This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.
Uses & Disclosures
Treatment: Your health information may be used by staff members or disclosed to other health care professional for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of diagnostic test (i.e. x-rays, MRI, EEG) will be available in your medical record to all health professions who ma provide treatment or wo may be consulted by staff members.
Payment: Your health information may be used to see payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations: Your health information may be used as necessary to support the day-to-day activities and management of Motivate Personal Physical Rehabilitation. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Law Enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.
Public Health Reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
Treatment Alternatives: We will use and disclose your protected health information to tell about or to recommend possible alternative treatments or options that may be of interest to you.
Other Uses and Disclosures: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision to revoke your authorization.
Your Health Information Rights
Although your health record is the physical property of the health care practitioner of the facility that compiled it, the information belongs to you. You have:
- The right to require restrictions on the use and disclosure of your protected health information
- The right to receive confidential communications concerning your medical condition and treatment
- The right to inspect and copy your protected health information
- The right to amend or submit corrections to your protected health information
- The right to receive an accounting of how and to whom your protected health information has been disclosed
- A right to receive a printed copy of this notice
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices outlined in this notice.
Request to Inspect Protected Health Information: You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulations, we require that request to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the practice manager. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request. We have 30 days to comply if the records are on site and 60 days if they are offsite.
Notice of Nondiscrimination
It is the policy of Motivate Personal Physical Rehabilitation to admit and treat all persons without regard to race, color, national origin, handicap or age. The same requirements are applied to all, and patients are assigned without regard to race, color, national origin, handicap or age. There is no distinction in the eligibility for or in the manner or providing patient services. All services are available without distinction to all patients and visitors regardless of to race, color, national origin, handicap or age. All persons and organizations having occasion to refer persons to the Motivate Personal Physical Rehabilitation are advised to do so without regard to the person’s race, color, national origin, handicap or age.
The Person designated to coordinate compliance with Section 504 of the Rehabilitation Act of 1973 (non-discrimination against the handicapped) is Denise Nichols, Clinic Director, who can be reached at (815) 637-1100.