Notice of Privacy Practices
Effective Date: January 1, 2025
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.
Our Commitment to Your Privacy
Peak Performance Physical Therapy is committed to protecting your protected health information (PHI). We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice currently in effect.
How We May Use and Disclose Your Health Information
For Treatment
We may use your health information to provide you with physical therapy treatment and services. We may also share your health information with other healthcare providers involved in your care, such as your physician, to coordinate your treatment.
For Payment
We may use and disclose your health information to bill and collect payment for services provided to you. This includes submitting claims to your health insurance, Medicare, Medicaid, or other payers.
For Healthcare Operations
We may use your health information for our internal operations, such as quality improvement, training, and auditing activities.
Other Permitted Uses and Disclosures
- To family members or friends: With your permission, to those involved in your care
- For public health activities: To prevent disease or injury
- For health oversight: To government agencies authorized to oversee healthcare
- For legal proceedings: In response to court orders or subpoenas
- For law enforcement: As required by law or court order
- For workers' compensation: As authorized by workers' compensation laws
- To avert serious threat: To prevent serious threat to health or safety
Uses Requiring Your Authorization
We will obtain your written authorization before using or disclosing your health information for:
- Marketing purposes
- Sale of your health information
- Most uses of psychotherapy notes
- Other purposes not described in this notice
You may revoke your authorization at any time in writing, except to the extent we have already acted on your previous authorization.
Your Rights Regarding Your Health Information
Right to Access
You have the right to inspect and obtain a copy of your health records. Requests must be in writing.
Right to Amend
You have the right to request amendments to your health information if you believe it is incorrect or incomplete.
Right to Restrict
You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to all restrictions.
Right to Confidential Communications
You have the right to request that we communicate with you in a specific way or at a specific location.
Right to Accounting of Disclosures
You have the right to receive a list of certain disclosures we have made of your health information.
Right to Paper Copy
You have the right to receive a paper copy of this notice upon request.
Our Responsibilities
- Maintain the privacy of your health information
- Provide you with this notice of our duties and practices
- Follow the terms of this notice currently in effect
- Notify you if a breach occurs that may have compromised your health information
Changes to This Notice
We reserve the right to change this notice and make the new provisions effective for all health information we maintain. We will post the current notice in our facility and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint:
- With our Privacy Officer (contact information below)
- With the Secretary of the U.S. Department of Health and Human Services
You will not be retaliated against for filing a complaint.
Contact Information
Peak Performance Physical Therapy
Privacy Officer
123 Wellness Way, Suite 100
Healthville, ST 12345
Email: privacy@peakperformancept.com
Phone: (555) 123-4567
Acknowledgment
You will be asked to sign an acknowledgment that you received this Notice of Privacy Practices. Your signature acknowledges only that you received a copy of this notice; it does not constitute authorization for us to use or disclose your health information.