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PRIVACY POLICY
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.
Summary
ProRehab, PC is
required by law to maintain the privacy of individually identifiable health
information about you, to provide this Notice of our legal duties and
privacy practices, and to abide by the terms of this Notice.
We may use or disclose
health information about you for the purpose of your treatment, and also to
the extent necessary to obtain payment for treatment and for certain
administrative purposes, including evaluation of the quality of care that
you receive. We may also use or disclose identifiable health information
about you without your authorization in certain other circumstances. For
example, subject to certain requirements, we may give out health information
without your authorization for public health purposes, for auditing
purposes, for research studies, and for emergencies. We also provide health
information when required by law.
Except as otherwise
provided in this Notice of Privacy Practices, we will only use or disclose
identifiable health information about you pursuant to your written
authorization.
We may change our
privacy policies at any time and the new policies will apply to all
information we maintain. Before making a significant change in our
policies, we will change this Notice and post the new one in our offices and
on our web site: prorehab-pc.com.
You may also request a copy of the Notice in effect at any time.
In most cases, you have
the right to look at or make a copy of health information that we use to
make decisions about you. We may charge our reasonable costs for copies.
You may request that we add to or change your health information if you
think it is incorrect or incomplete. Generally, you have the right to
receive a list of instances where we have disclosed health information about
you, except where the disclosure was for treatment, payment, administrative
purposes, or pursuant to your authorization or if another exception
applies. You may request restrictions on certain uses and disclosures of
information, although we are not required to agree to them. You have the
right to receive confidential communications in a alternate manner or
location if we can reasonably accommodate your request.
You should carefully review the pages
attached to this summary. For additional information, or to make a
complaint with respect to your privacy rights, you may contact our Privacy
Officer at the address and number listed below. You may also send a written
complaint to the U.S. Department of Health and Human Services. Our Privacy
Officer can provide you with the appropriate address.
For questions or complaints, please contact:
Tina Hoskins, RHIT, Privacy Officer ProRehab, PC 7300 E. Indiana St., Ste. 102
Evansville, IN 47715 Phone: 812-759-7455, or toll free 866-885-9691
Protected Health
Information
Protected health
information is individually identifiable health information that relates to
your past, present or future physical or mental health or condition, to the
provision of health care to you, or to payment for your health care.
Examples of Uses
and Disclosures for Treatment, Payment and Health Care Operations
We may use or disclose
your protected health information without your consent or authorization for
purposes of your treatment, for payment purposes, and for certain
administrative and other health care operations. Examples of uses for these
purposes follow.
Treatment:
We will use and
disclose your protected health information to provide, coordinate or manage
health care provided by us and by other health care providers. For example,
information obtained by a Physical Therapist, Occupational Therapist or any
other healthcare professional will be used to determine the course of
treatment that should work best for you. Your therapist will document in
your record his or her expectations of your treatment along with their
observations of how you are responding to your therapy. We will also
provide your physician or subsequent healthcare provider with copies of
various reports that should assist them in treating you. If your treating
physician needs the initial evaluation from ProRehab, PC we will fax a copy
to him/her so he/she may continue on with proper treatment.
Payment:
We may use or disclose
your protected health information as needed to obtain payment for health
care services we provide. For example, a bill may be sent to you or a claim
for payment may be sent to a third-party payer such as an insurance
company. The information on or accompanying the bill or claim may include
information such as your name, date of birth, social security number and
address, as well as your diagnosis and procedures and supplies used. In
some cases a progress note will be sent along with the claim.
Health Care
Operations:
We may use or disclose
your protected health information in order to support our business
activities and health care operations. These activities include, but are
not limited to, quality assessment and improvement activities, reviewing the
competence or qualification of health care professionals, conducting
training programs, business planning and development, business management
and general administrative activities. Some examples follow:
Quality Improvement
and Audits. Therapists and
members of our quality improvement team may use information in your health
record to assess the care and outcomes in your case and others like it. This
information will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and services we provide. For
example: When we perform audits for documentation, proper scanning of
information into our record system and billing, a random sampling of patient
records will be accessed to determine if proper procedures were followed and
to correct any errors discovered.
Appointment
reminders. We may use your
protected health information for appointment reminders. For example, we may
look at your medical record to determine the date and time of your next
appointment with us, and then send you a reminder letter to help you
remember the appointment.
New Services.
We may also look at your medical information and decide that another
treatment or a new service we offer may interest you and communicate with
you regarding the new treatment or service.
Business associates.
There are some services provided in our organization through business
contracts. When these services are contracted, we may disclose your
protected health information to our business associate, so that they can
perform the job we’ve ask them to do. To protect your health information,
however, we require the business associate to appropriately safeguard your
protected health information.
Uses and
Disclosures to Which You Have an Opportunity to Agree or Object
Directory.
Unless you notify us that you object, we will use your name, location and
general condition for directory purposes. This information will be released
to any who ask for you by name.
Notification.
We may use or disclose information to notify or assist in notifying a family
member, personal representative or another person responsible for your care,
of your location and general condition, unless you object.
Communication with
others involved with your care and disaster relief.
Unless you express an objection, or if in an emergency situation there is
not an opportunity for you to object and our health professionals, using
their best judgment, determine it is in your best interests, we may disclose
to a family member, other relative, close personal friend or any other
person you identify, health information relevant to that person’s
involvement in your care or payment related to your care. We may also
disclose protected health information relating to your location, condition
or death to any entity authorized to assist in disaster relief efforts.
Other Uses and Disclosures We Can Make Without Your Written Consent or
Authorization
Required by law.
We may use or disclose your protected health information to the extent that
use or disclosure is required by law. The use or disclosure will be made in
compliance with the law and will be limited to the relevant requirements of
the law.
Public health
activities. We may disclose your
protected health information for public health purposes and activities to a
public health authority that is permitted by law to collect or receive the
information for the purpose of preventing or controlling disease, injury or
disability. In certain circumstances, we may also have to report to your
employer certain work-related illnesses and injuries so that your workplace
can be monitored for safety. We may also disclose your protected health
information to a person subject to the jurisdiction of the Federal Drug
Administration (FDA) regarding products regulated by the FDA.
Communicable
Diseases. We may disclose your
protected health information, if authorized by law, to a person who may have
been exposed to a communicable disease or may otherwise be at risk of
spreading a disease or condition.
Employer.
We may disclose your protected health information to your employer if we are
providing health care to you at the request of your employer to conduct an
evaluation relating to medical surveillance of your workplace or to evaluate
whether you have a work-related illness or injury. We will notify you
before making such a disclosure by providing you with written notice at the
time we provide health care to you.
Abuse or neglect.
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, if applicable legal requirements are met, we may
disclose your protected health information if we believe that you have been
a victim of abuse, neglect or domestic violence to the governmental entity
or agency authorized to receive such information.
Health oversight
activities. We may disclose
protected health information to a health oversight agency for activities
authorized by law, such as audits, investigations and inspections. Oversight
agencies seeking this information include government agencies that oversee
the health care system, government benefit programs, other government
regulatory programs and civil rights laws.
Judicial and
administrative proceedings. We may
disclose protected health information in the course of any judicial or
administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly
authorized in the order), and if certain conditions are met, in response to
a subpoena, discovery request or other lawful process.
Law enforcement
purposes. We may also disclose
protected health information, so long as applicable legal requirements are
met, to law enforcement officials for law enforcement purposes.
Research.
We may disclose your protected health information to researchers when their
research has been approved by an institutional review board or privacy board
that has reviewed the research proposal and established protocol to ensure
measures are in place to preserve the privacy of your protected health
information.
Military Activities.
We may, if you are a member of the United States or foreign Armed Forces,
disclose your protected health information for activities that are deemed
necessary by appropriate military command authorities to assure the proper
execution of a military mission.
Special government
functions. We may disclose
protected health information for certain specialized government functions,
such as national security and intelligence, protective services for heads of
state.
Threats to health
or safety. Consistent with
applicable federal and state laws, we may disclose your protected health
information, if we believe that 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; and, in certain circumstances, as necessary for law
enforcement authorities to identify or apprehend an individual.
Workers
compensation. We may disclose your
protected health information as permitted or required to comply with
worker’s compensation laws and other similar legally established programs.
Relating to
decedents or for organ or tissue donations.
We may disclose protected health information relating to an individual's
death to coroners, medical examiners or funeral directors for their duties
as authorized by law, and to organ procurement organizations relating to
organ, eye, or tissue donations or transplants.
Your Rights Regarding Your Protected Health
Information. You have the following rights relating to your protected
health information. You will need to give or send a written request to our
Privacy Officer in order to exercise these rights. Forms for this purpose
are available in our office at the address on the front of this Notice.
To request restrictions on uses/disclosures:
You have the right to ask that we limit how we use or disclose your
protected health information. We will consider your request, but are not
required to agree to the restriction. To the extent that we do agree to any
restrictions on our use/disclosure of your protected health information, we
will abide by it except in emergency situations. We cannot agree to limit
uses/disclosures that are required by law. We may terminate our agreement
to a restriction by notifying you. Termination of the agreed restriction
will only apply to protected health information received after notice was
given to you.
To choose how we contact
you: You have the right to ask that we send you information at an
alternative address or by an alternative means. We must agree to your
request as long as it is reasonably easy for us to do so. When appropriate,
we may condition the provision of a reasonable accommodation upon receiving
information relating to how payment arrangements will be made.
To inspect and copy your
protected health information: With a few exceptions (such as
psychotherapy notes and records compiled in anticipation of litigation), you
have a right to see or receive copies of your protected health information
that is kept in a “designated record set.” A “designated record set” is a
group of records that includes billing records and records used to make
decisions about you. We will respond to your request within 30 days, if the
records are stored on-site. Otherwise, we will respond within 60 days.
These time limits may be extended by 30 days if we notify you of the reason
for the delay and when you can expect our response. If we deny your access,
we will give you written reasons for the denial and explain any right you
may have to have the denial reviewed. If you want copies of your protected
health information, a charge for copying and mailing may be imposed, based
on our costs. We may waive the copying charge for your first request.
To request amendment of
your protected health information: If you believe that there is a
mistake or missing information in our record of your protected health
information, you may request, in writing, that we correct or add to the
record. Your request must provide a reason for the proposed amendment. We
will respond within 60 days of receiving your request. This time limit may
be extended by 30 days if we notify of the reason for the delay and when you
can expect our response. We may deny the request if it does not contain a
reason for the amendment or if we determine that the protected health
information is: (i) correct and complete; (ii) not created by us and/or not
part of our records; (iii) not permitted to be disclosed; or (iv) not part
of a designated record set. Any denial will state the reasons for denial
and explain your rights to have the request and denial, along with any
statement in response that you provide, appended to your protected health
information. If we approve the amendment, we will add it to your protected
health information and so inform you. In addition, we will tell others that
need to know about the change in the protected health information.
To find out what
disclosures have been made: You have a right to get a list of when, to
whom, for what purpose, and what content of your protected health
information has been released other than disclosures: for treatment,
payment, and administrative and other health care operations; incidental to
permitted uses/disclosures; to you, your family, or the facility directory;
or pursuant to your written authorization. The list also will not include
any disclosures made for national security purposes, to law enforcement
officials or correctional facilities, or disclosures made before April 14,
2003. If specific personal identifying information has been removed before
disclosure, we may not be required to include such a disclosure in the list.
We will respond to your written request for such a list within 60 days of
receiving it. This time limit may be extended by 30 days if we notify of
the reason for the delay and when you can expect our response. Your request
can relate to disclosures going as far back as six years. There will be no
charge for up to one such list each year. There may be a charge for more
frequent requests.
To receive this notice:
You have a right to receive a paper copy of this Notice upon request.
We reserve the right to
change our Notice of Privacy Practices and to make the new provisions
effective for all protected health information we maintain, including
protected health information received in the past as well as protected
health information received after the effective date of the new Notice. A
current copy of our Notice will be posted in our office(s) and will also be
available on our web-site, prorehab-pc.com. You may also obtain a
copy by writing or calling the office and asking that one be mailed to you
or by asking for one the next time you are in our office.
For More
Information or to Make a Complaint
If you have a question
and would like additional information, you may contact the Privacy Officer
at the address or telephone number on the front of this Notice. If you
believe your privacy rights have been violated, you can file a complaint
with our Privacy Officer or the Secretary of Health and Human Services. Our
Privacy Officer will be able to give you information on how to file a
complaint with the Secretary of Health and Human Services.
There will be no
retaliation for filing a complaint.
Effective
Date: This Notice of Privacy
Practices is effective as of April 14, 2003. |