PF-1000 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.

PLEASE REVIEW IT CAREFULLY.

Treatment. Your health information may be used by staff members, contractors of the provider, volunteers, physical therapist assistant students, and other medical trainees in course of ther training, or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, other third-party payers who are responsible for paying all or part of the cost of your care, the credit bureau, debt collection agencies, including Small Claims Court. For example, your health plan my request and receive information on dates of service, the services provided, and the medical condition being treated.

Health care operations. Your health information may be used as necessary to suport the day-to-day activities and management of Garrett Orthopedic Physical Therapy and Rehabilitation, LLC. For exampe, information on the services you receive may be used to support budgeting and financial reporting, internal quality assessments, activities to evaluate and promote quality, and contacting other healthcare providers about treatment alternatives.

We may also disclose information to your doctor, staff members at your physician's office, or your attorney. We may contact your physician's office regarding your last and next doctor's appointment, birthdate, social security number, named insured on the insurance policy, social security number and date of birth of the insured, verify the spelling of names, etc. We may leave messages on your answering machine, call your cell phone, call you at work, or send you an e-mail messages. We may also transmit protected health information electronically, (e.g., claims, eligibility, referrals, benefits, claims status) orally or on paper.

Law enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting. For example, if we receive a subpoena for your records, or if public responsibility requires disclosure, e.g. to protect public health, child abuse or neglect.

Public health reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.

Workers' Compensation Programs are exempt from HIPAA's provisions. For disclosures of protected health information made for Workers' Compensation purposes under 45 CFR 164.512(I), the minimum necessary standard permits covered entities to disclose information to the full extent authorized by State or other laws. In addition, where protected health information is requested by a State Workers' Compensation or other public official for such purposes, covered entities are permitted reasonably to rely on the official's representations that the information requested is the minimum necessary for the intended purpose. 45 CFR 164.513(d)(3)(iii)(A)

For disclosures of protected health information for payment purposes, covered entities may disclose the type and amount of information necessary to receive payment for any health care provided to an injured or ill worker.

The minimum necessary standard does not apply to disclosures that are required by State or other laws, or made pursuant to the individual's authorization.

Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. In the event that a written notice of revocation is given regarding claim payment, your "account type" status will change to "self-pay." Therefore, payment in full, on each date of service, is required thereafter.

However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

We will keep all disclosures of your medical record to the minimum necessary. At times, the "minimum necessary" may include your entire medical record.

Appointment reminders. Your health information will be used by our staff to send you appointment reminders or to call you and remind you of a scheduled appointment. We may contact you at work, send you e-mail, or leave a message on your answering machine, or cell phone.

Information about treatments. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.

Marketing and Fundraising. Unless you request us not to, we will use your name and address to support our marketing/fundraising efforts.

You have certain rights under the federal privacy standards. These include:

• The right to request restrictions on the use and disclosure of your protected health information. Although, Garrett Orthopedic Physical Therapy, LLC is not required to agree to a requested restriction.
• The right to receive confidential communications concerning your medical condition and treatment.
• The right to inspect and copy your protected health information. The request must be made in writting with the reason that supports your request. If we do not agree with your request, you have the right to ask that your statement get placed in your medical record.
• The right to amend or submit corrections to your protected health information.
• The right to receive an accounting of how and to whom your protected health information has been disclosed, except for disclosures made for treatment, payment, and health care operations.
• The right to receive a printed copy of this notice.
• The right to request restrictions on the use and disclosure of your protected health information.

We are required by law to maintain the privacy of your protected health information and provide you with this notice of privacy practices. If you believe that your rights have been violated, you may complain to the Secretary of the U.S. Department of Health and Human Services or complain to us by talking to us, calling us, or writing to us with details.

We also are required to abide by the privacy policies and practices that are outlined in this notice.

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on your next office visit. The revised policies and practices will be applied to all protected health information we maintain.

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting an Office Assistant or the HIPAA Privacy Specialist

If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your conerns to:

HIPAA Privacy Specialist
Garrett Orthopedic Physical Therapy & Rehabilitation, LLC.
12743 Garrett Highway, Suite 5
Oakland, MD 21550

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address.

You will not be penalized or otherwise retaliated against for filing a complaint.

The name and address of the person you can contact for further information concerning our privacy practices is:

HIPAA Privacy Specialist
Garrett Orthopedic Physical Therapy & Rehabilitation, LLC.
13141 Garrett Highway
Oakland, MD 21550
(301) 334-5220

This notice is effective on or after April 4, 2003.