Physical Therapy for Dancers and Participants In The Dance of Life

MARIBETH CRUPI PHYSICAL THERAPY LLC
NOTICE OF PRIVACY PRACTICES

This notice describes how the medical information about you may be used and disclosed and how you can get access to this information. PLEASE REVIEW THIS NOTICE CAREFULLY.

Maribeth Crupi Physical Therapy LLC (“MCPT”) may record, transmit, or maintain, either on paper or electronically, personal information about you, your medical history and your healthcare treatment as part of providing you with healthcare services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose such information, our obligations regarding the use and disclosure of your medical information, and your rights with respect to the use and disclosure of your medical information. This Notice is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

OVERVIEW

We are legally required to protect the privacy of information that identifies you or could be used to identify you, and relates to your past, present or future physical or mental health condition(s) or the provision of past, present, or future healthcare services (including payment for those services). This information is called “protected health information” or “PHI” for short. We are legally required to follow the privacy practices that are described in this Notice and in accordance with the law will disclose the minimal amount of information necessary to provide your will optimal care. We reserve the right to change our privacy policies and the terms of this Notice at any time. This Notice will accordingly reflect any changes in policy at that time.

We will post a copy of this Notice in our Registration and Waiting Room area for public viewing and You may also request a copy of this Notice at any time from our office staff.

USE AND DISCLOSURE OF YOUR PHI

MCPT may use or disclose your PHI to carry out its responsibilities as a healthcare provider. MCPT may use or disclose your PHI without your written authorization for the following reasons:

Treatment. MCPT may disclose PHI to physicians, physical therapists, billing staff (as needed to submit claims) or other personnel who are involved with the administration of your care at MCPT or other locations.

Payment. We may use and disclose PHI so that payment for the treatment and services you receive at MCPT, may be billed to you or your assigned payor for physical therapy services, collected from an insurance company or any other third party. We may also need to disclose this information to insurance companies to establish insurance eligibility benefits for you. This may also include rendering copies of your treatment records as required to authorize initial or addition treatments.

Healthcare Operations. “Healthcare operations” at MCPT include activities related to

improving quality of care, staff training, medical education, and business management.

Appointment Reminders, Information about Healthcare Related Benefits and Treatment Alternatives. We may use and disclose medical information to contact you as a reminder that you have an appointment for a treatment or medical care at MCPT or to inform you of treatment alternatives or other healthcare services or benefits that we offer.

As Required By Law. We will disclose PHI when required to do so by federal or state law, including in response to a court or administrative order, subpoena, discovery request, warrant, summons or other lawful process. MCPT may also disclose PHI to law enforcement personnel or similar persons to avoid a serious threat to the health or safety of a person or the public.

In addition, MCPT may use your PHI without your written authorization under the following circumstances:

  • Emergency situations when your authorization cannot be reasonably obtained,

including for disaster relief purposes; •

  • To business associates (outside vendors or consultants that perform services on

behalf of MCPT and are contractually required to appropriately safeguard your information. This might include, but not be limited to, physical therapists and others serving as Yoga or Pilates Instructors in order that they be aware of any special care or needs while you participate in their programs.)

  • With your agreement, to a family member, relative, close personal friend, or any other person you identify
  • To facilitate organ or tissue donation if you are an organ donor; •
  • In connection with workers’ compensation claims;
    To report abuse, neglect, or domestic violence as required by state of federal law • For public health and health oversight activities, such as preventing or controlling disease or investigations; or
  • Certain actions, such as most uses of disclosures of physical therapy notes, the use and disclosure of PHI for marketing purposes, and disclosures related to litigation, will be made only with your written permission (authorization).
    Other uses or disclosures of PHI that are not covered by this Notice or applicable laws also will be made only with your written permission. Massachusetts provides special privacy protections for particularly sensitive conditions or illnesses such as HIV/AIDS, mental health, and substance abuse. MCPT will disclose such information only in a manner that is consistent with these laws.
    You may revoke your permission at any time by notice in writing to: Maribeth Crupi, PT Compliance Officer, Maribeth Crupi Physical Therapy LLC 10 Elizabeth Drive Wilmington, MA. Once you revoke your permission, we will stop using or disclosing such information for the reasons covered by your written authorization. However, we cannot take back any prior disclosures made with your permission. We will retain our records of the care provided to you as required by law.
  • YOUR RIGHTS REGARDING YOUR PHI

Although your medical information is the property of MCPT, you have certain rights regarding your PHI, including the right to:
Inspect and Copy. With certain exceptions, you have the right to inspect or receive a copy of your medical information or both. We may charge a fee for these services.
Request an Amendment. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend information that is kept by or for MCPT. We may deny your request if you ask us to amend information that (a) was not

created by MCPT; (b) is not part of the medical information kept by or for MCPT; (c) is not medical information you are permitted to inspect or copy; or (d) is accurate and complete in the record.
Request an Accounting of Disclosures. You may request a list of the disclosures we have made of PHI that were for purposes other than treatment, payment, healthcare operations and certain other purposes, or disclosures made with your written authorization within the last six (6) years. You may be charged a fee in connection with this request.

  • Restrict or Limit Use or Disclosure. You may ask us to restrict or limit the use or disclosure of your PHI, including the disclosure of information to someone who is involved in your care or the payment for your care, like a family member or friend. Your request must state: (1) what information you want to limit; (2) whether you want to limit MCPT’s use, disclosure or both; and (3) to whom the limits apply, for example, disclosures to your spouse. We are not required to agree to your request, unless it relates to an item or service you paid for in full and out of pocket. In this case, you may request that we not share health information pertaining only to that product or service with your health plan for the purposes of carrying out payment or healthcare operations and we will comply with your request unless the information is needed to provide you emergency treatment or except as required by law.
  • Confidential Communications. Generally, we will use the address, telephone number and, email address you give us to contact you. You may ask us to communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. If email communications are requested to be made with a minor patient, that will only occur if the email of the parent or legal guardian is provided so that all correspondence will include a carbon copy to them as well.
  • Notification in the Event of a Breach. Consistent with federal and state laws, we will notify you in the event unsecured PHI is used or disclosed by an unauthorized individual or company.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint by writing to Maribeth Crupi, PT, Compliance Officer at 978-447-5793. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. or through the regional office at J.F.K. Federal Building – Room 1874, Boston, MA 02203. The complaint must be filed within 180 days of the alleged violation. There will be no retaliation for filing a complaint.