THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ CAREFULLY.

At Therapy Choice, we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Practices describes the personal information we collect, how and when we use or disclose that information, and your rights as they relate to your protected health information as defined by federal regulations.

IMPORTANT WORDS

Information: means any Information, whether oral, electronic, or on paper, which is created or received by Therapy Choice and relates to a patient’s healthcare or payment for the provision of healthcare. This includes the results of tests and notes written by therapists, as well as your name, address, and telephone number.

You: means the patient. If you are a guardian or representative of a patient, please remember we are talking about the patient’s Information.

SHARING INFORMATION FOR TREATMENT, PAYMENT, HEALTH CARE OPERATIONS, AND OTHER WAYS

Treatment. Information obtained by a therapist or other member of the healthcare team will be recorded in your medical record. We use and share Information to provide, coordinate, or manage medical treatment or services for you. For example, we will share Information with a referring physician, a primary care physician and/or nurse helping in your care.

Payment.Your health Information may be used to seek payment. For example, a bill may be sent to you or your insurance company, Medicare, or other payers. The Information on or accompanying the bill may include Information that identifies you, as well as your diagnosis, procedures, dates serviced, and supplies used. We may let your health plan know about treatment that you are going to receive. We may do so to get pre-approval, or to see if your plan covers the treatment.

Health Care Operations.Your health Information may be used as necessary to support the day-to-day activities and management of Therapy Choice. For example, Information on the services that you received may be used to support budgeting and financial reporting and to promote the quality of our services.

Persons Involved in Your Care. Health care professionals, using their best judgment, may disclose to a family member, close personal friend or any other person you identify, your medical Information or general condition relevant to that person’s involvement in your care and/or payment related to your care. If family or friends are present while care is being provided, then we will assume they may hear the discussion, unless you tell us otherwise.

Workers’ Compensation. We may disclose your Information as authorized by laws relating to workers’ compensation or similar programs.

Information about you and your health is very personal. That’s why we at Therapy Choice are committed to respecting and protecting your medical Information. We reserve the right to change the terms of this Notice at any time. Any such changes will apply to all Information we keep, even if it was collected before the change. If we revise the terms of this Notice, we will post a revised notice at Therapy Choice and will make paper copies of the revised Notice of Privacy Practices available upon written request.
By, law we must:

• Keep your Information confidential, with certain exceptions described in this Notice; and


• Give you this Notice of our legal obligations and privacy practices regarding your Information; and


• Follow the terms of the Notice currently in effect.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

You have the following rights with respect to your medical Information:

• You may request a paper copy of this Notice of Privacy Practices for Protected Health Information.


• You may ask us to restrict certain uses and disclosures of your medical Information.


• You have the right to receive communications from us in a confidential manner.


• You may inspect and copy your medical Information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.


• You may ask us to amend your medical Information. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and Information regarding further rights you may have at that point.


• You have the right to receive an accounting of the disclosures of your medical Information made by Therapy Choice during the last six years (or following April 14, 2003), except for disclosures for treatment, payment or healthcare operations, disclosures which you authorized and certain other specific disclosures types.


• You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way.

IMPORTANT CONTACT INFORMATION

If you would like further information regarding your rights or regarding the uses and disclosures of your medical information, you may contact:

Therapy Choice
2716 Orthodox Street
Philadelphia, PA 19137
215-743-4435