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| PRIVACY
POLICY |
| THIS NOTICE DESCRIBES
HOW PROTECTED MEDICAL INFORMATION ABOUT YOU
OR YOUR CHILD MAY BE USED AND DISCLOSED AND
HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. |
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| 1. Dynamic Therapy,
Inc. is permitted to make uses and disclosures
of protected health information for treatment,
payment and health care operations, as described
in the following examples: |
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For treatment
- We may share with your physician copies
of your treatment plan or evaluation
to update him/her on your progress or
for his/her approval or recommendations. |
|
For payment
- We may send information to your health
insurance plan for them to review and
determine level of coverage for therapy
services. |
|
For health
care operations - We may access your
health information for purposes of quality
improvement within our facility. |
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|
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| 2. Dynamic Therapy,
Inc. is permitted or required, under specific
circumstances, to use or disclose protected
health information without the individual's
written authorization. |
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| 3. Other uses
and disclosures will be made only with the
Individual's written authorization, and the
individual may revoke such authorization. |
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| 4. Dynamic Therapy,
Inc. intends to engage in one or more of the
following activities: |
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Pediatric
Therapy Services, Inc. may contact the
individual to provide appointment reminders
or information about treatment alternatives
or other heath-related benefits and
services that may be of interest to
the parent or child. |
|
A group health
plan, or a health insurance issuer or
HMO with respect to a group health plan,
may disclose protected health information
to the sponsor of the plan. |
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|
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| 5. The Individual
has the following rights regarding protected
health information: |
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The right
to request restrictions on certain uses
and disclosures of protected health
information. Pediatric Therapy Services,
Inc. is not required to agree to a requested
restriction, however. |
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The right
to receive confidential communications
of protected health information, as
applicable. |
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The right
to inspect and copy protected health
information, as provided in the Privacy
Regulation. |
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The right
to amend protected health information,
as provided in the Privacy Regulation. |
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The right
to receive an accounting of disclosures
of protected health information. |
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The right
to obtain a paper copy of the Notice
from the covered entity upon request.
This right extends to an individual
who has agreed to receive the Notice
electronically. |
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|
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| 6. Dynamic Therapy,
Inc. is required by law to maintain the privacy
of protected health information and to provide
individuals with notice of its legal duties
and Privacy practices with respect to protected
health information. |
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| 7. Dynamic Therapy,
Inc. is required to abide by the terms of
the Notice currently in effect. |
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| 8. Dynamic Therapy,
Inc. reserves the right to change the terms
of this Notice. The new Notice provisions
will be effective for all protected health
information that it maintains. |
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| 9. Dynamic Therapy,
Inc. will provide individuals or patients
with a revised Notice by posting a notice
in a central location in the Pediatric Dynamic
Therapy for Kids waiting area. |
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| 10. Individuals
may complain to Dynamic Therapy, Inc. and
to the Secretary of the Department of Health
and Human Services, without fear of retaliation
by the organization, if they believe their
privacy rights have been violated. |
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| 11. Dynamic Therapy,
Inc.'s contact person for matters relating
to complaints is: |
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Debbie Giles,
Office Manager
1031 W. Williams Street, Ste. 104
Apex, North Carolina 27502 |
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| 11. This Notice
is first in effect on 3/1/2005 |
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| 12. Dynamic Therapy,
Inc. elects to limit the uses or disclosures
that it is permitted to make, as follows:
Dynamic Therapy, Inc. is committed to limiting
the disclosure of PHI (protected health information)
only to the degree necessary for the purposes
of treatment, payment and healthcare operations. |
