Notice of Health Information Practices (HIPPA)
This notice describes how information about patients may be used and disclosed, in addition to how patients can access this information.
Altitude Physical Therapy uses personal health information of patients responsibly. How and when we collect and use this information is explained in this notice. Patients' rights are also explained. This notice is consistent with all federal regulations.
Understanding Health Records/Information
All patient visits are documented in a chart. Patients' comprehensive medical history and subjective information, objective findings and assessment, diagnostic information and future plan of care are included. Verbal and written communication with other health care practitioners is also documented. This information can possibly serve as a:
This information should help you, the patient, to understand who, what, when and why others may access your information. Also, you can make informed decisions when authorizing disclosure to others.
Your Health Information Rights
Your medical records are the physical property of Altitude, however, the information in it belongs to you. You have the right to:
Altitude is required to:
We reserve the right to change our practices in order to maintain compliancy with updated federal guidelines. These changes will be made available to each patient when returning for a follow-up visit.
We will not use or disclose health information without authorization, except as described in this notice. We will also discontinue to use or disclose health information after we have received revocation of the authorization.
We will provide health information wihout authorization when necessary for treatment, payment or healthcare operations.
Appointment Notification: We may contact you on the telephone or by email to provide appointment reminders and to follow-up with you after treatment in our facility.
Worker's Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Correctional institutions: Should a patient eventually become an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for healthcare and the health and safety of other individuals.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpeona (e.g. child protection, etc.)
Federal law makes provision for heath information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
For more information or to report a problem
If you feel your privacy rights have been violated or you would like more information, you can contact our Privacy Officer, or the Office for Civil Rights, U.S. Department of Health and Human Services.
Patient Financial Responsibility
The patient (or patient's guardian if a minor) is ultimately responsible for the payment for his or her own treatment and care. Altitude PT will attempt to contact and verify coverage for you prior to your visit as a courtesy. However, it is not always possible to do so. The patient is required to provide us with the most correct and updated information about his or her insurance, and will be responsible for any charges incurred if the information provided is not correct or updated. We will not accept insurance if patients' address or information is not updated at the time of visit.Patients are responsible for the payment of copays, coinsurance, deductibles and all other procedures or treatment not covered by their insurance plan. Payment is due at the time of service, and for your convenience we accept cash, check and most major credit cards at our office.If you have waived insurance billing and have registered as a cash/private pay patient you agree that at the time of service you will be paying by cash, check or credit card. Due to this cash payment you are receiving a discount. We will not bill insurance for services provided under this arrangement. No forms will be produced now or in the future for you or us to submit for insurance billing. Cancellation/No Show Policy: Your therapist will recommend a specific treatment plan including a specific number of treatments per week. Attending all of these visits is crucial to your rehabilitation. Missing these appointments will only slow your recovery. Appointment "no shows" or last minute unexcused cancellations will not only slow your recovery down, but will also negatively impact our other patients who are looking for convenient appointment times. We will make every effort to be as flexible as we can to schedule appointments at times that are convenient for you. Please return this courtesy by attending all scheduled appointments.
1st no show/less than 24 hr cancel - no charge
2nd no show/less than 24 hr cancel - $50 charge will be assessed
**For patients with Medicaid or VA insurance, please note the specific cancellation and no-show policy agreement
Medicaid/VA Cancellation and No-Show Policy Agreement
A total of two no-shows may result in a discharge from physical therapy. You will be required to revisit your physician and obtain a new referral in order to continue therapy.
Disclaimer: Some Medicaid plans are switching to Denver Health. Please let us know if you receive notification of your plan changing.
COVID-19 Liability Release Waiver
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and local health departments have recommendations in place. I further acknowledge that Altitude Physical Therapy and Sports Medicine (hereafter referred to as “Altitude”) has put in place preventative measures to reduce the risk of contracting the Coronavirus. I understand that, while the risk is small due to preventative measures in place, there is a risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 resulting from direct or indirect contact with others at Altitude. I voluntarily seek services provided by Altitude and acknowledge that there is an option to utilize telemedicine instead. I acknowledge that I must comply with all set procedures to reduce the spread while attending all current and future appointments.
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