NOTICE OF PRIVACY PRACTICES
EFFECTIVE APRIL 14, 2003
As
Required by the Privacy Regulations Created as a Result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA), THIS NOTICE
DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT PATIENTS OF KINGS PARK
PHYSICAL THERAPY P.C. MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO YOUR PROTECTED HEALTH INFORMATION.
PLEASE
REVIEW THIS NOTICE CAREFULLY.
A.
OUR COMMITMENT TO YOUR PRIVACY
Kings Park Physical
Therapy (KPT) is dedicated to maintaining the privacy of your Protected
Health Information (PHI).
We are required to give you this notice and tell you how we
may use and disclose (give out) your personal medical information.
The terms of this notice
apply to all records containing your PHI that are created or retained by
us. We reserve the right to revise or amend this Notice of Privacy
Practices. Any revision or amendment to this notice will be effective for
all of your records that we have created or maintained in the past, and
for any of your records that we may create or maintain in the future. A
copy of our current notice is posted in our office in a visible location
at all times and you may request a copy of our most current notice at any
time. You may also receive a copy of any revised Notice of Privacy
Practices by accessing our website at
www.kingsparkpt.com
B.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE,
PLEASE CONTACT, IN WRITING, OUR PRIVACY OFFICER:
Laura
Ryan at Kings Park Physical Therapy, 277 Indian Head Road, Kings Park, NY
11754.
C.
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION (PHI) IN THE FOLLOWING WAYS:
Uses
and Disclosures of Protected Health Information
Your
protected health information for purposes involving treatment, payment and
health care operations may be used and disclosed by our physical
therapists, our office staff and others outside of the Facility that are
involved in your care and treatment for the purpose of providing health
care services to you. Your protected health information may also be used
and disclosed to pay your healthcare bills and to support the operation of
the Facility.
Following are examples of
the types of uses and disclosures of your protected healthcare information
that constitute treatment, payment and health care operations. These
examples are not meant to be exhaustive, but to describe the types of uses
and disclosures that may be made by us once you have become a patient.
1.
For
Treatment: We may use or disclose your personal health information
in order to treat you or to assist others in your treatment.
Additionally, we may disclose your health information to others that may
assist in your care such as your physician, spouse, children or parents.
Treatment means the provision, coordination or management of your
healthcare, including consultations between healthcare providers relating
to your care and referrals for healthcare from one healthcare provider to
another. For example, we may be asked to treat you for a broken leg and
may need to know if you have diabetes because diabetes may slow the
healing process; therefore, our therapists may need to discuss the
treatment plan with your physician based on this information.
2.
For
Payment:
We may use and disclose your health information in order to bill and
collect payment for the services and items you may receive from us. For
example, we may contact your health insurer to certify that you are
eligible for benefits (and for what range of benefits), and we may provide
your insurer with details regarding your treatment to determine if your
insurer will cover or pay for your treatment. We also may use and
disclose your PHI to obtain payment from third-parties that may be
responsible for such costs, such as family members. Also, we may use your
health information to bill you directly for services and items. Federal
or State law may require us to obtain a written release from you prior to
disclosing health information for payment purposes and we will ask you to
sign a release when necessary under applicable law.
3.
For
Healthcare Operations:
We may use or disclose, as‑needed, your protected health information to
operate our business. These activities include, but are not limited to,
quality assessment activities, employee review activities, student
training, licensing, marketing, and conducting or arranging for other
business activities. As examples of the ways in which we may use and
disclose your information for our operations, we may use your PHI to
evaluate the quality of care you received from us, or to conduct
cost-management and business planning activities for us. We may also
disclose your protected health information to medical school students that
see patients at our office. In addition, we may use a sign‑in sheet at
the registration desk where you will be asked to sign your name. We may
also call you by name in the waiting room when your therapist is ready to
see you. We may use or disclose your protected health information, as
necessary, to contact you to remind you of your appointment.
We may share your protected health information with third
party "business associates" that perform various activities for us.
Whenever an arrangement between Kings Park Physical Therapy and a business
associate involves the use or disclosure of your protected health
information, we will have a written contract that contains terms that will
protect the privacy of your protected health information.
We may also use and disclose your protected health
information for other marketing activities. For example, your name and
address may be used to send you a newsletter about the services we offer
at our facility. You may contact our Privacy Officer to request that
these materials not be sent to you.
4.
Treatment Options:
We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other
health‑related benefits and services that may be of interest to you. You
may contact our Privacy Officer to request that these materials not be
sent to you.
5.
Disclosures Required By Law:
We will use and disclose your PHI when we are required to do so by
federal, state or local law.
Uses
and Disclosures of Protected Health Information Based Upon Your Written
Authorization
Other uses and disclosures of your protected health
information will be made only with your written authorization, unless
otherwise permitted or required by law as described below. You may revoke
this authorization, at any time, in writing, except to the extent that we
have taken an action in reliance on the use or disclosure indicated in the
authorization.
Other Permitted and
Required Uses and Disclosures That May Be Made With Your Authorization or
Opportunity to Object
We may use and disclose your protected health information
in the following instances. You have the opportunity to agree or object
to the use or disclosure of all or part of your protected health
information. If you are not present or able to agree or object to the use
or disclosure of the protected health information, then we may use
professional judgment to determine whether the disclosure is in your best
interest. In this case only the protected health information that is
relevant to your healthcare will be disclosed.
Others Involved in Your
Healthcare:
Unless you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected health
information that directly relates to that person's involvement in your
healthcare. If you are unable to agree or object to such a disclosure, we
may disclose such information as necessary if we determine that it is in
your best interest based on our professional judgment. We may use or
disclose protected health information to notify or assist in notifying a
family member, personal representative or any other person that is
responsible for your care of your location, general condition or death.
Finally, we may use or disclose your protected health information to an
authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals
involved in your healthcare.
D.
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION (PHI) IN CERTAIN SPECIAL CIRCUMSTANCES
Other Permitted and
Required Uses and Disclosures That May Be Made Without Your Authorization
or Opportunity to Object
We
may use or disclose your protected health information in the following
situations without your consent or authorization. These situations
include:
1.
Required By Law:
We may use or disclose your protected health information to the extent
that the 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. You will be notified, as required by law, of any
such uses or disclosures.
2.
Public Health:
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 contracting or spreading the disease or
condition. We may disclose your protected health information for public
health activities and purposes to a public health authority that is
permitted by law to collect or receive the information. The disclosure
will be made for the purpose of controlling disease, injury or
disability. We may also disclose your protected health information, if
directed by the public health authority, to a foreign government agency
that is collaborating with the public health authority.
3.
Health Oversight Activities:
We may
disclose your PHI to a health oversight agency for activities authorized
by law. Oversight activities can include, for example, investigations,
inspections, audits, surveys, licensure and disciplinary actions; civil,
administrative, and criminal procedures or actions; or other activities
necessary for the government to monitor government programs, compliance
with civil rights laws and the health care system in general.
4.
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, 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. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws.
5.
Food and Drug Administration:
We may disclose your protected health information to a person or company
required by the Food and Drug Administration to report adverse events,
product defects or problems, biologic product deviations, track products;
to enable product recalls; to make repairs or replacements, or to conduct
post marketing surveillance, as required.
6.
Legal 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 certain conditions in response to a subpoena, discovery
request or other lawful process.
7.
Law
Enforcement: 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. We may also
disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual. We may
also disclose protected health information, so long as applicable legal
requirements are met for law enforcement purposes.
8.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for
the coroner or medical examiner to perform other duties authorized by
law. We may also disclose protected health information to a funeral
director, as authorized by law, in order to permit the funeral director to
carry out their duties. We may disclose such information in reasonable
anticipation of death. Protected health information may be used and
disclosed for cadaveric organ, eye or tissue donation purposes.
9.
Research:
We may disclose your protected health information to researchers when
their research has been approved by an institutional review board that has
reviewed the research proposal and established protocols to ensure the
privacy of your protected health information.
10.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel (1) for
activities deemed necessary by appropriate military command authorities;
(2) for the purpose of a determination by the Department of Veterans
Affairs of your eligibility for benefits, or (3) to foreign military
authority if you are a member of that foreign military services. We may
also disclose your protected health information to authorized federal
officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or
others legally authorized.
11.
Workers' Compensation:
Your protected health information may be disclosed by us as authorized to
comply with workers' compensation laws and other similar legally
established programs.
12.
Inmates:
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to you.
13.
Required Uses and Disclosures:
Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500 et.
seq.
E.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH
INFORMATION (PHI)
The
following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise these
rights.
1.
Confidential Communications.
You have the right to
request that Kings Park Physical Therapy communicate with you about your
health and related issues in a particular manner or at a certain
location. For instance, you may ask that we contact you at home, rather
than work. In order to request a type of confidential communication, you
must make a written request to the Privacy Officer, specifying the
requested method of contact, or the location where you wish to be
contacted. We will accommodate reasonable requests. You do not need to
give a reason for your request.
2.
Requesting Restrictions.
You have the right to request a restriction in our use or disclosure of
your PHI for treatment, payment or health care operations. Additionally,
you have the right to request that we restrict our disclosure of your PHI
to only certain individuals involved in your care 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. In order to request a restriction
in our use or disclosure of your PHI, you must make your request in
writing to the Privacy Officer. Your request must describe in a clear and
concise fashion: (a) the information you wish restricted (b) whether you
are requesting to limit the Facility’s use, disclosure or both and (c) to
whom you want the limits to apply.
3.
Inspection and Copies.
You have the right to inspect and obtain a copy of the PHI
that may be used to make decisions about you or your child, including
patient medical records and billing records. You must submit your request
in writing to the Privacy Officer in order to inspect and/or obtain a copy
of your PHI. We may charge a fee for the costs of copying, mailing, labor
and supplies associated with your request. We may deny your request to
inspect and/or copy in certain limited circumstances; however, you may
request a review of our denial.
4.
Amendment.
You may ask us to amend your health information if you believe it is
incorrect or incomplete, and you may request an amendment for as long as
the information is kept by or for Kings Park Physical Therapy. To request
an amendment, your request must be made in writing and submitted to our
Privacy Officer. You must provide us with a reason that supports your
request for amendment. We will deny your request if you fail to submit
your request (and the reason supporting your request) in writing. Also,
we may deny your request if you ask us to amend information that is in our
opinion: (a) accurate and complete; (b) not part of the PHI kept by or for
the Facility; (c) not part of the PHI which you would be permitted to
inspect and copy; or (d) not created by Kings Park Physical Therapy,
unless the individual or entity that created the information is not
available to amend the information.
5.
Accounting of Disclosures.
All of our patients have the right to request an "accounting of
disclosures." An "accounting of disclosures" is a list of certain
non-routine disclosures we have made of your PHI for non-treatment or
operations purposes. This right applies to disclosures for purposes other
than: (1) disclosures made pursuant to an authorization signed by you or
(2) disclosures for treatment, payment or healthcare operations of the
Facility as described in this Notice of Privacy Practices. Use of your
PHI as part of the routine patient care that is not required to be
documented. In order to obtain an accounting of disclosures, you must
submit your request in writing to our Privacy Officer. All requests for
an '"accounting of disclosures" must state a time period, which may not be
longer than six (6) years from the date of disclosure and may not include
dates before April 14, 2003. The first list you request within a 12-month
period is free of charge, but we may charge you for additional lists
within the same 12-month period. We will notify you of the costs involved
with additional requests, and you may withdraw your request before you
incur any costs. You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information.
You have the right it to receive specific information regarding these
disclosures that occurred after April 14, 2003. You may request a shorter
time frame. The right to receive this information is subject to certain
exceptions, restrictions and limitations.
6.
Right to a Paper Copy of This Notice.
You are entitled to receive
a paper copy of our Notice of Privacy Practices. You may ask us to give
you a copy of this notice at any time. To obtain a paper copy of this
notice, contact our Privacy Officer.
7.
Right to File a Complaint.
If you believe your privacy
rights have been violated, you may file a complaint with the Facility or
with the Secretary of the Department of Health and Human Services. To
file a complaint with The Facility, contact the Privacy Officer. All
complaints must be submitted in writing. You will not be penalized for
filing a complaint.
8.
Right to Provide an Authorization for Other Uses and Disclosures.
We
will obtain your
written authorization for uses and disclosures that are not identified by
this notice or permitted by applicable law. Any authorization you provide
to us regarding the use and disclosure of your PHI may be revoked at any
time in writing. After you revoke your authorization, we will no longer
use or disclose your PHI for the reasons described in the authorization.
Please note we are required to retain records of your care.
If you have any questions
regarding this notice or our health information privacy policies, please
contact our Privacy Officer, Laura Ryan at:
Kings Park Physical
Therapy
277 Indian Head Road
Kings Park, New York 11754
Att: Privacy Officer
(631)269-5170
