HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR COMMITMENT TO PROTECT YOUR MEDICAL AND PERSONAL INFORMATION
Paulseth & Associates Physical Therapy, Inc. is committed to protecting the privacy of your health information. Your confidential medical information is defined under federal law as “protected health information” (“PHI”). When we retain your confidential medical information on a computer system, it is called “electronic protected health information” (“ePHI”). This Notice applies to all PHI and ePHI related to your care that we have created or received. It also applies to any personal or general information we receive.
We are required by law to maintain the privacy of your protected health information; give you this notice of our legal duties and privacy practices with respect to health information about you; and follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose health information. Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to Terri Lueth, our practice Privacy Officer. Certain disclosures required by law or under emergency circumstances, may be made without your Acknowledgement or Authorization. Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure.
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: We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to doctors, nurses, health students, other therapists, or other personnel who are involved in taking care of you.
For Payment: We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you or an insurance company. For example, we may need to give your health plan information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
We may also provide medical information about you to our business associates, such as billing companies, claims processing companies, and others that process our health care claims. We require these business associates to appropriately safeguard the privacy of your information and not to disclose it to anyone else.
We may also provide information to other health care providers that have treated you or provided services to you to assist us or them in obtaining payment.
For Health Care Operations: We may use and disclose 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 health 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 may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our specific patients are.
Special Uses: We may use and disclose health information for purposes that involve your relationship to us as a patient. For example, we may use PHI to remind you of appointments via telephone or text messaging, carry out follow ups on your home exercise programs or discharge planning, advise you of new or updated services via telephone or newsletter, or release equipment or supplies to your designee.
Health-Related Products and Services: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, if you provide us your email address we may email you a company newsletter.
Individuals Involved in Your Care or Payment for Your Care. We may use and disclose medical information about you to a family member, friend, or other person who is involved in your care or the payment for your health care. We may disclose medical information about you to an organization assisting in disaster relief efforts so that your family can be notified about your condition, status and location. You have the right during registration to restrict what information is provided and/or to whom.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may help potential researchers look at records to identify patients who may be included in a research project as long as the researcher does not remove or take a copy of any Health Information.
Clinical Observation. We participate with local schools and universities to provide students interested in pursuing or completing a degree in physical therapy with clinical experience. The involvement in your care is dependent on the status of the student. We will disclose to you the student’s involvement and you may decline to have them observe your treatment or participate in your treatment.
As Required By Law. We will disclose health information about you when required to do so by federal, state, or local law. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence, when dealing with gunshot wounds, to report reactions to medications or problems with products, or to notify people of recalls of products they may be using.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety, or to the health and safety of the public or another person. Any such disclosure, however, would only be to someone able to help prevent the threat or lessen such harm.
Public Health Activities. We may disclose Health Information for public health activities. For example, we may report information about various diseases as required by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
Minors. We may release medical information about minors to their parents or legal guardians. However, in instances where California law allows minors to consent to their own treatment, information will not be released to a minor’s parents without the minor’s consent unless otherwise specifically allowed under California law.
Workers’ Compensation. We may release medical information about you for workers’ compensation or similar agencies as necessary to determine if you are eligible for benefits for work-related injuries or illness.
Military and Veterans. If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Employers. We may release medical information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either 1) to conduct an assessment relating to a medical examination of your workplace, or 2) to determine the extent of your work related illness or injury. In such circumstances we will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you sign a specific authorization for the release of that information to your employer.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may use and disclose medical information about you in response to a court or administrative order. We may also use and disclose medical information about you in response to a court or administrative ordered subpoena or discovery request, but only after efforts have been made to tell you about the request.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Incidental Disclosures. Incidental disclosures may occur during the course of treatment due to our open gym/exercise floor plan. For example, another client may over hear a therapist asking you if your knee pain has improved. You may request a private treatment room if this concerns you.
Other Uses and Disclosures of Medical Information. Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with written permission. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to Terri Lueth, our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. Any disclosure that we made in reliance on your authorization before you revoked it will not be affected by the revocation.
WHAT RIGHTS YOU HAVE REGARDING YOUR MEDICAL INFORMATION
The Right To Inspect and Copy. You have the right to inspect and receive a copy of the Health Information that may be used to make decisions about your care. Usually, this includes health and billing records. To inspect and copy this Health Information, you must submit your request in writing to Terri Lueth, our Privacy Officer. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information
Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, you must provide the request in writing along with the reason for the request to Terri Lueth, Privacy Officer. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the health information kept by or for our practice; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete. Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.
Right to an Accounting of Disclosures. You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described. To request this list of disclosures, you must submit your request in writing to Terri Lueth, Privacy Officer.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not disclose information to your spouse about treatment you had. We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to Terri Lueth, Privacy Officer.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. To request confidential communications, you must make your request in writing to Terri Lueth, Privacy Officer. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice at any time. To obtain a paper copy of this notice, please contact Terri Lueth, Privacy Officer.
CHANGES TO THIS NOTICE. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at our office. The notice will contain the effective date on the first page. If the content of the notice changes during your treatment period, we will offer you a copy of the current notice in effect.
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, contact Terri Lueth, Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Acknowledgement of Receipt of this Notice. We will request that you sign receipt of this notice. If you choose not to, or are not able to sign, a staff member will sign their name and date the acknowledgement section. This acknowledgement will be filed with your records.
You may contact our Privacy Officer:
Terri Lueth
10351 Santa Monica Blvd., Suite 101
Los Angeles, CA 90025
(310) 286-0447