Health Privacy Policy

Notice of Privacy Policy Practices for Personal Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to the information.

Please review carefully.

We are required by the Health Insurance Portability & Accountability Act of 1996 (HIPAA) to maintain the privacy of your personal health information (PHI). PHI includes individually identifiable health information in any form including information transmitted electronically, orally, or in written form.

We are required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. This notice also describes your rights to control how your PHI is used.

We may use and disclose your medical records for each of the following purposes only: treatment, payment, and health care operations.

  • Treatment means providing, coordinating or managing health care and related services among health care providers or by health care provider with a third party, consultations between health care providers regarding a patient, or the referral of a patient by one health care provider to another.

  • Payment means activities such as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review.

  • Health care operations include the business aspects of running a practice, such as conducting quality assessments and improvement activities, auditing functions, cost-management analysis, and customer service.

We may contact you to provide appointment reminders or other services that may be of interest to you. We will disclose your protected health information to any person you identify that is involved in payment for your care.

We will use and disclose your protected health information when required by federal, state or local law. There are certain situations in which we are required by ethical standards to reveal information obtained during treatment to persons or agencies, even if you do not give permission. These situations are as follows:

  • If you threaten grave bodily harm or death to yourself or another person, we are required by ethical standards to inform the intended victim and/or appropriate law enforcement agencies.

  • If you report your knowledge of physical or sexual abuse of a minor child or of an elder (over 65) or any sexual conduct/contact with a minor, we are required by law to inform the appropriate child welfare or social agency which may then investigate the matter.

  • If we are required by a court of law (court order) to turn over records to the court or if we are ordered to testify regarding those records.

Any other uses and disclosures will be made only with your written authorization. You will be provided with an authorization form upon request.

You may revoke your permission to release PHI at any time. It must be in writing with effective date and be specific to the health information being protected. We are not required to agree to your request.

You have the right to request restrictions regarding the use of your PHI, however, we may choose to refuse your restrictions if it is in conflict with providing you with quality healthcare or in the event of an emergency situation. This request must be made in writing.

You have the right to review and photocopy any or all portions of your PHI. We have the right to assess a fee for photocopying of the health information.

You have the right to request an amendment to your PHI. It must be in writing and explain why the information should be amended. We can deny the amendment if your request is not in writing, does not include a reason to support the request, or is information we did not create. A written explanation will be provided if we deny your request.

We will abide by the terms of this notice. We reserve the right to make changes to this notice and will continue to maintain the confidentiality of all PHI. Changes to this notice will be posted with this notice in our clinic and on our website.

You have the right to complain to us if you believe your rights to privacy have been violated. If you feel we have violated your privacy rights, you may file a written complaint to:

Orchard Physical Therapy

Attn: Privacy Officer, Breanna Crawford

1129 NE 12th St Bend, OR 97701

541-728-3559

All complaints will be investigated. No personal issue will be raised by filing a compliant with us.

You may also file a complaint to:

The U.S. Department of Health and Human Services Office of Civil Rights

200 Independence Ave, S.W.

Washington, DC 20201

1-877-696-6775