A WORLD OF DIFFERENCE
Notice of Privacy Practices
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
If you have any questions about this notice please contact:
Cheryl Zehtaban, Office Manager
This Notice of Privacy Practices (NPP) describes how we may use and disclose
your protected health information to carry out treatment, payment or health care
operations and for other purposes that are permitted or required by law. It
also describes your rights to access and control your protected health information.
Protected Health Information (PHI) is information about you, including demographic
information, that may identify you and that relates to your past, present or future
physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices.
We may change the terms of the notice, at any time. The new notice will be
effective for all protected health information that we maintain at that time.
You may obtain any revised NPP by calling the clinic office (501-227-9920) and requesting
that a revised copy be sent to you in the mail or asking for one at the time of
your next appointment.
1. Uses and Disclosures of Protected Health Information (PHI):
Uses and Disclosures of Protected Health Information Based Upon Your Written
Consent
You will be asked by your therapist or her assistant or business officer to sign
a consent form. Once you have consented to use and disclosure of your protected
health information for treatment, payment and health care operations by signing
the consent form, your therapist or her assistant or business officer will use or
disclose your PHI as described in this section 1. Your protected health information
may be used and disclosed by your therapist, our office staff and others outside
of our office that are involved in your care and treatment for the purpose of providing
health care services to you. Your PHI may also be used and disclosed to pay
your health care bills and to support the operation of A WORLD OF DIFFERENCE.
Following are examples of the types of uses and disclosures of your protected
health care information that A WORLD OF DIFFERENCE is permitted to make once you
have signed our consent form. These examples are not meant to be exhaustive,
but to describe the types of uses and disclosures that may be made by our clinic
once you have provided consent.
Treatment:
We will use and disclose your PHI to provide, coordinate, or manage your health
care and any related services. This includes the coordination or management
of your health care with a third party that has already obtained your permission
to have access to your PHI. For example, we would disclose your PHI, as necessary,
to your Primary Care Physical therapist (PCP) and/or your referring physical therapist
that provides care for you. We will also disclose PHI to other physical therapists
that may be treating you when we have the necessary permissions from you to disclose
your PHI. For example, your PHI may be provided to a physical therapist to
whom you have been referred to ensure that the physical therapist has the necessary
information to diagnose or treat you.
In addition, we may disclose your PHI from time-to-time to another physical therapist
or health care provider (e.g., a specialist or laboratory) who, at the request of
your therapist, becomes involved in your care by providing assistance with your
health care diagnosis or treatment to your therapist.
Payment:
Your PHI will be used, as needed, to obtain payment for your health care services.
This may include certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend for you such
as; making a determination of eligibility or coverage for insurance benefits, reviewing
services provided to you for medical necessity, and undertaking utilization review
activities. For example, obtaining approval for physical therapy may require that
your relevant protected health information be disclosed to a nurse employed by your
insurance company to obtain approval for you to receive physical therapy.
Healthcare Operations:
We may use or disclose, as-needed, your protected health information in order
to support the business activities of your therapist’s practice. These activities
include, but are not limited to, quality assessment activities, employee review
activities, training of clinic personnel, licensing, marketing and fundraising activities,
and conducting or arranging for other business activities.
In addition, we may 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 will share your protected health information with third party “business associates”
that perform various activities (e.g., billing, transcription services) for the
practice. Whenever an arrangement between our office 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 use or disclose your PHI, as necessary, to provide you with information
about treatment alternatives or other health-related benefits and services that
may be of interest to you. 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 our practice and a special educational program we think
you may be interested in. We may also send you information about products or services
that we believe may be beneficial to you. You may contact our Office Manager to
request that these materials not be sent to you.
We may use or disclose your demographic information and the dates that you received
treatment from your physical therapist, as necessary, in order to contact you for
fundraising activities supported by our office. If you do not want to receive these
materials, please contact our Office Manager and request that these fundraising
materials not be sent to you.
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 your therapist or therapist’s practice has 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
Consent, 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 your health
care provider may, using professional judgment, determine whether the disclosure
is in your best interest. In this case, only the protected health information that
is relevant to your health care 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 PHI that directly relates to
that person’s involvement in your health care. 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 health care.
Emergencies:
We may use or disclose your PHI in an emergency treatment situation. If this
happens, your physical therapist shall try to obtain your consent as soon as reasonably
practicable after the delivery of treatment. If your physical therapist or another
therapist in the practice is required by law to treat you and the physical therapist
has attempted to obtain your consent but is unable to obtain your consent, he or
she may still use or disclose your protected health information to treat you.
Communication Barriers:
We may use and disclose your protected health information if your therapist or
another therapist in the practice attempts to obtain consent from you but is unable
to do so due to substantial communication barriers and the therapist determines,
using professional judgment, that you intend to consent to use or disclosure under
the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without
Your Consent, 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:
Required By Law:
We may use or disclose your PHI 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.
Public Health:
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.
Communicable Diseases:
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.
Health Oversight:
We may disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections. Oversight
agencies seeking this information include government agencies that oversee the health
care system, government benefit programs, other government regulatory programs and
civil rights laws.
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.
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.
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.
Law Enforcement:
We may also disclose protected health information, so long as applicable legal
requirements are met, for law enforcement purposes. These law enforcement purposes
include (1) legal processes and otherwise required by law, (2) limited information
requests for identification and location purposes, (3) pertaining to victims of
a crime, (4) suspicion that death has occurred as a result of criminal conduct,
(5) in the event that a crime occurs on the premises of the practice, and (6) medical
emergency (not on the Practice’s premises) and it is likely that a crime has occurred.
Criminal Activity:
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.
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.
Workers’ Compensation:
We may disclose your protected health information as authorized to comply with
workers’ compensation laws and other similar legally established programs.
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.
2. Your Rights:
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.
You have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information about
you that is contained in a designated record set for as long as we maintain the
protected health information. A “designated record set” contains medical and billing
records and any other records that your therapist and the practice use for making
decisions about you.
Under federal law, however, you may not inspect or copy the following records:
information compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding, and protected health information that is
subject to law that prohibits access to protected health information. Depending
on the circumstances, a decision to deny access may be re-viewable. In some circumstances,
you may have a right to have this decision reviewed. Please contact our Office Manager
if you have questions about access to your medical record.
You have the right to request a restriction of your protected health
information. This means you may ask us not to use or disclose any part
of your protected health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health information
not be disclosed to family members or friends who may be involved in your care or
for notification purposes as described in this Notice of Privacy Practices. Your
request must state the specific restriction requested and to whom you want the restriction
to apply.
Your physical therapist is not required to agree to a restriction that
you may request. If your physical therapist believes it is in your best interest
to permit use and disclosure of your protected health information, your protected
health information will not be restricted. If your therapist does agree to the requested
restriction, we may not use or disclose your protected health information in violation
of that restriction unless it is needed to provide emergency treatment. With this
in mind, please discuss any restriction you wish to request with your health care
provider. You may request a restriction by indicating any restrictions on the consent
form supplied by A WORLD OF DIFFERENCE.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location. We will
accommodate reasonable requests. We may also condition this accommodation by asking
you for information as to how payment will be handled or specification of an alternative
address or other method of contact. We will not request an explanation from you
as to the basis for the request. Please make this request in writing to our Office
Manager.
You may have the right to have your physical therapist amend your
protected health information. This means you may request an amendment
of protected health information about you in a designated record set for as long
as we maintain this information. In certain cases, we may deny your request for
an amendment. If we deny your request for amendment, you have the right to file
a statement of disagreement with us and we may prepare a rebuttal to your statement
and will provide you with a copy of any such rebuttal. Please contact our Office
Manager to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Practices. It excludes disclosures
we may have made to you, for a facility directory, to family members or friends
involved in your care, or for notification purposes. You have the right to receive
specific information regarding these disclosures that occurred after April 14, 2003.
You may request a shorter timeframe. The right to receive this information is subject
to certain exceptions, restrictions and limitations.
3. Complaints:
You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint with
us by notifying our Office Manager of your complaint. We will not retaliate against
you for filing a complaint.
You may contact our Privacy Compliance Officer, Cheryl Zehtaban
(501) 227-9920 for further information about the complaint process.
This notice was published and becomes effective on February 1, 2003.
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