Notice of Privacy Practices

Effective Date: 9/26/2024

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact our privacy officer:

Shane Williams Jr.
drshane@atphysiotherapy.com

Summary of Rights and Obligations Concerning Health Information. Athletic Training Physiotherapy, LLC is committed to preserving the privacy and confidentiality of your health information, which is required both by federal and state law. We are required by law to provide you with this notice of our legal duties, your rights, and our privacy practices, with respect to using and disclosing your health information that is created or retained by Athletic Training Physiotherapy, LLC. Each time you visit us, we make a record of your visit. Typically, this record contains your symptoms, examination and test results, our assessment of your condition, a record of your treatment interventions, and a plan for future care or treatment. We have an ethical and legal obligation to protect the privacy of your health information, and we will only use or disclose this information in limited circumstances. In general, we may use and disclose your health information to:

  • plan your care and treatment;

  • provide treatment by us or others;

  • communicate with other providers such as referring physicians;

  • receive payment from you, your health plan, or your health insurer;

  • make quality assessments and work to improve the care we render and the outcomes we achieve, known as health care operations;

  • make you aware of services and treatments that may be of interest to you; and

  • comply with state and federal laws that require us to disclose your health information.

We may also use or disclose your health information where you have authorized us to do so.

Although your health record belongs to Athletic Training Physiotherapy, LLC, the information in your record belongs to you. You have the right to:

  • ensure the accuracy of your health record;

  • request confidential communications between you and your physician and request limits on the use and

disclosure of your health information; and

  • request an accounting of certain uses and disclosures of health information we have made about you.

We are required to:

  • maintain the privacy of your health information;

  • provide you with notice, such as this Notice of Privacy Practices, as to our legal duties and privacy practices with

respect to information we collect and maintain about you;

  • abide by the terms of our most current Notice of Privacy Practices;

  • notify you if we are unable to agree to a requested restriction; and

  • accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all your health information that we maintain.

Should our information practices change, a revised Notice of Privacy Practices will be available upon request. If there is a material change, a revised Notice of Privacy Practices will be distributed to the extent required by law. We will not use or disclose your health information without your authorization, except as described in our most current Notice of Privacy Practices. In the following pages, we explain our privacy practices and your rights to your health information in more detail.

If you have limited proficiency in English, you may request a Notice of Privacy Practices in another language and we will have this document translated for you upon request.

  1. How This Medical Practice May Use or Disclose Your Health Information: This medical practice collects health information about you and stores it in a chart, on a computer, and in an electronic health record/personal health record. This is your medical record. The medical record is the property of this practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

  • Treatment. We may use and disclose your protected health information to provide, coordinate and manage your care. That may include consulting with other health care providers about your health care or referring you to another health care provider for treatment including physicians, nurses, and other health care providers involved in your care. For example, we may release your protected health information to a provider who performs services we do not provide to ensure they have the necessary information needed to diagnose and treat you. We may use and disclose your health information in order to inform you of alternative treatments.

  • Payment. We may use and disclose your health information to obtain payment for the services we provide. For example, we may need to disclose some details of medical condition and treatment to your health insurer to verify your eligibility for treatment. We may provide health information to other health care providers to assist them in obtaining payment for services they have provided to you. Further, we may provide health information to a collection agency, small claims court, or other court of competent jurisdiction in the event your claims for our services are not pain within 90 days and you have not made alternative arrangements with us.

  • Health Care Operations. We may use and disclose your health information to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information as necessary to obtain authorization for referrals or services from your health insurer. We may use and disclose your health information to conduct cost-management and business planning activities for our practice. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs. We may also provide such information to other health care entities for their health care operations. For example, we may provide information to your health insurer for its quality review purposes.

  • Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.

  • Students. Students/interns in rehabilitation or health service related programs work in our facility from time to time to meet their educational requirements or to get healthcare experience. These students may observe or participate in your treatment or use your health information to assist in their training. You have the right to refuse to be examined, observed, or treated by any student or intern. If you do not want a student or intern to observe or participate in your care, please notify your provider.

  • Business Associates. Sometimes Athletic Training Physiotherapy LLC contracts with third-party business associates for services. Examples include answering services, transcriptionists, billing services, consultants, and legal counsel. We may disclose your health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, however, we require our business associates to appropriately safeguard your information.

  • Notification/Communication with Family/Friends. We may disclose to a family member, other relative, close personal friend or any other person you identify, your health information to the extent it is relevant to that person’s involvement in your care or payment related to your care. We may disclose the health information of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

  • Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you. In face-to-face communications, such as appointments with your provider, we may tell you about other products and services that may be of interest to you.

  • Newsletters and Other Communications. We may use your personal information in order to communicate to you via newsletters (including electronic newsletters), mailings, or other means regarding treatment options, health related information, disease management programs, wellness programs, or other community based initiatives or activities in which our practice is participating.

  • Disaster Relief. We may disclose your health information in disaster relief situations where disaster relief organizations seek your health information to coordinate your care, or notify family and friends of your location and condition. We will provide you with an opportunity to agree or object to such a disclosure whenever we practicably can do so.

  • Marketing and Sale of Health Information. We are required by law to obtain your written authorization before we use or disclose your health information to send you marketing communications about products or services offered by third parties where we have received financial remuneration from the third party for such communications. However, we do not have to obtain your written authorization to discuss services or products offered by third parties in face-to-face communications or to offer promotional gifts of nominal value. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We will not otherwise use or disclose your health information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.

  • Fundraising. We may use certain information (name only, address, telephone number, date of service, age and gender) to contact you as part of fundraising efforts our practice participates in. If you do not wish to be contacted about our fundraising activities, please notify your provider or our privacy officer.

  • Public Health Activities. We may disclose medical information about you for public health activities. These activities generally include the following:

  • licensing and certification carried out by public health authorities;

  • prevention or control of disease, injury, or disability;

  • reports of births and deaths;

  • reports of child abuse or neglect;

  • notifications to people who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

  • organ or tissue donation; and

  • notifications to appropriate government authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required by law, or if you agree to the disclosure, or when authorized by law and in our professional judgment disclosure is required to prevent serious harm.

  • Health Oversight. We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.

  • Research. We may disclose your health information to researchers when the information does not directly identify you as the source of the information or when a waiver has been issued by an institutional review board or a privacy board that has reviewed the research proposal and protocols for compliance with standards to ensure the privacy of your health information.

  • Workers Compensation. We may disclose your health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

  • Law Enforcement. We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes. We may release your health information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at Athletic Training Physiotherapy LLC; to coroners or medical examiners; in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime; to authorized federal officials for intelligence, counterintelligence, and other national security authorized by law; and to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.

  • De-identified Information. We may use your health information to create “de-identified” information or we may disclose your information to a business associate so that the business associate can create de-identified information on our behalf. When we “de-identify” health information, we remove information that identifies you as the source of the information. Health information is considered “de-identified” only if there is no reasonable basis to believe that the health information could be used to identify you.

  • Personal Representative. If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with respect to disclosures of your health information. If you become deceased, we may disclose health information to an executor or administrator of your estate to the extent that person is acting as your personal representative.

  • Limited Data Set. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research, public health, and health care operations. We may not disseminate the limited data set unless we enter into a data use agreement with the recipient in which the recipient agrees to limit the use of that data set to the purposes for which it was provided, ensure the security of the data, and not identify the information or use it to contact any individual.

  1. Authorization for Other Uses of Medical Information. Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization or, if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has the right to contest a claim or the insurance coverage itself. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain our records of the care that we provided to you.

  2. Your Health Information Rights. You have the following rights regarding medical information we gather about you:

  3. Right to Obtain a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.

  4. Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes medical and billing records.

To inspect and copy medical information, you must submit a written request to Athletic Training Physiotherapy, LLC or our privacy officer. If you request a copy of your medical information, we may, subject to state law restrictions or limitations, charge a reasonable fee for the costs of labor, postage, and supplies associated with your request. We may not charge you a fee if you require your medical information for a claim for benefits under the Social Security Act (such as claims for Social Security, Supplemental Security Income, and any other state or federal needs-based benefit program).

If your medical information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. We may deny your request under limited circumstances.  If we deny your request to access your child’s records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision.  If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional. We may charge you a reasonable cost based fee limited to the labor costs associated with transmitting the electronic health record.

  1. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we retain the information.

To request an amendment, your request must be made in writing and submitted to Athletic Training Physiotherapy, LLC or our privacy officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the medical information kept by or for Athletic Training Physiotherapy, LLC; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.

If we deny your request for amendment, you may submit a statement of disagreement. We may reasonably limit the length of this statement. Your letter of disagreement will be included in your medical record, but we may also include a rebuttal statement.

  1. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of your health information made by this medical practice. In your accounting, we are not required to list certain disclosures, including: disclosures made for treatment, payment, healthcare operations, notification and communication with family/friends or disclosures made incidental to treatment, payment, healthcare operations, and notification and communication with family/friends of Section 2 of this Notice of Privacy Practices. This medical practice does not have to account for disclosures which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.

To request an accounting of disclosures, you must submit your request in writing to our privacy officer. Your request must state a time period which may not be longer than six years. Your request should indicate in what form you would like the accounting of disclosures (for example, on paper or electronically by email). We may charge you for the reasonable costs of providing the accounting of disclosures. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time, before any costs are incurred. Under limited circumstances mandated by federal and state law, we may temporarily deny your request for an accounting of disclosures.

  1. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. If you paid out-of-pocket for a specific item or service, you have the right to request that medical information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we are required to honor that request unless we are required by law to disclose the information. You also have the right to request a limit on the medical information we communicate about you to someone who is involved in your care or the payment for your care.

Except as noted above, we are not required to agree to your request. If we do agree, we will comply with your request unless the restricted information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to your provider or our privacy officer. In your request, you must tell us: what information you want to limit, whether you want to limit our use, disclosure, or both, and to whom you want the limits to apply.

  1. Right to Request Confidential Communications. You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you can ask that we only contact you at work or by e-mail. To request confidential communications, you must make your request in writing to your provider or our privacy officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

  2. Right to Receive Notice of a Breach. We are required to notify you by first class mail or by email (if you have indicated a preference to receive information by email), of any breaches of Unsecured Protected Health Information as soon as possible, but in any event, no later than 60 days following the discovery of the breach. “Unsecured Protected Health Information'' is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users.

  3. Webinar and Online Training Attendance. 

  • You must not rely on the information on this website, or from Athletic Training Physiotherapy, LLC online education workshops as an alternative to medical advice from your doctor or other professional healthcare provider.

  • If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider.

  • If you think you may be suffering from any medical condition, you should seek immediate medical attention.

  • You should never delay seeking medical advice, disregard medical advice or discontinue medical treatment because of information on this website or within an online educational workshop.

  • Do not share personal information, contact information, or protected health information during the event that you wish to keep private.

  • Athletic Training Physiotherapy, LLC is not responsible to you or anyone else for any loss or injury suffered in connection with the use of this website, online educational workshops, or any of the content.

  1. Complaints. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. To file a complaint with us, contact our privacy officer at the address listed above. All complaints must be submitted in writing and should be submitted within 180 days of when you knew or should have known that the alleged violation occurred. See the Office for Civil Rights website, www.hhs.gov/ocr/hipaa/ for more information. You will not be penalized in any way for filing a complaint.