SUMMIT PHYSICAL THERAPY
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. SUMMIT PHYSICAL THERAPY (SUMMIT) HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)
We are legally required to make our best efforts to protect the privacy of your health information. We call this protected health information, or PHI, and it includes information that can be used to identify you that we’ve created or received about your past, present or future health or condition, the provision of health care to you, or the payment for this health care. When we retain your confidential information in our computer system, it is called “electronic protected health information” (“ePHI”). This notice applies to all PHI and ePHI related to your care that Summit has created or received. It also applies to any personal or general information Summit receives from patients or other healthcare providers. We must provide you with this Notice of Privacy Practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we will use our best efforts to not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We will use our best efforts to follow this Notice of Privacy Practices. We do, however, reserve the right to change the terms of this Notice of Privacy Practices and our policies at any time for PHI we have of yours already as well as any PHI we receive in the future. Before we make any important change to our policies, we will promptly change this Notice of Privacy Practices and prominently post the new Notice of Privacy Practices in a public area.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We will attempt in good faith to obtain your signed Acknowledgment that you received this Notice to use and disclose PHI and ePHI. We use and disclose PHI for many different reasons. Below, we describe the different categories of our uses and disclosures and give some examples of each.
- For treatment. We may disclose your PHI to health care personnel who provide you with health care services or are involved in your care.
- For payment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you.
- For health care operations. We may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided services to you. We may also provide your PHI to accountants, attorneys, consultants, and others in order to make sure we’re complying with the laws that affect us.
Additional examples of uses and disclosures that do not require your authorization are:
- When required by law. We will disclose your PHI when required to do so by federal, state or local law.
- For public health activities. We report information to government officials in charge of collecting certain information.
- For health oversight activities. We will provide information to assist the government when it conducts an investigation or inspection of a health care provider.
- For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
- For research purposes. We may provide PHI in order to conduct medical research if certain requirements are satisfied.
- For public safety. To avoid a serious threat to the health or safety of a person or the public or disaster relief purposes, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.
- For specific government functions. We may disclose PHI of military personnel and veterans, and disclose PHI for national security purposes.
- For worker’s compensation purposes. We may provide PHI to comply with worker’s compensation laws.
- For appointment reminders and health related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives or other health care services or benefits we offer.
- For coroners, medical examiners and funeral directors. We may disclose PHI, for example, to identify a deceased person.
- For change of ownership. In the event SUMMIT is sold or merged with another organization, your PHI will become the property of the new owner.
A USE OR DISCLOSURE FOR WHICH YOU TO HAVE THE OPPORTUNITY TO OBJECT
Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to object may be obtained retroactively in emergency situations.
ALL OTHER USES AND DISCLOSURES REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION
In any other situation not described above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization, in writing, to stop any future uses and disclosures (to the extent that we haven’t taken any action relying in the authorization).
YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI
- The right to request limits on uses and disclosures of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept the request. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required to make.
- The right to choose how we send PHI to you. You will have the right to ask that we send information to you to an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, e-mail instead of regular mail). Your request must be in writing. We will agree to your request so long as we can easily provide it in the format you requested, and we agree on payment, if any, for the alternate transmission.
- The right to get copies of your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we don’t have your PHI but we know who does, we will tell you how to get the PHI. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request copies of your PHI, there will be an appropriate fee for copying and postage.
- The right to get a list of the disclosures we have made. You have the right to get a list of instances in which we have disclosed your PHI. However, the list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment or health care operations, directly to you or to your family. The list also will not include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or those made before April 14, 2003. We will respond within 60 days of receiving your written request. The list we give you will include disclosures made in the last 6 years unless you request a shorter time frame. We will provide the list to you at no charge but, if you make more than one request in a 12 month period, you will be charged appropriately for each additional request.
- The right to amend your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we amend our records. You must provide the request, and your reason for the request, in writing. We will respond within 60 days of receiving your written request. We may deny your request, in writing, if the PHI is correct or complete; not created by us; not allowed to be disclosed; or, not part of our designated record set. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file a written statement of disagreement, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we’ve done it, and tell others who need to know about the change to your PHI.
- The right to get a paper copy or e-mail of this Notice of Privacy Practices. You have the right to get a paper copy or e-mail of this Notice of Privacy Practices. Even if you have agreed to receive the Notice of Privacy Practices via e-mail, you also have the right to request a paper copy of this Notice of Privacy Practices.
- The right to restrict disclosure of PHI regarding out-of-pocket payments. You may also request a restriction on disclosure of protected health information to a health plan for purpose of payment or health care operations if you paid for the services out of your own pocket, in full. This does not apply to services that are covered by insurance. You are required to pay cash, in full, for the services before the restriction applies.
- The right to request electronic protected health information. With respect to ePHI, Summit agrees to give to you your ePHI in the form and format requested by you, if it is readily producible in that form or format. If it is not readily producible in the form or format requested, we will give you a readable hard copy form. Any directive given to Summit by you to transmit ePHI must be done in writing by you, signed and clearly identify the designated person and location to send the ePHI. Summit will provide you access to your PHI or ePHI within thirty (30) days from the date of request.
- The right to receive breach notifications. You have the right to receive notification from us if any breach of your unsecured protected health information occurs.
- The right to receive an accounting of PHI disclosures. You have a limited right to receive an accounting of all disclosures we make to other persons or entities of your medical records information except for disclosures required for treatment, payment and health care operations, disclosures that require an Authorization, disclosures incidental to another permissible use or disclosure, and otherwise as allowed by law. We will not charge you for the first accounting in any 12-month period; however, we will charge you a reasonable fee for each subsequent request for an accounting within the same 12-month period.
- The right to inspect and copy medical record information. You have the right to inspect, copy and access your medical records. Access to your medical records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding or for which your access is otherwise restricted by law. We will charge a reasonable fee for providing a copy of your medical records, or a summary of those records, at your request, which includes the cost of copying, postage, or preparation of an explanation or summary of the information. All requests related to your rights herein must be made in writing and addressed to “Privacy Officer” at the address noted below.
HOW TO CONTACT US OR COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the SUMMIT Privacy Officer listed below. You also may send a written complaint to the Secretary of the U.S. Department of Health and Human Services. More information is available about compliance online at the government’s website: www.hhs.gov/ocr/hipaa. We will take no retaliatory action against you if you file a complaint about our privacy practices. Provided, however, this Notice of Privacy Practices shall not be construed as a contract or legally binding agreement. Any non-compliance with any provision of this Notice shall not be construed as a breach of contract, breach of confidentiality, invasion of privacy, misappropriation of name or likeness, violation of any consumer protection law, negligence or violation of any state law. By signing the Acknowledgement of Receipt of this Notice, you agree that the sole legal recourse for non-compliance by SUMMIT with this Notice is to file a written complaint to the Secretary of the U.S. Department of Health and Human Services, and that no complaint or cause of action may be filed in any federal or state court for breach of contract, breach of confidentiality, invasion of privacy, misappropriation of name or likeness, violation of any consumer protection law, negligence or violation of any state law, or under any tort theory.
If you have any questions about this notice or any complaints about our privacy practices, please contact:
Drayer Physical Therapy Institute, LLC
8205 Presidents Drive, 2nd Floor
Hummelstown, PA 17036
Phone: (717) 220-2100
EFFECTIVE DATE OF THIS NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices went into effect on April 14, 2003.