will not be accessible to you (for example, records relating to venereal disease, abortion, or care or treatment to which the minor is able to consent himself/herself without your consent such as chemical dependence treatment or care received by a married minor).
E. Right to Amend Your Records. You have the right to request that we amend your PHI maintained in your patient record file or billing records. If you desire to amend your records, please obtain an amendment request form from the Privacy Officer and submit the completed form to the Privacy Officer. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
F. Right to Ask Us To Limit What We Share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.
G. Right to Receive an Accounting of Disclosures. Upon request, you may obtain a list of certain disclosures of your PHI made by us during any period of time prior to the date of your request; provided that such period does not exceed six years. If you request an accounting more than once during a twelve (12) month period, we may charge you a reasonable fee for the accounting statement.
H. Breach Notification. If a breach (an impermissible use or disclosure of PHI under the HIPAA Privacy Rule) occurs that compromises the privacy and security of your PHI, you will be promptly notified via first class mail, or alternatively, by email if you've agreed to receive electronic communications from us.
I. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you agreed to receive such notice electronically.
VII. Effective Date and Change Terms of This Notice
A. Effective Date. This Notice is effective on February 2016.
B. Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for your entire PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in our waiting room and on our Internet site at www.apostherapy.com. You also may obtain any new notice by contacting the Privacy Officer.
VIII. Privacy Officer
You may contact the Privacy Officer at:email@example.com
Privacy Officer: Sasha Lalite
Telephone Number: 855-999-2767
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