Harvest Physical Therapy DBA One Accord Physical Therapy
Statement of Privacy Notice
Effective June 1, 2003
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.
We may disclose your health care information to other healthcare
professionals within our practice for the purpose of treatment,
payment or healthcare operations.
We may disclose your health information to your insurance provider
for the purpose of payment or health care operations.
We may disclose your health information as necessary to comply
with State Workers’ Compensation Laws.
We may disclose your health information to notify or assist in
notifying a family member, or another person responsible for your
care about your medical condition or in the event of an emergency or
of your death.
As required by law, we may disclose your health information to
public health authorities for purposes related to: preventing or
controlling disease, injury or disability, reporting child abuse or
neglect, reporting domestic violence, reporting to the Food and Drug
Administration problems with products and reactions to medications,
and reporting disease or infection exposure.
We may disclose your health information in the course of any
administrative or judicial proceeding.
We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a suspect,
fugitive, material witness or missing person, complying with a court
order or subpoena, and other law enforcement purposes.
We may disclose your health information to coroners or medical
examiners.
We may disclose your health information to organizations involved in
procuring, banking, or transplanting organs and tissues.
We may disclose your health information to researchers conducting
research that has been approved by an Institutional Review Board.
It may be necessary to disclose your health information to
appropriate persons in order to prevent or lessen a serious and
imminent threat to the health or safety of a particular person or to the
general public.
We may disclose your health information for military, national
security, prisoner and government benefits purposes.
We may leave a message on an automated answering device or
person answering the phone for the purposes of scheduling
appointments. No personal health information will be disclosed
during this recording or message other than the date and time of
your scheduled appointment along with a request to call our office if
you need to cancel or reschedule your appointment."
We may contact you by phone, mail, or email. "It is our practice to
participate in charitable and marketing events to raise awareness,
food donations, gifts, money, etc. During these times, we may send
you a letter, post card, invitation or call your home to invite you to
participate in the charitable activity.
In the event that we are sold or merged with another organization,
your health information/record will become the property of the new
owner.
You have the right to request restrictions on certain uses
and disclosures of your health information. Please be
advised, however, that we are not required to agree to the
restriction that you requested.
You have the right to have your health information
received or communicated through an alternative method
or sent to an alternative location other than the usual
method of communication or delivery, upon your request.
You have the right to inspect and copy your health
information.
You have a right to request that we amend your protected
health information. Please be advised, however, that we
are not required to agree to amend your protected health
information. If your request to amend your health
information has been denied, you will be provided with an
explanation of our denial reason(s) and information about
how you can disagree with the denial.
You have a right to receive an accounting of disclosures
of your protected health information made by us.
You have a right to a paper copy of this Notice of Privacy
Practices at any time upon request.
We reserve the right to amend this Notice of Privacy Practices at any
time in the future, and will make the new provisions effective for all
information that it maintains. Until such amendment is made, we are
required by law to comply with this Notice.
We are required by law to maintain the privacy of your health
information and to provide you with notice of its legal duties and
privacy practices with respect to your health information. If you have
questions about any part of this notice or if you want more
information about your privacy rights, please contact us by calling
this office at (520) 536-8621. If our Privacy Officer is not available,
you may make an appointment for a personal conference in person
or by telephone within 2 working days.
Complaints about your Privacy rights, or how we have handled your
health information should be directed to our Privacy Officer by calling
this office at (520) 836 -8621. If our Privacy Officer is not available,
you may make an appointment for a personal conference in person
or by telephone within 2 working days.
If you are not satisfied with the manner in which this office handles
your complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
I have read the Privacy Notice and understand my rights contained
in the notice.
By way of my signature, I provide the company above with my
authorization and consent to use and disclose my protected health
care information for the purposes of treatment, payment and health
care operations as described in the Privacy Notice