Updated: August 31, 2020
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.
|USES AND DISCLOSURES|
Treatment: Your health information may be used by staff members 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, or credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, services provided, and the medical condition being treated.
Health care options: Your health information is used as necessary to support the day to day activities and management of Golden Bear Physical Therapy. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Law enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government-mandated reporting.
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.
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. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us to revoke your authorization.
|ADDITIONAL USES OF INFORMATION|
Information about treatments: Your health information may be used to send you information that you find interesting on the treatment and management of your condition.
□ Please do not use my information for fundraising purposes.
You have certain rights under the federal privacy standards. These include:
- The right to request restrictions on the use of your protected health information.
- The right to receive confidential communications regarding your medical condition and treatment.
- The right to inspect your protected health information.
- The right to amend or submit corrections to your protected health information
- The right to receive a printed copy of this notice.
Golden Bear Physical Therapy Duties: We are required by law to maintain the privacy of your protected health information and provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices outlined in this notice.
Right to Revise Privacy Practices: As permitted by law, we reserve the right to amend or modify our private policies and practices. These changes in our policies and practices may be required changes by federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies will be applied to all protected health information we maintain.
Request to Inspect Protected Health Information: 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 the receptionist. Your request will be reviewed and will generally be approved unless there are legal medical reasons to deny the request.
Complaints: If you would like to submit a complaint or feel your privacy rights have been violated please contact our privacy officer at email@example.com. You will not be penalized or otherwise retaliated against for filing a complaint. You may also file a complaint with the Office of Civil Rights US Department of Health and Human Services