PRIVACY NOTICE
This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access to This Information. Please Review This Document Carefully.
1. About Protected Health Information (PHI)
In this Notice, “we”, “our” or “us” means Physical Therapy at the MAC and our employees, “you” and “your” refers to each of our patients who are entitled to a copy of this Notice.
We are required by federal and state law to protect the privacy of your health information. For example, federal health information privacy regulations require us to protect information about you in the manner that we describe here in this Notice. Certain types of health information may specifically identity you. Because we must protect this health information we call this Protected Health Information---or “PHI”. In this Notice, we tell you about:
- How we use your PHI
- When we may disclose your PHI to others
- Your privacy rights and how to use them
- Our privacy duties
- Who to contact for more information or a complaint
2. Some of the ways we use (within the organization) or disclose (outside of the organization) your Protected Health Information.
We will use your PHI to treat you. We will use your PHI and disclose it to get paid for your care and related services. We use or disclose your PHI for certain activities that we call “health care operations”. We will also use or disclose your PHI as required or permitted by law. We will give you examples of each of these to help explain them but space does not permit a complete list of all uses or disclosures. This is one reason why you can contact us and ask us questions.
- Treatment
- Payment
- Health Care Operations
- Special Uses
- Uses & Disclosures Required or Permitted by Law
Permitted:
i. If you do not verbally object, we may share some of your PHI with a family member or a friend if he/she is involved in your care
ii. We may use your PHI in an emergency if you are not able to express yourself
iii. If we receive certain assurance that protect your privacy, we may use or disclose your PHI for research
Required:
i. When required by law; for example, when ordered by a court to turn over certain types of your PHI, we must do so
ii. For public health activities such as reporting a communicable disease or reporting an adverse reaction to the Food and Drug Administration
iii. To report neglect, abuse or domestic violence
iv. To the government regulators or its agents to determine whether we comply with applicable rules and regulations
v. In judicial or administrative proceedings such as a response to a valid subpoena
vi. When properly requested by law enforcement officials or other legal requirements such as reporting gun shot wounds
vii. To advert a health hazard or to respond to a threat to public safety such as an imminent crime against another person
viii. Deemed necessary by appropriate military command authorities if you are in the Armed Forces
ix. In connection with certain types of organ donor programs
- Stricter Requirement That We Follow
3. Your Authorization May Be Required
In the situations noted above we have the right to use and disclose your PHI. In some situations, however, we must ask for, and you must agree to give, a written authorization that has specific instructions and limits on our use or disclosure of your PHI. If you change your mind, at a later date, you may revoke your authorization.
4. Your Privacy Rights and How to Exercise Them
You have specific rights under our federally required privacy program. Each of them is summarized below:
- Your Right to Request Limited Use or Disclosure
- Your Right to Confidential Communication
- Your Right to Inspect and Copy
- Your Right to Revoke Your Authorization
- Your Right to Amend Your PHI
- Your Right to Know Who Else Sees your PHI
- Your Right to Complain
5. Some of Our Privacy Obligations and How We Perform Them
We are required to comply with the federal health information privacy regulations. Those rules require us to protect your PHI. Those rules also require us to give you Notice of our Privacy Practices. This document is our Notice. If you did not get a paper copy of this Notice, you may request one. We will abide by the privacy practices set forth in this Notice. However, we reserve the right to change this Notice and our Privacy Practices when permitted or required by law.
If we change our Notice of Privacy Practices we will provide our revised Notice to you when you next seek treatment from us.
6. Contact Us
If you have questions about this Notice, or if you have a complaint or concern, please contact:
Name: Sasha Kolbeck c/o Rose City Physical Therapy
Address: 1515 NE 18th Ave, Suite 400, Portland, Oregon 97209
Phone: 503-272-8785
Effective Date: This notice takes effect on June 15, 2016