This notice outlines your protected health information, how it may be used, and what your rights are. Please review carefully and ask any questions prior to signing. Questions about this notice can be directed to admin@fitrehabonline.com.

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The law requires us to:

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• make sure that protected health information that identifies you is kept private

• notify you about how we protect protected health information about you

• explain how, when and why we use and disclose protected health information

• follow the terms of the Notice that is currently in effect.

 

We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all protected health information that we maintain by:

 

• posting the revised Notice on our website.

 

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

 

The following categories describe different ways that we use and disclose protected health information without your written authorization.

 

For Treatment: We may use and disclose protected health information to contact you as a reminder that you have an appointment for treatment.

 

For Payment for Services: We may use and disclose protected health information about you so that the treatment and services you receive at Optimal Living Solutions, LLC dba Bayside Therapy & Performance may be billed to and payment may be collected.

 

For Health Care Operations: We may use and disclose protected health information about you for health care operations, such as our quality assessment and improvement activities, case management, coordination of care, business planning, customer services and other activities. These uses and disclosures are necessary to reduce health care costs and make sure that all of our clients receive quality care. We may also combine protected health information about many clients to decide what additional services should offer, what services are not needed, and whether treatments are effective.

 

As Required By Law: We will disclose protected health information about you when required to do so by federal, state or local law.

 

Health Risks: We may disclose protected health information about you to a government authority if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent or lessen a serious and imminent threat to you or another person.

 

Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, we may disclose your information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made, either by us or the requesting party, to tell you about the request or to obtain an order protecting the information requested.

 

Business Associates: Public Health. As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

 

To Avert a Serious Threat to Health or Safety: We may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

 

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These activities include audits, investigations, and inspections, which may be necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

Law Enforcement: We may release protected health information as required by law, or in response to an order or warrant of a court, a subpoena, or an administrative request. We may also disclose protected health information in response to a request related to identification or location of an individual, victims of crime, decedents, or a crime on the premises.

 

YOU CAN OBJECT TO CERTAIN USES AND DISCLOSURES. Unless you object, or request that only a limited amount or type of information be shared, we may use or disclose protected health information about you in the following circumstances:

• We may share with a family member, relative, friend, or other person identified by you protected health information directly relevant to that person’s involvement in your care or payment for your care. We may also share information to notify these individuals of your general condition.

 

If you would like to object to use and disclosure of protected health information in these circumstances, please send an email to admin@fitrehabonline.com stating your objection.

 

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU.

 

You have the following rights regarding protected health information we maintain about you:

 

Right to Inspect and Copy: You have the right to inspect and copy protected health information that may be used to make decisions about your care. To request records regarding your protected health information, please email admin@fitrehabonline.com. There are certain situations in which we are not required to comply with your request. In these circumstances, we will respond to your email, stating why we will not grant your request and describe any rights you may have to request a review of our denial.

 

Right to Request Restrictions: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care. There are certain situations in which 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, the disclosure is to the Secretary of the Department of Health and Human Services, or the disclosure is for one of the purposes described above. To request restrictions, you must email your restriction(s) to admin@fitrehabonline.com.

 

Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. Upon completion of this packet, you will receive a completed copy through your registered email. If you do not receive such email, please email admin@fitrehabonline.com and a copy will be sent to you.

 

OTHER USES AND DISCLOSURES

 

We will obtain your written authorization before using or disclosing your protected health information for purposes other than those provided above (or as otherwise permitted or required by law). You may revoke this authorization at any time. Upon receipt of the written revocation, we will stop using or disclosing your information, except to the extent that we have already taken action in reliance on the authorization.

 

YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

 

If you believe your privacy rights have been violated, you may file a written complaint with admin@fitrehabonline.com, or with the Secretary of the Department of Health and Human Services. A complaint to the Secretary should be filed within 180 days of the occurrence of the complaint or violation. If you file a complaint, we will not take any action against you or change our treatment of you in any way.