STATEMENT OF PRIVACY PRACTICES

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This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

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• Your protected health information may include information created by or received from the clinic. It may be in the form of written or electronic records or spoken words, and it may include details about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, and similar types of health-related information.

• Your protected health information may be released to your insurance provider so that Connect & Beyond Physical Therapy can receive payment for providing you with needed physical therapy services. Connect & Beyond Physical Therapy may also share your health information with your physician or with those involved in payment activities related to the care you received.

• Your protected health information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime, or domestic violence.

• Your protected health information may be released to other healthcare providers if you require emergency care.

• Information regarding your appointment time, attendance at our facility, or other general details of your scheduled appointments may be provided over the phone to callers who request such information by providing your name.

• Your protected health information may be released only after receiving written authorization from you, except as provided above or for purposes of treatment, payment, or healthcare operations. You may revoke your permission to release your protected health information at any time; such revocation must be in writing, include an effective date, and specify the health information to be protected. Connect & Beyond Physical Therapy is not required to agree to your request.

• Connect & Beyond Physical Therapy may contact you by phone or mail (or leave a message on an automated answering device) to remind you of appointments or verify insurance or demographic information. You have the right to request a more confidential method for providing your protected health information or an alternative communication method at the time of your visit. Connect & Beyond Physical Therapy will honor all reasonable requests.

• By providing your phone number, you consent to receive text messages from Connect & Beyond Physical Therapy regarding appointments, scheduling updates, and other relevant notifications. Your personal information will not be shared with third parties for marketing purposes. Message frequency may vary. You may reply STOP at any time to opt out of future messages or HELP for more information. Standard message and data rates may apply.

• You have the right to review and obtain a photocopy of any or all portions of your health information. Connect & Beyond Physical Therapy may assess a fee for photocopying this information.

• You have the right to request an amendment to your health information. Such a request must be in writing and include an explanation of why the information should be amended. Connect & Beyond Physical Therapy may deny the amendment request; if so, a written explanation will be provided.

• You have the right to possess a copy of this statement of privacy practices upon request. This copy can be provided as an electronic transmission or on paper.

• Connect & Beyond Physical Therapy is required by law to protect the privacy of its patients. It will safeguard all patient health information and provide you with a list of practices used to protect that information upon request.

• Connect & Beyond Physical Therapy will abide by the terms of this notice. We reserve the right to make changes to this notice and will continue to maintain the confidentiality of all health information. Changes to this notice will be redistributed at your next visit to Connect & Beyond Physical Therapy.

• You have the right to file a complaint with Connect & Beyond Physical Therapy if you believe your privacy rights have been violated. If you feel your privacy rights have been violated, please mail your written complaint to: 12540 SW 68th Ave, Tigard, OR 97223

• All complaints will be investigated, and no adverse action will result from filing a complaint with Connect & Beyond Physical Therapy.

• You may also file a complaint with: Region IV, Office of Civil Rights
  U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street SW, Atlanta, GA 30303-8900

 

If you would like more information regarding this privacy notice, please contact our office at 503-974-9708.