2841 Hartland Rd. # 401B ∙ Falls Church, VA 22043 ∙ (703) 204-0533
131 Elden Street, #16 and #208 ∙ Herndon, VA 20170 ∙ (703) 204-0533
19465 Deerfield Avenue, #311 ∙ Leesburg, VA 20176 ∙ (703) 204-0533
12011 Lee Jackson Memorial Hwy, #101 ∙ Fairfax, VA 22033 ∙ (703) 204-0533
2877 Duke Street ∙ Alexandria, VA 22314 ∙ (703) 204-0533
8230 Boone Blvd. #202 ∙ Tysons Corner, VA 22182 ∙ (703) 204-0533
1701 Clarendon Blvd, #110 ∙ Arlington, VA 22209 ∙ (703) 204-0533
Effective Date: August 1, 2006
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
If you have any questions about this notice, please contact the office. Each time you visit a hospital, physician, physical therapist or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing related information. This notice applies to all of the records of your care generated by the office, whether made by office personnel, medical staff, or your personal doctor.
We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.
How we may use and disclose Health Information about you.
The following categories describe examples of the way we use and disclose health information:
For Treatment: We may use health information about you to provide you treatment or services. We may disclose health information about you to doctors, medical staff, or other office personnel who are involved in taking care of you at the office. For example: the physical therapist treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. We may also provide your primary healthcare provider, your treating physician or other subsequent health care provider with copies of various reports that should assist him or her in treating you.
For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your treatment so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.
For Health Care Operations: Members of the clinical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine health information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, and other personnel. And we may combine health information we have to see where we can make improvements. We may remove information that identifies you from this set of health information to protect your privacy.
We may also use and disclose health information:
When disclosing information, primarily appointment reminders and billing/collections efforts, we may leave messages on your answering machine/voice mail.
Business Associates: There are some services provided in our organization through contracts with business associates. Examples include transcription services for our medical records, vendor/technicians for our computer software system. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your third party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Organized Health Care Arrangement: This facility and its medical staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and health care operations. Physical Therapists, Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.
Affiliated Covered Entity: Protected health information will be made available to hospital personnel at local affiliated hospitals as necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time. Please contact the Facility Privacy Official for further information on the specific sites included in this affiliated covered entity.
As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:
Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
State Specific Requirements: Many states have requirements for reporting including population based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the Right to:
Inspect and Obtain a Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed by our Medical Director. We will comply with the outcome of the review.
Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about certain treatment you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To exercise any of your rights, please obtain the required forms from our office and submit your request in writing.
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted in the office and include the effective date.
If you believe your privacy rights have been violated, you may file a complaint with our main office by contacting the main number and asking for the clinic manager. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
MICHAEL EROLE, MSMSPT, CSCS, FACILITY PRIVACY OFFICIAL
Telephone Number: (703) 204-0533