North Platte Physical Therapy, Big Country Rehabilitation, Monument Physical Therapy
Effective Date: April 14, 2003
North Platte Physical Therapy
Big Country Rehabilitation
We are required by law to:
Make sure that health information that identifies you is kept private
Provide you this notice of our legal duties and privacy practices
Follow the terms of the notice currently in effect
The following categories describe different ways we may use and disclose your health information. Not every use or disclosure in a category will be listed, but all permitted uses fall within these categories.
We may use health information about you to provide health care treatment or services. We may disclose this information to doctors, nurses, technicians, health students, or other personnel involved in your care. For example, we may contact your physician’s office regarding concerns about swelling related to ankle rehabilitation.
We may use and disclose health information so that treatment and services may be billed and payment collected from you, your insurance company, or a third party. For example, we may provide your health plan information about your visit so it will pay or reimburse you for treatment.
We may use and disclose health information for practice operations. These uses help ensure quality care. For example, we may review treatment records to evaluate staff performance and improve services.
We will disclose health information when required by federal, state, or local law.
If you are a member of the armed forces or separated from service, we may release health information as required by military authorities or the Department of Veterans Affairs.
We may release health information for Workers’ Compensation or similar programs providing benefits for work-related injuries or illness.
We may disclose health information for public health activities such as reporting medication reactions, product problems, or product recalls.
We may disclose health information to a health oversight agency for audits, investigations, inspections, and licensure activities.
If involved in a lawsuit or dispute, we may disclose health information in response to court or administrative orders, subpoenas, or other lawful processes.
We may release health information if requested by law enforcement in response to court orders, warrants, subpoenas, or similar processes.
We may release health information to a coroner or medical examiner.
If you are an inmate or in custody of law enforcement, we may release health information to correctional authorities.
You have the following rights regarding your health information.
You have the right to inspect and copy protected health information maintained by us. Requests must be submitted in writing to the Privacy Officer. A fee may apply for copying and mailing. Requests may be denied for legal or medical reasons.
If you believe your health information is incorrect or incomplete, you may request an amendment in writing to the Privacy Officer. We may deny requests that are not in writing or lack supporting reasons.
We may deny amendments if the information:
Was not created by us
Is not part of our records
Is not available for inspection
Is accurate and complete
You may request a list of disclosures of your health information, excluding treatment, payment, and operations uses. Requests must be in writing and may not exceed six years prior to April 14, 2003. The first request in a 12-month period is free.
You may request restrictions on how we use or disclose your health information. Requests must be in writing. We are not required to agree to restrictions but will comply if we do agree unless emergency treatment is required.
You may request that we communicate with you in a specific way or location. Requests must be submitted in writing. We will accommodate reasonable requests.
We reserve the right to change this notice and make changes effective for information we already maintain and future information. The current notice will be posted in our facility and provided during registration if updated.
If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer. You will not be penalized for filing a complaint.
Todd Gentzler, M.P.T.
PO Box 1790
Douglas, WY 82633
Phone: 307-358-9464
Effective Date: April 14, 2003
We request that you sign a separate acknowledgment confirming you received a copy of this notice. If you choose not to sign, a staff member will document that the notice was provided.
North Platte Physical Therapy
Fecha de Vigencia: 14 de Abril de 2003
North Platte Physical Therapy
Big Country Rehabilitation
Weston County Rehab
La ley requiere que mantengamos privada su información de salud, que le proporcionemos este aviso, y que cumplamos con los términos vigentes.
Usted tiene derecho a:
Inspeccionar y obtener copia de su información
Solicitar correcciones
Solicitar un listado de divulgaciones
Solicitar restricciones
Solicitar comunicaciones confidenciales
Las solicitudes deben hacerse por escrito al Oficial de Privacidad.
North Platte Community Therapies
Kristi Gersch
Privacy Officer
PO Box 1705
Cody, WY 82414
Fecha de Vigencia: 14 de Abril de 2003
