Performance Physical Therapy,
Inc (Perf PTI)
Notice of Privacy 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. If you have any questions about this Notice,
please contact our Privacy Officer, Kim Sachtler.
1. Uses and Disclosures of Protected Health Information:
will use or disclose you protected health information (PHI) as described in this section. You PHI may be
used and disclosed by Perf PTI, our office staff and others outside our office that are involved in your care and treatment
for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay
your health care bills and to support the operation of Perf PTI. Following are examples of the type of
uses and disclosures your PHI that Perf PTI is permitted to make. These examples are not meant to be exhaustive,
but to describe the types of uses and disclosure that may be made by our office.
Treatment: We will use and disclose you PHI to provide, coordinate, or manage you health care and any related services. This
may include doctors, nurses, technicians, other physical therapists, or other providers who have referred you for services
or are involved in your care. For example, we may feel that a patient we are treating for chronic low back
pain would benefit from an evaluation by a pain specialist to address a pharmacological pain management. The health information
we share with the pain specialist would be considered a treatment related disclosure.
Payment: Your PHI will be used, as needed, to obtain payment for your health care services. This may include
the disclosure of health information to your insurance company, including Medicare and Medicaid, for certain activities before
it approves or pays for the health care services recommended, such as: making a determination of eligibility or coverage for
insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Health Care Operations: We may use or disclose, as needed, you PHI in order to support the business activities of Perf
PTI. These activities include, but are not limited to, quality assessment activities, employee review activities,
training of clinical students or staff, licensing, marketing, and conducting or arranging for other business activities. For
example, we may disclose you PHI to physical therapy students treating patients in our office. In addition,
we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may use
your name and PHI for patient flow tracking in the office. We may use or disclose you PHI, as necessary,
to contact you or remind you of an appointment. We will share you PHI with third party business associates
that perform various activities such as billing and transcription.
Other Special Uses: Perf PTI may use your
PHI to inform you of our other health-related products and services.
Uses and Disclosures Required by Law:
federal health information privacy regulations either permit or require us to use or disclose you PHI in the following ways:
we may share some of you PHI with a family member or friend involved in you care if you do not object, we may use your PHI
in an emergency situation when you may not be able to express yourself, and we may use or disclose your PHI for research purposes
if you are provided with very specific assurances that your privacy will be protected. We may also disclose
you PHI when we are required to do so by law, for example by court order or subpoena. Disclosures to health
oversight agencies are sometimes required by law to report certain diseases or adverse drug reactions.
We may use and disclose health information
about you to avert a serious threat to your health or safety or the health or safety of the public or others.
If you in the Armed Forces, we may release health information about you when it is determined to be necessary by the
appropriate military command authorities. We may also release information about you for worker’s
compensation or other similar programs that provide benefits for work-related injury or illness.
Your authorization is required before your PHI may be
used or disclosed by us for other purposes.
Your Privacy Rights
Following is a description
of your rights with respect to you PHI and a brief explanation of how you may exercise these 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 Communications: You have the right to request confidential communication from us at a location
of your choosing. This request must be in writing.
Access to PHI: You have the right to request a copy of your medical record. You must make this request in writing
and we may charge a fee to cover the costs of copying and mailing. Any requests that your medical record
be sent to a third party of your choosing must also be made through a written request that clearly identifies the relevant
third party and grants express permission to release record to that third party.
Amendments: You have the right to request an amendment be made to you PHI, if you disagree with what it says
about you. This request must be made in writing. If we disagree with you, we are not
required to make the change. You do have the right to submit a written statement about why you disagree
that will become part of your record. We may not amend parts of your medical record that we did not create.
Complaints: If you feel that your privacy rights have been violated, you have the right to make a complaint
to us in writing without fear of retaliation. Your complaint should contain enough specific information
so that we may adequately investigate and respond to your concerns. If you are not satisfied with our response,
you may complain directly to the Secretary of Health and Human Services.
Our Duty to Protect Your Privacy: We are required to comply with the federal health information privacy regulations by maintaining the privacy of you
PHI. These rules require us to provide you with this document, our Notice of Privacy Practices.
We reserve the right to update this notice if required by law. 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.
Privacy Contact: If you would like more information about our
privacy practices or wish to file a complaint, you may contact:
Kim Sachtler, Vice President of Operations
720 Robb Dr., Suite 103
Reno, NV 89523