Notice of Protected Health Information
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.
Purpose of Notice
Under the federal health care privacy regulations pertaining
to the Health Insurance Portability and Accountability Act
of 1996 set forth at 45 CFR § 160.101 et seq. (the “Privacy
Regulations”), Pinnacle Therapy Services, Inc. (“the Practice”)
is required to protect the privacy of your individually
identifiable health information, which includes information
about your health history, symptoms, test results, diagnoses,
treatment, and claims and payment history. We are also
required to provide you with this Notice of Protected Health
Information Practices regarding our legal duties, policies
and procedures to protect and maintain the privacy of your
health information (“the Notice”). We will not use or disclose
your health information except as provided for in this Notice.
However, we reserve the right to change the terms of this
Notice and make new notice provisions for all your health
information that we maintain.
Permitted Uses and Disclosures of Your Health Information
1. Uses and Disclosures with Patient Consent:
Under the Privacy Regulations, after having made good
faith efforts to obtain your acknowledgement of receipt
of this Notice, we are permitted to use and disclose your
health information for the following purposes:
a. Treatment. We are permitted to use
your health information in the provision and coordination
of your health care. We may disclose information contained
in your medical record to your primary health care provider,
consulting providers, and to other health care personnel
who have a need for such information for your care and treatment.
For example, your physical therapist may disclose your health
information when consulting with a physician regarding your
medical condition.
b. Payment. We are permitted to use your
health information for the purposes of determining coverage,
billing, claims management, medical data processing and
reimbursement. This information may be released to an insurance
company, third party payor or other authorized entities
involved in the payment of your medical bill and may include
copies or portions of your medical record which are necessary
for payment of your account. For example, a bill sent to
your insurance company may include information that identifies
you, your diagnosis, and the procedures and supplies used
in your treatment.
c. Health Care Operations. We are permitted
to use and disclose your health information during the Practice's
routine health care operations, including, but not limited
to, quality assurance, utilization reviews, medical reviews,
auditing, accreditation, certification, licensing or credentialing
activities and for education purposes.
2. Uses and Disclosures With Patient Authorization.
Under the Privacy Regulations, we can
use and disclose your health information for purposes other
than treatment, payment or health care operations with your
written authorization. For example, with your authorization
we can provide your name and medical condition to companies
who might be able to provide you useful items or services.
Under the Privacy Regulations, you may revoke your authorization;
however, such revocation will not have any effect on uses
or disclosures of your health information prior to our receipt
of the revocation.
3. Uses and Disclosures With Patient Opportunity
to Verbally Agree or Object. Under the Privacy
Regulations, we are permitted to disclose your health information
without your written consent or authorization to a family
member, a close personal friend or any other person identified
by you, if the information is directly relevant to that
person's involvement in your care or treatment. You must
be notified in advance of the use or disclosure and have
the opportunity to verbally agree or object.
4. Uses and Disclosures Without an Acknowledgement,
Authorization or Opportunity to Verbally Agree or Object.
Under the Privacy Regulations, we are permitted
to use or disclose your health information without your
consent, authorization or the opportunity to verbally agree
or object with regard to the following:
- Uses and Disclosures Required by Law.
We will disclose your health information when required
to do so by law.
- Public Health Activities. We may disclose
your health information for public health reporting, reporting
of communicable diseases and vital statistics and similar
other circumstances.
- Abuse and Neglect. We may disclose your
health information if we have a reasonable belief of abuse,
neglect or domestic violence.
- Regulatory Agencies. We may disclose
your health information to a health care oversight agency
for activities authorized by law, including, but not limited
to, licensure, certification, audits, investigations and
inspections. These activities are necessary for the government
and certain private health oversight agencies to monitor
the health care system, government programs and compliance
with civil rights.
- Judicial and Administrative Proceedings.
We may disclose health information in judicial and administrative
proceedings, as well as in response to an order of a court,
administrative tribunal, or in response to a subpoena,
summons, warrant, discovery request or similar legal request.
- Law Enforcement Purposes. We may disclose
your health information to law enforcement officials when
required to do so by law.
- Coroners, Medical Examiners, Funeral Directors.
We may disclose your health information to a coroner or
medical examiner. This may be necessary, for example,
to determine a cause of death. We may also disclose your
health information to funeral directors, as necessary,
to carry out their duties.
- Research. Under certain circumstances,
we may disclose your health information to researchers
when their clinical research study has been approved by
an institutional review board that has reviewed the research
proposal and provided that certain safeguards are in place
to ensure the privacy and protection of your health information.
- Threats to Health and Safety. We
may use or disclose your health information if we believe,
in good faith, the use or disclosure is necessary to prevent
or lessen a serious or imminent threat to the health or
safety of a person or the public.
- Military/Veterans. If you are
a member of the armed forces, we may disclose your health
information as required by military command authorities.
- Workers’ Compensation. We may
disclose your health information to the extent necessary
to comply with laws relating to workers’ compensation
or other similar programs.
- Marketing. We may use or disclose your
health information to make a marketing communication to
you, if such communication is conducted face-to-face,
concerns products or services of nominal value, or identifies
us as the communicating party and that we will receive
remuneration for making the communication and, where required
by the Privacy Regulations, instructions describing how
you may verbally object to receiving future communications.
- Appointment Reminders. We may use and
disclose your health information to remind you of an appointment
for treatment and medical care at our practice.
- Other Uses and Disclosures. In addition
to the reasons outlined above, we may use and disclose
your health information for other purposes permitted by
the Privacy Regulations.
5. Uses and Disclosures to Business Associates.
With an acknowledgement or a proper authorization, we are
permitted to disclose your health information to Business
Associates and to allow Business Associates to receive your
health information on our behalf. A Business Associate
is defined under the Privacy Regulations as an individual
or entity under contract with us to perform or assist us
in a function or activity which requires the use of your
health information. Examples of business associates include,
but are not limited to, consultants, accountants, lawyers,
medical transcriptionists and third party billing companies.
We require all Business Associates to protect the confidentiality
of your health information.
Patient Rights
Although your medical record is our property, you have
the following rights concerning your medical record and
health information:
- Right to Request Restrictions on the Use and Disclosure
of Your Health Information. You have the right
to request restrictions on the use and disclosure of your
health information for treatment, payment and health care
operations. However, we are not required to agree with
such a request. If, however, we agree to the requested
restriction, it is binding on us.
- Right to Inspect and Copy Your Health Information.
You have the right to inspect and copy your own health
information upon request. However, we are not required
to provide you access to all the health information that
we maintain. For example, this right does not extend
to psychotherapy notes, information compiled in reasonable
anticipation of, or for use in, a civil, criminal or administrative
proceeding, or subject to or exempt from Clinical Laboratory
Improvements Amendments of 1988. Access may also be denied
if disclosure would reasonably endanger you or another
person.
- Right to Verbally Object. You have the
right to verbally object to certain disclosures that are
routinely made for treatment, payment or healthcare operations
or for other purposes without an Authorization. For example,
we are required to give you an opportunity to object to
the sharing of your health information with a person or
family member accompanying you for treatment.
- Right to Seek an Amendment of Your Health Information.
You have the right to request an amendment of your health
information. If we disagree with the requested amendment,
we will permit you to include a statement in the record.
Moreover, we will provide you with a written explanation
of the reasons for the denial and the procedures for filing
appropriate complaints and appeals.
- Right to an Accounting of Disclosure of Your Health
information. You have the right to receive an
accounting of disclosures made by us of your health information
within six (6) years prior to the date of your request;
provided, however that we need not provide an accounting
for any information disclosed prior to April 14, 2003.
The accounting will not include disclosures related to
treatment, payment or health care operations, disclosures
made to you, disclosures made pursuant to a validly executed
authorization, disclosures permitted by the Privacy Regulations,
disclosures to persons involved in your care, or disclosures
that occurred prior to the April 14, 2003 compliance deadline
under the Privacy Regulations. The accounting of disclosures
shall include the date of each disclosure, name and address
of the person or organization who received your health
information, a brief description of the information disclosed,
and the purpose for the disclosure.
- Right to Confidential Communications.
You have the right to receive confidential communications
of your health information by alternative means or alternative
locations. For example, you may request that we only
contact you at work or by mail.
- Right to Revoke Your Authorization. You
have the right to revoke a validly executed authorization
for the use or disclosure of your health information.
However, such revocation will not have any effect on uses
or disclosures prior to the receipt of the revocation.
- Right to Receive Copy of this Notice.
You have the right to receive a copy of this Notice.
Contact Information and How to Report a Privacy Rights
Violation
If you have questions and would like additional information
regarding the uses and disclosures of your health information,
you may contact the Compliance Officer at 215-497-9890.
Moreover, the Practice has established an internal complaint
process for reporting privacy rights violations. If you
believe that your privacy rights have been violated, you
may file a complaint with us or the Secretary of the Department
of Health and Human Services at 200 Independence Avenue,
S.W., Washington, D.C. 20201. To file a complaint with
us, please contact the Compliance Officer at 215-497-9890.
All complaints must be submitted to the Practice in writing
at 204 Floral Vale Boulevard, Yardley, PA 19067. There
will be no retaliation for filing a complaint.
Effective Date
The effective date of this Notice is April 14, 2003.
