Notice of Privacy
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU MAY OBTAIN THIS INFORMATION, PLEASE REVIEW CAREFULLY. This includes protecting your actual medical record, billing information, electronic transmissions, faxes and phone calls that may include medical information. We have also taken steps to ensure that any associates that may have access to patient records, protect your patient information. This is required by the Privacy Regulations, created as a result of the Healthy Insurance Portability and Accountability Act of 1996 (HIPAA). Understand that the minimum information possible will be released.
Our commitment to your privacy
Dubuque Physical Therapy and Physical Therapy Solutions are dedicated to maintaining the privacy of your health information. We are required by law to maintain the confidentiality of your health information.
We realize that these laws are complicated, but we must provide you with the following information:
We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us. The following are situations and/or entities that may receive medical information without your consent.
1. Public health authorities and health oversight agencies that are authorized by law to collect information.
2. Lawsuits and similar proceedings in response to a a court or administrative order.
3. If required to do so by a law enforcement official. Under certain circumstances, we may disclose health information to law enforcement officials as required by law. These would include: certain types of wounds, pursuant to certain subpoenas or court orders, suspected victims of crimes, crimes on our premises, and crimes in emergencies.
4. We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes.
5. We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being part of a crime or has escaped from legal custody.
6. When necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat.
7. If you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities, information will be released.
8. Information may be shared with Federal officials for intelligence and national security activities as authorized by law.
9. Correctional institutions or law enforcement officials may receive information if you are an inmate or under the custody of a law enforcement official.
10. Patients with occupational injuries will have information released. By Iowa law, the employer has the right to medical information about your injury. Only information pertinent to the injury will be released to your employer or his representatives including; nurse case managers, insurance companies, adjuster, and repricing companies.
11. The sources referring you to the clinic Information may be shared with your referring doctor.
12. Certain information may be shared with agencies or companies so secure approval for tests or treatment that you may need.
13. Your insurance company including a third party clearing house, billing service, repricing companies and managed care companies.
14. You may also receive informational mailings from Dubuque Physical Therapy and Physical Therapy Solutions. We will never share or sell your information to any outside party.
15. Dubuque Physical Therapy and Physical Therapy Solutions have the right to collect fees from you for service received. Every effort is made to protect your personal health information in the unfortunate event that your account should be sent to a collection agency. We do not release diagnosis information, but by law the collections agency must be able to tell you for what you are being charged.
16. Patient information may also be reviewed as needed by Dubuque Physical Therapy and Physical Therapy Solutions staff during day to day operation of the clinic including statistical information, collections and practice operations and management.
17. Dubuque Physical Therapy and Physical Therapy Solutions also have the right to change its privacy policy and the terms of this notice from time to time provided that the changes are permitted by law.
18. Medical information to notify or help notify; a family member, your personal representative, or another person responsible for your care. In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decision in your best interest about allowing someone to puck up medicine, medical supplies, x-ray or medical information for you.
19. To help them carry out their duties, we may share the medical information of a deceased person with the coroner, medial examiner, funeral director, or an organ procurement organization.
20. Messages may be left on your answering machine or e-mail regarding care or as appointment reminders. Appointment reminder cards may also be sent.,
21. At times Dubuque Physical Therapy and Physical Therapy Solutions may hire Business Associates who may have access to your Protected Health Information. These Associates are required to protect the privacy of our patients and comply with the state and federal law in keeping your Protected Health Information confidential. An example would be a computer software vendor who services the software programs we use.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
1. Communications. You can request that our practice communicate with you about your health and related issues in a particular manner or a certain location. For instance, you may ask that we contact you at home, rather than work. We will accommodate reasonable written requests.
2. You can request a restriction in our use of disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your car or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
3. Right to copy of this notice. You are entitled to receive a copy of this Notice of Privacy Practices. You may request a copy of this Notice any time. To obtain a copy of this notice, please complete a Request for Record Form available from our front desk receptionist or put your request in writing.
4. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact: Dubuque Physical Therapy, 4005 Westmark Drive, Suite 320, Dubuque, IA 52002 or Physical Therapy Solutions, Stone Creek Shopping Center, 6131/2 16th Avenue, Dyersville, IA 52040
. All complaints must be submitted in writing. You will not be penalized for filing a complaint. We are interested in correcting any violation of your privacy.
5. Right to provide an authorization for other uses and disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.
6. You also have a right to receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions. If you wish to receive such a list, please put your request in writing.
7. You have a right to request that we change your medical information. We may deny your request if we did not create the information you want changed or if we do not believe the information in your record is inaccurate or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change your information, we will provide an addendum to your record and make reasonable efforts to tell others, (including people you name) of the change and to include the changes in any future sharing of the information.
If you have any questions regarding this notice or our health information privacy policies, please contact Dubuque Physical Therapy, 4005 Westmark Drive, Suite 320, Dubuque, IA 52002, (563) 588-3891 or Physical Therapy Solutions, Stone Creek Shopping Center, 6131/2 16th Avenue, Dyersville, IA 52040, (563) 875-8615.
Effective Date: April 14, 2003
Revisions: