Notice of Privacy Practices for Protected Health Information (PHI)

Physical Therapy Plus, Inc.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Effective date: October 1, 2013

The Practice of Physical Therapy Plus, Inc. is required by applicable federal and state laws to maintain the privacy of your health information.  Protected health information (PHI) is the information we create and maintain in the course of providing our services to you.  Such information may include documentation of your symptoms, examination and test results, diagnoses and treatment protocols.  It also may include billing documents for those services. We are permitted by federal privacy law (the Health Insurance Portability & Accountability Act of 1996 (HIPAA)), to use and disclose your PHI, without your written authorization, for purposes of treatment, payment, and health care operations. 

Examples of Using Your Health Information for Treatment Purposes:

Example of Using Your Health Information for Payment Purposes:

Example of a Using Your Information for Health Care Operations:

Your Health Information Rights

The health and billing records we maintain are the physical property of the Practice.  The information in them, however, belongs to you.  You have a right to:

Our Responsibilities

The Practice is required to:

We reserve the right to amend, change, or eliminate provisions of our privacy practices and to enact new provisions regarding the PHI we maintain about you.  If our information practices change, we will amend our Notice.  You are entitled to receive a copy of the revised Notice upon request by phone or by visiting our website or Practice.

Other Uses and Disclosures of your PHI

Communication with Family

Notification

Research

Disaster Relief

Organ Procurement Organizations

Food and Drug Administration (FDA)

Workers’ Compensation

Public Health

As Required by Law

Employers

Law Enforcement

Health Oversight

Judicial/Administrative Proceedings

For Specialized Governmental Functions or Serious Threat

Correctional Institutions

Coroners, Medical Examiners, and Funeral Directors

Website

Other uses and disclosures of your PHI not described in this Notice will only be made with your authorization, unless otherwise permitted or required by law.  Most uses and disclosure of psychotherapy notes, uses and disclosures of your PHI for marketing purposes, and disclosures of your PHI that constitute a sale of PHI will require your authorization.  You may revoke any authorization at any time by submitting a written revocation request to the Practice (as previously provided in this Notice under "Your Health Information Rights.")

To Request Information, Exercise a Patient Right, or File a Complaint

If you have questions, would like additional information, want to exercise a Patient Right described above, or believe your (or someone else’s) privacy rights have been violated, you may contact the Practice’s Privacy Officer at (303) 807-7797, or in writing to us at:

Richard Vaughan
Physical Therapy Plus, Inc.
9950 W. 80th Avenue, # 11
Arvada, 80005

Please note that all complaints must be submitted in writing to the Privacy Officer at the above address.  You may also file a complaint with the Secretary of Health and Human Services (HHS), Office for Civil Rights (OCR).  Your complaint must be filed in writing, either on paper or electronically, by mail, fax, or e-mail.  The address for the Colorado regional office is:  Office for Civil Rights, U.S. Department of Health and Human Services, 999 18th Street, Suite 417, Denver, CO 80202; or call (800) 368-1019.  More information regarding the steps to file a complaint can be found at:   www.hhs.gov/ocr/privacy/hipaa/complaints.