Restore U Physical Therapy (“Restore U”) understands that your medical and health information is personal. We are committed to protecting this information. At Restore U, we create a record of the services and care that you receive in the Clinic. We need this record so that we can provide you with the best care possible and meet certain legal requirements. This Notice applies to all of the records of your care generated by Restore U, whether made by Restore U personnel or your personal physicians and allied health practitioners. In this Notice, you will find information about how Restore U may use and disclose medical information about you, referred to as protected health information (“PHI”). Additionally, this Notice will address your rights and the obligations that Restore U has regarding any use or disclosure of your PHI. For the purposes of treatment, payment, or other related operations described in this Notice, Restore U staff may share PHI with each other.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

Restore may disclose or use your PHI, in ways detailed below, without obtaining your written authorization.

Treatment: In the course of managing, providing, or coordinating your medical treatment, Restore U may use and disclose your PHI. This may include the disclosure of PHI to another health care provider for treatment purposes. Such uses and disclosures may occur between therapists, physicians, nurses, technicians, students, and other health care professionals who provide health care services to you who or are otherwise involved in your care. Restore U may also disclose your PHI to people outside the clinic, such as family members, clergy, or others who provide services as part of your care.

Payment: Restore may use and disclose PHI in order to help you facilitate reimbursement for the health care services provided to you. For example, Restore U may need to give PHI to your health plan in order for you to be reimbursed for the services provided to you.

Health Care Operations: Restore U may use and disclose PHI as part of its operations. Restore U may disclose PHI to physicians, nurses, technicians, students, attorneys, consultants, accountants, and others for review and learning purposes, to help make sure Restore U is complying with all applicable laws, and to help Restore U continue to provide quality health care to its patients. Restore U may disclose PHI to other health care providers and health plans for such entity’s quality assessment and improvement activities, credentialing and peer review activities, and health care fraud and abuse detection or compliance, provided that such entity has, or has had in the past, a relationship with the patient who is the subject of the information.

As Required by Law and Law Enforcement: Restore U may use or disclose PHI when required to do so by applicable law and when ordered to do so in a judicial or administrative proceeding.

For Public Health Activities and Public Health Risks: Restore U may disclose PHI to government officials in charge of collecting information about births or deaths, preventing and controlling disease, reports of child abuse or neglect and other victims of abuse, neglect, or domestic violence, reactions to medications, or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.

For Health Oversight Activities: Restore U may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.

Coroners, Medical Examiners, and Funeral Directors: Restore U may disclose PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a deceased individual, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.

Research: Under certain circumstances, Restore U may use and disclose PHI for medical research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one treatment to those who received another, for the same condition.

To Avoid a Serious Threat to Health or Safety: Restore U may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.

Workers’ Compensation: Restore U may disclose PHI to comply with workers’ compensation or other similar laws. These programs provide benefits for work related injuries or illnesses.

Appointment Reminders, Health-related Benefits and Services, Marketing: Restore U may use and disclose your PHI to contact you and remind you of an appointment at Restore U.

Disclosures to you or for HIPPA Compliance Investigations: Restore U may disclose your PHI to you or your personal representative, and is required to do so in certain circumstances described below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI. Restore U must disclose your PHI to the Secretary of the United States Department of Health and Human Services (the “Secretary”) when requested by the Secretary in order to investigate Restore U’s compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996.

Disclosures to Individuals Involved in Your Health Care or Payment for Your Health Care. Unless you object, Restore U may disclose your PHI to a family member, other relative, friend, or other person you identify as involved in your health care or payment for your health care. Restore U may also notify these people about your location or condition. In addition, Restore U may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

OTHER USES AND DISCLOSURES

Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which with some limitations, you have the right to revoke in writing. If you revoke your permission, Restore U will no longer use or disclose PHI about you for the reasons covered in your written authorization. You understand that Restore U is unable to take back any disclosures already made with your permission, and that Restore U is required to retain records of the care provided to you.

REGULATORY REQUIREMENTS

Restore U is required by law to maintain the privacy of your PHI, to provide individuals with notice of Restore U’s legal duties and privacy practices with respect to PHI, and to abide by the terms described in the Notice currently in effect. We will post a copy of the current Notice in the clinic. RIGHTS. You have the following rights regarding your PHI.

Restrictions: You may request that Restore U resist the use and disclosure of your PHI. For example, you could ask that we not use or disclose information about a treatment you received. To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the restrictions to apply, for example, disclosures to your spouse.

Alternative Communications: You have the right to request that communications of PHI to you from Restore U be made by particular means or at particular locations. For instance, you might request that communications be made at your work address, instead of your home address. Your requests must be made in writing and sent to the Privacy Officer. Restore U will accommodate your reasonable requests without requiring you to provide a reason for your request. Inspect and Copy. Generally, you have the right to inspect and copy your PHI that Restore U maintains, provided that you make your request in writing to the Privacy Officer. If you request copies of your PHI, we may impose a reasonable fee to cover copying and postage.

Accounting of Disclosures: You generally have the right to request and receive a list of disclosures of your PHI we have made at any time during the six (6) years prior to the date of your request. The list will not include disclosures made at your request, with your authorization, and does not include certain uses and disclosures to which this Notice already applies, such as those (i) for treatment, payment, and health care operations; (ii) made to you; (iii) to persons involved in your health care; (iv) for national security or intelligence purposes; or (v) to correctional institutions or law enforcement officials. You should submit any such request to the Privacy Officer. Restore U will provide the list to you at no charge, but if you make more than one request in a year, you will be charged a fee of the costs of providing the list.

Right to Copy of Notice: You have the right to receive a paper copy of this Notice upon request. To obtain a paper copy of this Notice, please contact the Privacy Officer.

Right to File a Complaint: You may complain to Restore U if you believe your privacy rights, with respect to your PHI, have been violated by contacting the Privacy Officer and submitting a written complaint. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

The current Privacy Officer of Restore U is Joann Abrams. If you have any questions about this Notice, contact the Privacy Officer: by email at [email protected] OR by phone at 443-431-9606. This notice was originally published and became effective on August 4, 2021.