NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED BY BODY EASE THERAPY (“BODY EASE”) AND HOW TO ACCESS THIS INFORMATION
Effective Date Of This Notice: January 1, 2015
PLEASE REVIEW THIS NOTICE CAREFULLY If you have any questions about this notice, please contact Body Ease at (610) 314-0780.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
This Notice applies to all of the records generated or received by Body Ease, whether we documented the health information, or another provider forwarded it to us.
Our pledge regarding your health information is backed up by Federal law. The privacy and security provisions of the Health Insurance Portability and Accountability Act (HIPAA) require us to make sure that:
- health information that identifies you is kept private;
- make available this notice of our legal duties and privacy practices with respect to health information about you; and
- follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we may use or disclose health information about you, notwithstanding anything else contained in this disclosure. Unless otherwise noted each of these uses and disclosures may be made without your permission. For each category of use or disclosure, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, unless we ask for a separate authorization, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment, Payment, and Operations: We may use health information about you to provide you with healthcare treatment and services; specifically, Myofascial Release services. We will not disclose any details about your treatment to any person other than a Body Ease therapist without your express written permission. We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, a state Medicaid agency or a third party. We may use and disclose health information about you for operations of our Myofascial Release practice. These uses and disclosures are necessary to run our practice and make sure that all of our clients receive quality care. We may remove information that identifies you from this set of health information so others may use it to study healthcare delivery without learning who our specific patients are. We may use and disclose health information to contact you as a reminder that you have an appointment. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose. We may include certain health information in e-mails that we send to you.
As Required By Law: We will disclose health information about you when required to do so by the laws, statutes, ordinances and regulations of the United States, any of its constituent states, federal districts, incorporated or unincorporated territories, any county, local, municipal or military authority, or when required to do so by the order or subpoena of a court of competent jurisdiction. We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. We may release health information if asked to do so by a law enforcement official; in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; if you are the victim of a crime and we are unable to obtain your consent; about a death we believe may be the result of criminal conduct; in an instance of criminal conduct at our facility; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime. We may release health information to a coroner or health examiner to determine cause of death.
To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability; to report reactions to medications or problems with products; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence, or for oversight activities of any health oversight agency. We will only make this disclosure if you agree or when required or authorized by law.
Non-emergency releases of information of the types set forth above will be made only after efforts have been made to tell you about the request and you have time to obtain an order protecting the information requested.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
- Right to Inspect and Copy: You have certain rights to inspect and copy health and billing records that may be used to make decisions about your care. This does not include therapists’ notes.
- Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing on a form provided by us.
- Right to an Accounting of Disclosures: You have the right to request a list (accounting) of any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described.
- Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain manner or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. During our intake process, we will ask you how you wish to receive communications about your health care or for any other instructions on notifying you about your health information. We will accommodate all reasonable requests.
- Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice at any time upon request. You may also view a copy of this Notice in each facility and on our website at www.ppdel.org.
- Right to Receive Notice of a Breach: We are required to notify you following a breach of unsecured protected health information.
To request an inspection, amendment or other accounting as set forth above, you must submit your request in writing on a form that we will provide to you. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. We may charge you for the costs of providing the requested information. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
MINORS AND PERSONS WITH GUARDIANS
Minors and persons with guardians have all the rights outlined in this Notice with respect to health information, except in emergency situations or when the law requires reporting of abuse and neglect. If you are a minor or a person with a guardian obtaining healthcare, your parent or legal guardian may have the right to access your medical record and make certain decisions regarding the uses and disclosures of your health information.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our facility and on our website. The Notice contains the effective date on the first page.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact Rachel Gottesman at Body Ease. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
USES OF HEALTH INFORMATION REQUIRING AN AUTHORIZATION
Any use or disclosure of health information not covered by this Notice or required by applicable law may be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any timeYou understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain the records of the care that we provided to you.