Notice of Privacy Practice

This notice describes how medical information about you may be used, disclosed, and how you can get access to this information.  If you have any questions about this Notice please contact our Privacy Official.  This Notice of Privacy Practice describes briefly how Sports Physical Therapy Institute may use and disclose your protected health information to carry out treatment, payment, or healthcare operations. 

Following are examples of the types of uses and disclosures of your protected health information that Sports Physical Therapy Institute is permitted to make once you have signed the consent form.  These are not meant to be an exhaustive, but to describe the types of uses and disclosures that may occur once you have provided consent. 

      Treatment:  We will use and disclose you protected health information to provide, coordinate, and administer your health care and any related services.  This includes the coordination or management of your care with a third party that has already obtained your permission to have access to your personal health information.  We will disclose protected health information to physicians who are involved in your care.  We will also use and disclose your protected health information with adjusters, nurse case managers, pre-certification boards, or third parties that are involved in your treatment.  In addition, we may disclose your protected health information from time-to-time to another healthcare provider who, at the request of your referring physician or physical therapist, should be involved in your care by providing assistance with your health care diagnosis or treatment.

      Payment:  Your protected health information will be used, as needed, to obtain payment for health care services.  This may include certain activities that your health insurance plan may require to approve or pay for health care services your physician, or we recommend for you.  These activities include making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.  Payment for your healthcare services will include use and disclosure of your protected health information with our billing vendors.  These vendors are under contract to maintain our patients protected health information. 

      Healthcare Operations: We may use or disclose, as needed, your protected health information to support the business activities of Sports Physical Therapy Institute.  These activities include, but are not limited to, quality assessment activities, employee review activities, training of staff, and marketing functions.  We will use your protected health information as necessary, to contact you about your appointment or treatment.

      We will share your protected health information with third party business associates that perform various functions (billing, documentation, etc.) for the practice.  Whenever an arrangement by our office and a business associate involves the use or disclosure of your protected health information we will have a written contract that contains terms that will protect the privacy of your protected information.

      We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We may use your name and address to send you a newsletter about our practice and services we offer.  You may contact our Privacy Official to request that these materials not be sent to you.

The following is a statement of your rights with respect to your protected health information and a description of how you may exercise these rights. 

1. You have the right to inspect and copy your protected heath information.

2. You have the right to request a restriction of you protected health information.

3. You have the right to request confidential communications from us by alternative means or at an alternative location.

4. You may have the right to have your physical therapist amend your protected health information.

5. You have the right to receive an accounting of certain disclosures we have made of your protected health information.

6. You have the right to obtain a paper copy of this notice form us.

  To obtain more information, please refer to your new patient packet. 

Complaints

You may communicate with SPTI’s Privacy Official or the Secretary of Health and Human Services if you believe your rights have been violated.  You may file a complaint by notifying our Privacy Official.  There will be no retaliation against you for filing a complaint.

You may contact our Privacy Official, Samantha Hyman, at 866-860-2645 or sptibill2002@aol.com for further information about this process.