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Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Uses and Disclosures   Your protected health information (PHI) will be used for the purposes of treatment, payment and health care operations.  Please see examples of each below:

Treatment:  Sharing of medical information between healthcare providers that are involved in your care (i.e. your physician, other therapists, etc)

Payment:   Sending of billing information through Medical Processing Service to your insurance company

Health Care Operations:  Periodic quality assurance monitoring

Other Special Uses:  Use your PHI to contact you for an appointment reminder or to inform you of other health-related services.

In addition to the above uses, your PHI may be utilized or disclosed for the following circumstances:
 

  • with a family member or friend involved in your care if you do not object
  • in an emergency situation when you may not be able to express yourself
  • when required by law by court order or subpoena
  • when required by law to report to health oversight agencies
  • when necessary to comply with Worker’s Compensation, U.S. Military, or similar programs that provide benefits for your work-related injury or illness
  • when necessary to prevent or lessen a serious threat to the health or safety of another person or the public


For all other uses not mentioned above, you will be asked for your written authorization.  

Patient Privacy Rights

Restrictions: You have the right to request restrictions on how your PHI is used, however, we are not required to agree with your request. If we do agree, we must abide by your request.

Confidential:  You have the right to request communications in a confidential manner such as providing an alternate address or phone number

Access to Medical Information:  You have the right to inspect or have a copy of your medical information.  A reasonable fee for copying and postage may be charged.

Ammendments: If you disagree with any of your PHI, you have the right to request in writing an amendment be made.  If a mutual agreement can not be made, then the request is not required to be granted.  In this case, your written statement of disagreement will become part of your record.  Also, any part of your medical record that was created by other entities or providers may not be amended by this provider.

Accounting of Disclosures: You have the right to request an accounting of the disclosures made except for those that were made with your specific authorization or for treatment, payment, or health care operations.

Complaints

At any time that you feel that your privacy rights have been violated, you may register a complaint in writing to Brad Freemyer, PT @ 930 Woodstock Rd, Suite 310, Roswell, GA 30075.  In no circumstances will you be penalized or receive retaliation for any complaint.  If you are not satisfied with the response to your complaint, you may complain directly to the U.S. Secretary of Health and Human Services or the Georgia State Board of Physical Therapy.

Our Duty to Protect Your Privacy

We are required to comply with the federal health information privacy regulations by maintaining the privacy of your PHI. These rules require us to provide you with this document, our Notice of Privacy Practices and to follow the terms listed. We reserve the right to update this notice.  If we do update this notice at any time in the future, you will receive a revised notice when you next seek treatment from us.
 

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