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.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we've shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Get a copy of health and claims records. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say "yes" to all reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say "no" if it would affect your care. If you pay for a service out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations purposes; we will say "yes" unless a law requires us to share it.

Get a list of those with whom we've shared information. You can ask for an accounting of the times we've shared your health information for six years prior to your request, who we shared it with, and why. We'll provide one accounting a year for free but may charge a reasonable, cost-based fee for another one within 12 months.

Get a copy of this privacy notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.

Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.

File a complaint if you feel your rights are violated. You can complain by contacting us using the information on this page, or by filing a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (200 Independence Avenue, S.W., Washington, D.C. 20201; 1-877-696-6775; www.hhs.gov/ocr/privacy/hipaa/complaints/). We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information, talk to us and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are not able to tell us your preference (for example, if you are unconscious), we may go ahead and share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission: marketing purposes, sale of your information, and most sharing of psychotherapy notes. For fundraising, we may contact you, but you can tell us not to contact you again.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

  • Treat you. We can use your health information and share it with other professionals who are treating you.
  • Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
  • Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. We can share health information about you for:

  • Preventing disease, helping with product recalls, and reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety
  • Health research
  • Complying with state or federal law, including HHS oversight of our compliance
  • Organ procurement organizations
  • A coroner, medical examiner, or funeral director when an individual dies
  • Workers' compensation claims, law enforcement purposes, health oversight agencies, and special government functions such as military and national security
  • Responding to a court or administrative order, or a subpoena

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by letting us know in writing.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Other Instructions for Notice

Effective as of 9/1/2020. The privacy official for Dr. Pepper Physical Therapy can be contacted at talin@drpepperpt.com.