If you have any questions about this Notice of Privacy Practices (“Notice”), please contact Hope Marie Manning, PA-C, CAQ- Psych, who acts as our Privacy Officer, at telephone number 720-513-1215. This Notice is effective as of Jan 1st, 2024 and applies to all Protected Health Information in our hands and created on or after this effective date, whether generated by us or received from other health care providers. This Notice is subject to change from time to time by the Practice and any such revisions will be posted
in our offices.
WHO WILL FOLLOW THIS NOTICE?
The Practice offers health care services that are covered by the Privacy Standards of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its regulations. This Notice describes the information privacy practices that the Practice
follows, and the Practice is required by law to abide by its terms.
YOUR HEALTH INFORMATION
This Notice applies to any Protected Health Information (as defined below) that the Practice prepares, receives, or maintains concerning your health, health status, and the health care and services you receive from the Practice. This Notice is given to you in accordance with HIPAA and its regulations.
The Practice is required by law to give you this Notice and to preserve the privacy of the Protected Health Information which we maintain. This Notice will tell you about the ways in which we may use and disclose your Protected Health Information and. describes your rights and our obligations regarding the use and disclosure of that information. This Notice does not apply to any information which is not Protected Health Information or which the Practice does not prepare, receive, or maintain. The Practice will observe the confidentiality of such other information as required by law and will abide by the then-current Notice. We are also required by law to notify you following a breach of unsecured Protected Health Information.
INTRODUCTION
At the Practice, we are committed to treating and using Protected Health Information about you responsibly. This Notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your Protected Health Information.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION IN TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
As detailed below, your Protected Health Information may be used by the Practice for these reasons:
TREATMENT, PAYMENT, OPERATIONS AND OTHER USES AND DISCLOSURES
1. Treatment: The Practice may use and disclose your Protected Health Information in the course of providing or managing your health care as well as any related services. For the purpose of treatment, we may coordinate your health care with a third party. For example, we may disclose your Protected Health Information to a pharmacy to fulfill a prescription for medication or to a physician or other health care professional or facility who or which is assisting in your health care. In addition, we may disclose Protected Health Information to other health care providers related to the treatment provided by those other providers.
2. Payment: When needed, the Practice will use or disclose your Protected Health Information to obtain payment for its services. Such uses or disclosures may include disclosures to your health insurer to get approval for a recommended procedure or to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. When obtaining payment for your health care, we may also disclose your Protected Health Information to your insurance company to demonstrate the medical necessity of the care or for utilization review when required to do so by your insurance company. Finally, we may also disclose your Protected Health Information to another provider where that provider is involved in your care and requires the information to obtain payment.
3. Operations: The Practice may use or disclose your Protected Health Information when needed for the Practice’s health care operations for the purposes of management or administration of the Practice and for offering quality health care services. Health care operations may include:
(1) quality evaluations and improvement activities; (2) employee review activities and training programs; (3) accreditation, certification, licensing, or credentialing activities; (4) reviews and audits such as compliance reviews, medical reviews, legal services, and maintaining compliance programs; and (5) business management and general administrative activities. For instance, we may use, as needed, Protected Health Information of patients to review their treatment course when making quality assessments regarding any specialized care or treatment. In addition, we may disclose your Protected Health Information to another provider or health plan for their health care operations.
4. Other Uses and Disclosures: As part of treatment, payment, and health care operations, the Practice may also use or disclose your Protected Health Information to: (1) remind you of an appointment; (2) inform you of potential treatment alternatives or options; or (3) inform you of health-related benefits or services that may be of interest to you.
USES AND DISCLOSURES TO WHICH YOU MAY OBJECT
Family/Friends: The Practice may disclose your Protected Health Information to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose Protected Health Information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. If you have any objection to the use and disclosure of your Protected Health Information in this manner, please tell us.
USES AND DISCLOSURES THAT ARE REQUIRED OR PERMITTED WITHOUT YOUR AUTHORIZATION
Regulatory Agencies: The Practice may disclose your Protected Health Information to government and certain private health oversight agencies, such as the Colorado Department of Public Health and Environment, or the Colorado Physical Therapy Board for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations, and inspections. These activities are necessary to monitor compliance with the requirements of government programs.
Law Enforcement/Litigation: The Practice may disclose your Protected Health Information for enforcement purposes as required by law or in response to a court order or other process in litigation.
Public Health: As required by law, the Practice may disclose your Protected Health Information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, we are required to report the existence of a communicable disease, such as acquired immune deficiency syndrome ("AIDS"), to the Department of Public Health and Environment to protect the health and well-being of the general public.
Workers’ Compensation: The Practice may release Protected Health Information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Military/Veterans: The Practice may disclose your Protected Health Information as required by military command authorities if you are a member of the armed forces.
Organ Procurement Organizations: To the extent allowed by law, the Practice may disclose your Protected Health Information to organ procurement organizations and other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
As Otherwise Required or Permitted By Law: The Practice will disclose your Protected Health Information in any situation in which such disclosure is required by law (e.g., child abuse, domestic abuse) or any other use permitted under HIPAA, its amendments, or regulations.
USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION:
Other than the circumstances described above, the Practice will not disclose your Protected Health Information unless you provide written authorization. An authorization is specifically required in most situations involving uses or disclosures of Protected Health Information for marketing purpose, for the sale of Protected Health Information, or for psychotherapy purposes. You may revoke your authorization in writing at any time except to the extent that we have already acted in reliance upon the authorization.
YOUR RIGHTS RELATED TO YOUR HEALTH INFORMATION:
Although all records concerning your treatment obtained at the Practice are the property of the Practice, you have the following rights concerning your Protected Health Information:
- Right to Confidential Communications: You have the right to receive confidential communications of your Protected Health Information by alternative means or at alternative locations. For example, you may request that we contact you at work or by mail.
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Right to Inspect and Copy: You generally have the right to inspect and copy your Protected Health Information, except as restricted by your physician or other health care professional or by law. Further, if we maintain your health records on an electronic healthrecords system, you have the right to request an electronic copy of your health records.
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Right to Amend: You have the right to request an amendment or correction to your Protected Health Information. If we agree that an amendment or correction is appropriate, we will ensure that the amendment or correction is attached to your medical record.
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Right to an Accounting: You have the right to obtain a statement of the disclosures that have been made of your Protected Health Information other than by your authorization, other than to you and other than for the purpose of treatment, payment, or routine operational purposes.
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Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your Protected Health Information. If we agree, we will abide by the restrictions. Additionally, if you (or anyone on your behalf besides a health plan) pay for the care or services at issue in full out of your own pocket, we are required to comply with your request not to disclose your Protected Health Information to a health plan, unless required by law to do so.
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Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice, upon request, if this Notice has been provided to you electronically.
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Right to Revoke Authorization: You have the right to revoke your authorization to use or disclose your Protected Health Information, except to the extent that action has already been taken in reliance on your authorization.
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Right to Notice of Breach of Security: You have the right to be notified in the event of a breach of unsecured Protected Health Information occurs.
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Right to Opt Out: You may be contacted for certain fund-raising purposes and you have the right to opt out of receiving such communications.
THE PRACTICE’S RIGHTS
1. The Practice is allowed a reasonable time (typically 30 days) with which to comply with a patient’s request to review or copy their health information. The Practice is allowed an additional reasonable period of time if the record is off site. The Practice may charge a fee for copying the health record.
2. Requests for examination and copying medical records are subject to the provisions of existing Colorado law, including without limitation all relevant rules, regulations, and policies of the licensing boards.
3. The patient will be supervised by the Practice staff during any in-person review of the record. Supervision is allowed and required to prevent the removal or altering of the medical record. The patient will not be charged for in-person examination of the records.
THE PRACTICE’S DUTIES
1. The Practice is required by law to maintain the privacy of confidential information and provide individuals with notice of its legal duties and privacy practices with respect to such information.
2. The Practice is required to abide by the terms of this Notice.
3. The Practice reserves the right to change the terms of its Notice from time to time and to make the new Notice provisions effective for all confidential information that it maintains.
FOR MORE INFORMATION REGARDING HOW TO EXERCISE THESE RIGHTS: If you have questions or would like more information regarding any of the rights listed above, please contact Hope Marie Manning, PA-C, CAQ-Psych, who acts as our Privacy Officer, at the telephone number on the first page of this Notice.
IF YOU BELIEVE THAT YOUR RIGHTS HAVE BEEN VIOLATED: If you believe your privacy rights, as described in this Notice, have been violated, you may file a complaint with our office and/or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer as listed on the first page of this Notice. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ or e-mailing OCRMail@hhs.gov. You will not be penalized or retaliated against for filing a complaint.
ACKNOWLEDGMENT OF RECEIPT OF PRIVACY NOTICE
I hereby acknowledge that I have received a copy of the Notice of Privacy Practices for the Practice.