Rehab 1 LLC 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.
Purpose of the Privacy Notice: Our Legal Duties
At Rehab 1 LLC, we are committed to protecting the privacy of your protected health information as required by the HIPAA privacy rule (45 C.F.R., parts 160 and 164, as amended). “Protected health information” is your individually identifiable health information which includes information about your health history, symptoms, test results, diagnoses, treatment, insurance claims and payment history.
We are required by state and federal laws to maintain the privacy of your protected health information. This notice describes our privacy practices, which include how we use, disclose and protect our patients’ protected health information. We are also required by the HIPAA Privacy Rule to give you a copy of this Notice about our privacy practices which includes our legal duties, and your rights concerning protected health information. We will not use or disclose your protected health information except as described in this Notice as long as it is in effect.
It may become necessary, and we reserve the right to revise our privacy practices and the terms of this Notice. If changes are made, the new terms of our Notice will become effective for all protected health information that we maintain, including protected health information we created or received before we made the changes. Upon revision of the Notice, we will make the Notice available to you upon request and the revised Notice will be prominently displayed in our offices.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
Permitted Uses and Disclosures of Your Health Information
- Uses and Disclosures of Protected Health Information for Treatment, Payment and Health Care Operations: After reading this Notice and receiving a copy of it, you will be asked to sign an Acknowledgement that indicates you received a copy of this Notice. After having made a good faith effort to obtain your Acknowledgement of receipt of this Notice, we are permitted to use and disclose your protected health information for the following purposes:
- Treatment: We are permitted to use your health information in providing, coordinating, and managing your treatment including the performance of tests. We may disclose health information in your medical record to your primary health care provider, consulting providers, and to other health care personnel who have a need for this information to provide treatment. For example, your physical therapist may disclose your health information when communicating with a physician regarding your treatment plan and progress.
- Payment: We are permitted to use and disclose your health information to obtain payment and be reimbursed for our services. Copies of your entire medical record or parts of your medical record may be released to an insurance company, third party payor, or other authorized entities required for payment for our services. For example, a bill sent to an insurance company may include your name, diagnosis and details of the treatment you are receiving.
- Health Care Operations: We are permitted to use and disclose your protected health information for the purpose of routine health care operations which support the core functions of treatment and payment. For example, we may use and disclose your protected health information during utilization reviews, quality assessment and improvement activities, credentialing health care providers and auditing a medical record.
- Uses and Disclosures of Protected Health Information with Patient Authorization: The Privacy rule allows us to use and disclose your health information for purposes other than treatment, payment, and health care operations with your written authorization. For example, with your authorization, we could provide your name and diagnosis to a company seeking to provide supplies or equipment that may be useful to you.
- Uses and Disclosures of Protected Health Information with verbal agreement/objection: Under the Privacy rule, we are permitted to disclose your health information without your written consent or authorization to a family member, a close personal friend or any other person identified by you, if the information is directly relevant to that person’s involvement in your care or treatment. You must be notified in advance of the use or disclosure and have the opportunity to verbally object or agree. For example, if someone accompanies you to treatment, and we will be discussing health information, you will be asked if we may discuss the health information with that person present.
- Uses and Disclosures of Protected Health Information without an acknowledgement, authorization or opportunity to verbally agree or object. The privacy regulations permit us to use or disclose our health information without your consent, authorization or the opportunity to verbally agree or object with regard to the following:
- Uses and Disclosures Required by Law: We will disclose your health information when required to do so by law. For example, we must provide the Department of Health and Human Services with information on request for the purpose of determining our compliance with federal privacy laws.
- Workers’ Compensation: We may disclose your protected health information to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
- Marketing: We may use or disclose your health information to make a marketing communication to you, if such communication is conducted face-to-face, concerns products or services of nominal value, or identifies us as the communicating party and that we will receive remuneration for making the communication and, where required by the Privacy Regulations, instructions describing how you may verbally object to receiving future communications.
- Appointment Reminders: We may use and disclose your health information to remind you of an appointment for treatment and medical care at our office.
- Public Health Activities: We may disclose your health information for public health reporting that is permitted or required by law. For example, reporting of communicable diseases.
- Abuse and Neglect: We may disclose your health information to a government authority that is authorized by law to receive reports of abuse, neglect or domestic violence.
- Regulatory Agencies: We may disclose your health information to a health care oversight agency for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations and inspections. These activities are necessary for the government and certain private health oversight agencies to monitor the health care system, government programs and compliance with civil rights.
- Legal Proceedings: We may disclose health information in judicial and administrative proceedings, as well as in response to an order of a court, administrative tribunal, or in response to a subpoena, summons, warrant, discovery request or similar legal request.
- Law Enforcement Purposes: We may disclose your health information to law enforcement officials when required to do so by law.
- Coroners, Medical Examiners, Funeral Directors: We may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to determine a cause of death. We may also disclose your health information to funeral directors so that they may carry out their duties.
- Research: We may disclose your protected health information to researchers when an institutional review board or privacy board has reviewed and approved the research proposal and established safeguards to ensure the privacy of the information.
- Threats to health and safety: We may use or disclose your health information if we believe, in good faith, the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- Military/Veterans: If you are, or were, Armed Forces personnel, we may disclose your protected health information for activities deemed necessary by appropriate military command authorities.
- Other uses and disclosures: In addition to the reasons outlined above, we may use and disclose your health information for other purposes permitted by the Privacy Regulations.
- Uses and Disclosures of Protected Health Information to Business Associates: In connection with our payment and health care operations activities, we contract with individuals and entities (called “Business Associates”) to perform various functions on our behalf or to provide certain types of services (such as computer support, billing support, accounting and legal services). Our business associates may receive, create, maintain, use or disclose protected health information. We require our business associates to agree in writing to appropriately safeguard your information.
- PATIENT RIGHTS: You have the following rights concerning your protected health information:
- Right to access: You have the right to look at or get copies of your protected health information which includes your medical record, billing records and other records used to make decisions about your health care. You must make a request in writing to obtain access to your protected health information. We are not required to provide you access to all the health information that we maintain. Exceptions include, for example, psychotherapy notes, information compiled in anticipation of, or for use in, legal proceedings, or information that, if released would reasonably endanger you or another person.
- Right to Request Restrictions on the Use and Disclosure of Your Health Information: You have the right to request a restriction on the protected health information we use or disclose about you for treatment, payment of health care operations. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement unless the information is needed to provide emergency treatment to you. Any agreement we may make to a request for restrictions must be in writing signed by a person authorized to make such an agreement on our behalf.
- Right to verbally object: You have the right to verbally object to certain disclosures that are routinely made for treatment, payment, healthcare operations, or other purposes for which an Authorization is not required. For example, if another person or family member accompanies you to treatment, we are required to give you an opportunity to object to the sharing of your health information.
- Right to seek an amendment of your health information: If you believe that your protected health information is incorrect or incomplete, you have the right to request that we amend your protected health information. Your request must be in writing, and it must explain why the information should be amended.
We may deny your request if we did not create the information you want amended or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a written disagreement to be placed in your record.
If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
- Right to an accounting of disclosures of your health information: You have a right to an accounting of certain disclosures of your health information that occurred within six years prior to the date of your request. We are not responsible for the accounting of disclosures made for the purposes of treatment, payment, or health care operations, disclosures made to you, disclosures made based on a valid authorization, disclosures permitted by the Privacy regulations, or any disclosures made prior to April 14, 2003. An accounting will include the date(s) of the disclosure, to whom we made the disclosure, a brief description of the information disclosed and the purpose for the disclosure.
The first list you request within a 12 month period will be free. If you request this list more than once in a 12 month period, we may charge you a reasonable fee based on current Pennsylvania law.
- Right to confidential communications: You have the right to receive confidential
communications of your health information by alternative means or at alternative locations. For example, you may request that we only contact you at work or via your work e-mail. You must make your request in writing and we must accommodate your request if it is reasonable, specifies the alternative means or location and does not interfere with treatment, payment or healthcare operations.
- Right to revoke your authorization: If you provide us with an authorization for the use or disclosure of your health information, you may revoke the authorization in writing, and this revocation will be effective for future uses and disclosures of protected health information but will not have any effect on information that we have already used or disclosed, relying on the authorization.
- Right to receive a copy of this notice: You have the right to receive a paper copy of this notice. If you receive the Notice on our web site or by electronic mail, you are entitled to receive this Notice in written form. Please contact us using the information listed at the end of this Notice to obtain this Notice in written form.
- Questions? If you want more information about our privacy policies or practices or have questions or concerns, please contact us using the information below.
- How to report privacy rights violation: The practice has established an internal complaint process for reporting privacy violations. If you feel your privacy rights have been violated, you may file a complaint with us in writing at Rehab1, LLC, 613 Cricklewood Road, West Chester, PA 19382 or with the Secretary of the Department of Health and Human Services at 200 Independence Avenue, S. W., Washington, D.C. 20201.
We support your right to protect the privacy of your protected health information. We will not retaliate in anyway if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
- Contact information (for additional information, questions, or to file a complaint):
HIPAA Compliance Officer/confidential
Rehab 1 LLC
613 Cricklewood Road
West Chester, PA 19382
Phone # 610-453-6986
Fax # 610-399-0401
Effective date: The effective date of this notice is: April 14, 2003