phone (757)-504-4530 fax (757)-598-3523
FEDERAL HIPAA NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH
INFORMATION
Fearless Physical Therapy PLLC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
“We refers to Fearless Physical Therapy.”You” or “yours” refers to any individual receiving treatment by Fearless Physical Therapy employees.
Federal law – means the Health Insurance Portability and Accountability Act and related privacy rules — requires Fearless Physical Therapy to keep your health information private. We are not allowed to use or disclose it unless we receive your permission or unless permitted by law. Federal law requires us to give you this Notice of our legal duties and privacy practices. This Notice is to inform you of the uses and disclosures of your health information that we may make. It also informs you of your rights and our duties with regard to this health information.
We must follow the terms of this Notice. We do reserve the right to change the terms of this
Notice and make the new Notice provisions applicable to all the health information we keep. This includes health information we had prior to any change in this Notice. We must promptly change this Notice when there is a material change to our uses or disclosures, your rights, our duties, and other related circumstances. To receive such Notices by email, you should tell the contact listed at the end of this Notice.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
Federal law permits us to use and disclose protected health information for purposes of
treatment, payment, and health care operations as those terms are defined under federal law. We will comply with any state or federal law that is more restrictive as to our uses and disclosures of protected health information.
There are also times when federal law permits or requires us to use or disclose your information without your written permission.
Additionally, where appropriate, we may disclose protected health information to a group health plan or plan sponsor in accordance with federal law.
Permitted Disclosures:
We may not make all of the uses and disclosures listed here, but federal law permits use or
disclosure of your information without your permission
• When we disclose your information to you.
• To third-party non-Fearless Physical Therapy associates that perform services for us or on our behalf.
• Where disclosure is required by law.
• To a public health authority authorized by law to collect or receive your information to
prevent or control disease, injury, or disability or when reviewing reports of child abuse or
for the conduct of other authorized public health activities and responsibilities.
• To a health oversight agency for such activities.
• For judicial and administrative proceedings.
• To a law enforcement official for a law enforcement purpose.
• To a medical examiner for the purpose of identifying a deceased person, determining the
cause of death, or other duties authorized by law.
• To organ donor organizations in order to aid in such donations.
• For certain research purposes authorized by and subject to federal law.
• To avert a serious threat to health or safety.
• To government officials regarding military personnel and certain domestic and foreign
government officials for certain functions authorized by federal law.
• To comply with workers’ compensation and other similar programs.
Required Disclosures
We must disclose your information when required by the Secretary of the Department of Health
and Human Services to make sure we comply with federal law.
We are also required, with certain exceptions, to provide you with access to inspect and obtain a
copy of your information that we keep. See “Federal Law Provides You with the Right to Inspect and Copy Protected Health Information” below.
INDIVIDUAL RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO REQUEST RESTRICTIONS: You have the right to request that restrictions be placed on certain uses and disclosures of your information.
We are not required to agree. If we do agree, we may not use or disclose any of your information except where you need emergency treatment. We may end an agreement to restrict as allowed by federal law. If you wish additional information, you should write to the contact listed at the end of this Notice.
FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO ALTERNATIVE CONFIDENTIAL
COMMUNICATION OF PROTECTED HEALTH INFORMATION: If you choose to have your
information sent to you by a means of your choice or to an address of your choice, we will do so if the request is reasonable. You must clearly state that disclosure of all or any part of your
information could endanger you if not sent per your choice. Any such request should be sent in
writing to the contact listed at the end of this Notice. If you wish additional information, you should write to the contact listed at the end of this Notice.
FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO INSPECT AND COPY PROTECTED HEALTH INFORMATION: You have the right to inspect and copy your information, certain information relating to civil, criminal, or administrative proceedings, and certain information prohibited by law from disclosure. Any request should be sent in writing to the contact listed at the end of this Notice. If you wish additional information, you should write to the contact listed at the end of this Notice.
FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO A PAPER COPY OF THIS NOTICE:
You have the right, even if you have agreed to receive notice by email, to get a paper copy of this Notice. All requests should be in writing and sent to the contact listed at the end of this Notice.
FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO FILE A COMPLAINT. If you believe your privacy rights have been violated, you have the right to complain to us by writing to the contact listed at the end of this Notice. Federal law prohibits retaliation against you for filing such a complaint. The contact listed at the end of this Notice is also available to provide you information regarding questions you have or other information concerning this Notice.
THE CONTACT TO WHOM YOU SHOULD ADDRESS YOUR COMPLAINT IS:
Fearless Physical Therapy PLLCMarquis Jordan PT,DPT
http://www.fearlessphysicaltherapist.com
Telephone Number: 757-504-4530
Fearless Physical Therapy PLLC 