HIPAA

Health Insurance Portability & Accountability Act

Notice of Privacy

Practices Updated for the HIPAA Omnibus Rule

Effective November 1, 2015

This Notice describes how medical information about you may be used and disclosed and how you get access to this information.

When you receive care from Intensive Physical Therapy Institute, LLC (IPTI), we may use your protected health information (PHI) for treating you, billing for services, and conducting our normal business known as healthcare operations. Examples of how we use your information include:

  • Treatment: We may use or disclose your PHI to give you medical treatment or services and to manage and coordinate your medical care. For example, your PHI may be provided to a physician or other healthcare provider to whom you have been referred.

  • Payment: We may use or disclose your PHI so that we can bill for the treatment and services you receive from us and can collect payment from you, a health plan, or a third party.

  • Appointment Reminders: We may use PHI to contact you that you have an appointment for medical care.

  • Minors: We may disclose PHI of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.

  • Research: We may use and disclose your PHI for research purposes.

  • We may disclose your PHI as required by law.

  • Business Associates: We may disclose PHI to our business associates who perform functions on your behalf.

• Military and Veterans: If you are a member or covered dependent of the armed forces, we may disclose PHI as required by military command authority.

• Public Health Risks: We may disclose PHI for public health activities.

• Abuse, Neglect, or Domestic Violence: We may disclose PHI to the appropriate authority if we believe a patient has been a victim of abuse, neglect, or domestic violence and the patient agrees or we are required or authorized by law to make the disclosure.

• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose PHI in response to a court or administrative order.

• Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to the above mentioned so they can carry out their duties.

• Organ or Tissue Donations: If you are an organ or tissue donor, we may disclose PHI as required by law.
• Worker’s Compensation: We may use or disclose your PHI for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.

• Law Enforcement: We may disclose PHI for law enforcement purposes, so long as applicable legal requirements are met.

Uses and disclosures that require us to give you an opportunity to object and opt out:

• Individuals Involved in Y our Care or Payment for Your Care: Unless you object, we may disclose to a member of your family, a relative, a close
friend or any other person you identify, your PHI that directly relates to that involvement in your healthcare. If you are unable to object or agree to such a disclosure, we may act in your best interest in our professional judgment.

• Disaster Relief: We may disclose your PHI to disaster relief organizations that seek your PHI to coordinate your care. We will provide you with an opportunity to agree or object to such a disclosure whenever we can do so practically.

The following uses will be made only with your written authorization:

• Most uses and disclosures of psychotherapy notes.

• Uses and disclosures of PHI for marketing purposes.

• Disclosures that constitute a sale of your PHI.

Your Rights Regarding Your PHI

  • Right to Inspect and Copy: You have the right to inspect and copy PHI that may be used to make decisions about your care. We have up to 30 days to make it available to you at a reasonable fee.

  • Right to a Summary of Explanation: We can also provide you with a summary of your PHI, rather than the entire record.

  • Right to an Electronic Copy: Y ou have the right to request an electronic copy.

  • Right to Get Notice of a Breech: You have the right to be notified upon a breach of any of your PHI.

  • Right to an Accounting: You have the right to ask for an “accounting of disclosures,” which is a list of the disclosures we made of your PHI. The right applies to disclosures other than treatment, payment or healthcare operations as described in the Privacy Notice.

  • Right to Request Restrictions: Y ou have the right to a restriction or limitations on the PHI we use to disclose for treatment, payment, or healthcare operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care, like a family member or friend.

  • Out of Pocket Payments: If you paid out of pocket in full at the time of

service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a health plan for purposes of payment, and we will honor that request.

  • Right to Request Confidential Communications: You have the right to request we communicate with you only in certain ways to preserve your privacy.

  • Right to an Electronic or Paper Copy: you have the right to an electronic or paper copy of the complete Privacy Notice. Please so designate on your Acknowledgement of Receipt of Notice of Privacy Practices.

    To exercise your rights described in this Notice, send your request, in writing, to our Privacy Office at the below address.

    Intensive Physical Therapy Institute, LLC 4568 South Highland Drive, Ste 180 Salt Lake City, UT 84117 (801)-251-0257

    We reserve the right to change this Notice. We reserve the right to make the changed Notice effective for the Protected Health Information we already have as well as for any Protected Health Information we create or receive in the future. A copy of our current Notice is posted in our office and on our website.

© 2017 by Intensive Physical Therapy Institute, LLC.

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Salt Lake City, Utah, United States

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