1. About Protected Health Information – PHI

In this Notice, “we,” “our” or “us” means Complete PT Pool & Land Physical Therapy Inc. and our  employees. “you” and “your” refer to you as a patient who is entitled to a copy of this Notice.

We are required by federal and state privacy regulations to protect the privacy of your health information in the manner that we describe here. Certain types of health information may specifically identify you. Because we must protect this health information, we call this Protected Health Information–or “PHI.” In this Notice, we tell you:

  • How we use your PHI
  • When we may disclose your PHI to others
  • Your privacy rights and how to use them
  • Our privacy duties
  • Who to contact for more information or with a complaint

2. Some of the Ways we Use or Disclose Your Protected Health Information

We will use your PHI to treat you. We will use your PHI and disclose it to get paid for your care. We are allowed to use or disclose your PHI for health care “operations,” which involve the administration, education and quality assurance in our company. We will give you examples of each of these to help explain them, but space does not permit a complete list of all uses or disclosures. For more information, you may contact us and ask us questions.

Treatment.   We may disclose your PHI and share it with your physician regarding your condition and treatment. Our staff members may share your PHI amongst themselves to coordinate your care. We may disclose your PHI to persons in a position to authorize your treatment. We may also use or disclose your PHI for many other types of treatment activity.

Payment.  After we treat you, we will ask your insurer to pay us. We may type some of your PHI into our computers and send a claim to your Insurer. Here, we use your PHI to tell your insurer what type of health problem you had and what we did to treat you. Your insurer may ask us to give them your membership number in your employer’s health plan, or your insurer may want to review your medical record to be sure that your care was necessary. When we use and disclose your PHI this way, it helps us to get paid for your care and treatment.

Health Care Operations. We also use and disclose your PHI in our health care operations. For example, our staff meets periodically to study medical records to monitor the quality of care in our clinic. Your medical record and PHI could be used in these quality assessments. Other operational uses or disclosures may involve business planning for our company, or the resolution of a complaint.

Special uses. We also use or disclose your PHI for purposes that involve your relationship to us as a patient. We may use or disclose your PHI to:

  • Remind you that you have an appointment with us for treatment.
  • Tell you about treatment alternatives and options.
  • Tell you about our other health benefits and services.

Your Authorization May be Required. In many cases summarized here, we may use or disclose your PHI either with your consent or as required or permitted by law. In all other cases, we must ask for, and you must agree to give, a written authorization that has specific instructions and limits on our use or disclosure of your PHI. If you later change your mind, you may revoke your authorization.

3. Certain Uses and Disclosures of Your PHI that are Required or Permitted by Law

Many laws and regulations apply to us that affect your PHI. These laws and regulations may either require us or permit us to use or disclose your PHI. From the federal health information privacy regulations, here is a list describing required or permitted uses and disclosures.

  • If you do not verbally object, we may share your PHI with a family member, friend, or personal representative that is involved in your care.
  • We may use your PHI in an emergency when you are not able to express yourself.
  • If we receive certain assurances that protect your privacy, we may use or disclose your PHI for research.

We may also use or disclose your PHI:

  • When required by law; for example, when ordered by a Court to turn over certain types of your PHI, we must do so.
  • For public health activities such as reporting a communicable disease or reporting an adverse drug reaction to the Food and Drug Administration.
  • To report neglect, abuse or domestic violence.
  • To the government regulators or its agents to determine whether we comply with applicable rules and regulations.
  • In judicial or administrative proceedings such as in response to a valid subpoena.
  • When properly requested by law enforcement officials (such as reporting gunshot wounds), or for other legal requirements.
  • If we reasonably believe that to do so will avert a health hazard or to respond to a threat to a public safety such as an imminent crime against another person.
  • If you are Armed Forces personnel and it is deemed necessary by appropriate military command authorities.
  • In connection with certain types of organ donor programs.

4. Certain Stricter Requirements that We Follow

Several state laws may apply to your PHI that set a stricter standard than the protections required by the federal health privacy regulations. Stricter state law in California, for example, limits us from disclosing:

  • Medical information except when released by patient authorization, as stated in Confidentiality of Medical Information Act
  • Mental health information, as stated in Lanterman-Petris-Short Act
  • Any information regarding HIV tests or status, including identity of persons tested, as stated in the HIV Test Confidentiality Law
  • Miscellaneous other provisions that may supersede federal regulations in some cases

5. Your Privacy Rights and How to Exercise Them

You have specific rights under our federally required privacy program. Each of them is summarized here.

Your Right to Request Limited Use or Disclosure. You have the right to request that we do not use or disclose your PHI in a particular way. However, we are not required to abide by your request. If we do agree to your request, we must abide by the agreement.

Your Right to Confidential Communication. You have the right to receive confidential communication from us at a location that you provide. We require that you make your request in writing, provide us with the other address, and explain to us if the request will interfere with your method of payment for your care.

Your Right to Revoke Your Consent. If you have granted us your consent or authorization to use or disclose your PHI, you may revoke the consent or authorization in writing. We can disclose your PHI until we receive your written revocation of your original authorization.  The revocation is not effective until it is received by CPT.  

Your Right to Inspect and Copy. You have the right to inspect and copy your PHI. We may refuse to give you access to your record if we think it may cause you harm. If we refuse you access, we have to explain why and give you someone to contact about our decision. This contact person will tell you how and when to get a review of our refusal.

Your Right to Amend Your PHI. If you disagree with what your PHI in our records says about you, you have the right to request in writing that we amend your PHI when it is in a record that we create or have maintained for us. We are not required to respond to your request if the records in question are not our records. We may refuse to make your requested amendment. Then, you will have a right to submit a written statement about why you disagree. If we still disagree, we may prepare a counter statement. Your statement and our counter statement must be made part of our record about you.

Your Right to Know Who Else Sees Your PHI. You have the right to request an accounting of certain disclosures that we have made of your PHI over the past six years. You cannot ask for disclosures before April 14, 2003. We do not have to account for all disclosures, including those involving treatment, payment, and health care operations as described above. There is no charge for an annual accounting but there may be for additional accountings. We will tell you if there is a charge for your accounting, and you will have the right to withdraw your request or pay to proceed.

Your Right to Complain. If you believe that your privacy rights have been violated, you have the right to make a complaint to us, or to the Secretary of Health and Human Services. We will not retaliate against you if you file a complaint about us. To file a complaint, you should submit it in writing to the contact person identified in this notice (7, below). Your complaint should provide a reasonable amount of specific detail to enable us to investigate a potential problem.

6. Some of Our Privacy Obligations and How We Perform Them

We are required to comply with the federal health information privacy regulations. Those rules require us to protect your PHI. Those rules also require us to give you Notice of our privacy practices. This document is our Notice. If you did not get a paper copy of this Notice, you may have one. We will abide by the privacy practices set forth in this Notice. However, we reserve the right to change this Notice and our privacy practices when permitted or as required by law.

If we change our Notice of privacy practices, we will provide our revised Notice to you when you next seek treatment from us.

7. Contact Information

If you have questions about this Notice, or if you have a complaint, please contact:

Jane Hasle, Privacy Officer
3283 Motor Ave.
Los Angeles, CA 90034
310-845-9690

8: Effective Date

This Notice takes effect on April 14, 2003.