This Notice of Privacy Practices is given to you as a requirement of the Health Insurance Portability and
Accountability Act (HIPPA). This notice communicates to you how we may use or disclose your protected
health information (PHI), with whom we may share the information with, and about the safeguards we have in
place to protect it. It also explains your rights to access and amend your protected health information. You
have the right to approve or refuse the release of specific information outside of our practice except when the
release is required or authorized by law or regulation.
Our policy has always been to keep the patient’s records safe. Records are usually kept in a folder of papers
with the patient’s name and identification number on it. Records can also be stored in a computer or secured
data software. Records tell what treatments and tests a patient has had and medical information the doctors
have provided. Files are kept for at least 6 years from the date of termination of services.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE: You will be asked to provide a signed
acknowledgment of receipt of this notice on the patient form. Our intent is to make you aware of the possible
uses and disclosures of your protected health information and your privacy rights. The delivery of therapy
services will in no way be conditioned upon our signed acknowledgment. If you decline to provide a signed
acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health
information for treatment, payment and health care operations when necessary.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION: “Protected health
information” (PHI) is individually identifiable health information. This information includes demographics (for
example, age, address), and relates to your past, present, or future physical or mental health or condition and
related health care services. Our practice is required by law to do the following: • Keep your PHI private • Give
you this notice of our legal duties and privacy practices related to the use and disclosure of PHI • Follow the
terms of the notice currently in effect • Communicate to you any changes we may make in the notice.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION: Following are
examples of permitted uses and disclosures of your PHI. These examples are not exhaustive.
1. Treatment- We will use and disclose your PHI to provide, coordinate, or manage your therapy and/or related
services. This includes the coordination or management of your treatment with a third party. For example, we
may disclose your PHI from time-to-time to another physician (for example, your ordering physician,
orthopedic physician) who becomes involved in your care for diagnosis or treatment.
2. Payment- Your PHI will be used, as needed, to obtain payment for therapy services provided. This may
include certain activities we may need to undertake before your health care insurer approves or pays for the
therapy services recommended for you, such as determining eligibility or coverage for benefits, reviewing
services provided to you for medical necessity, and undertaking utilization review activities. For example,
obtaining approval for speech or physical therapy might require that your relevant PHI to be disclosed to obtain
approval of therapy
3. Practice Operations- We may use or disclose, as needed, your PHI to support our daily activities related to
therapy services. These activities include, but are not limited to billing, collections, oversight or staff
performance reviews, licensing, communications about a product or service, and conducting or arranging for
other health care related activities. For example, we may disclose your PHI to a billing agency in order to
prepare claims for reimbursement for the services we provide to you. We may disclose your PHI to school level students, that see patients in office for training/educational purposes. We may call you by name in the waiting
room when your therapist is ready to see you. We may use or disclose your PHI, as necessary, to contact you to
remind you of your appointment via phone, email, or mail. These business associates at our practice will also be
required to protect your health information.
4. Required by Law- We may use or disclose your PHI if law or regulation requires the use or disclosure
5. Public Health- We may disclose your PHI to a public health authority that is permitted by law to collect or
receive the information. For example, disclosure may be necessary to report child abuse or neglect •