NOTICE OF PRIVACY PRACTICES
The privacy practices of Infinity & Beyond Pediatric Therapy (from now on referred to as “we” or “our practice”).
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
We believe your health information is personal. Our practice keeps a record of you and the services and care you receive. This record is protected by law and is called your “protected health information.” We are committed to keeping the health information that identifies you and your care private.
We are required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with notice of our legal duties and privacy practices concerning PHI. We are also required to abide by the terms of this notice for as long as it remains in effect and to notify you in the event of a breach of your unsecured PHI.
1. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Authorization and Consent. Our practice uses and shares your PHI to carry out treatment, payment, and health care operations. Except as provided in this notice or permitted by law, we will not use or share your information without your permission.
Uses and Disclosures for Treatment. We use and share your PHI to provide you with our health care services, and we may also share your PHI for the treatment activities of another health care provider. Treatment includes consultations between health care providers and referrals for health care services from one health care provider to another.
Uses and Disclosures for Payment. We use and share your PHI so that the health care services you receive can be billed and paid for by you, your insurance company, or another third party. We may also share your health information with a friend or family member who helps pay for your care.
Uses and Disclosures for Health Care Operations. We use and share your PHI for our health care operations, including improving clinical treatment, patient care, and business management.
Communications and Services. We may contact you about appointments and scheduling, treatments, and other matters. We may also send you information regarding health-related products and services that we feel may be of interest to you. You have the right to choose not to receive these communications, and we will tell you how to cancel them.
2. OTHER USES AND DISCLOSURES
We are permitted, and in some cases required by law, to make specific other uses and disclosures of your protected health information without your consent or authorization.
We will share information about you when required to do so by law. We can share health information about you in response to a lawsuit or legal action or for public health and safety reasons, such as reporting suspected child abuse, neglect, or domestic violence. We may release health information to help control the spread of disease or notify a person whose health or safety is threatened. We may also share health information with a government oversight agency for activities authorized by law.
3. YOUR RIGHTS REGARDING HEALTH INFORMATION
Right to an Accounting. You may request an accounting of the times we have shared your health information without your written authorization for six (6) years before the date of your request and with whom we shared it (other than yourself). The accounting does not include disclosures for treatment, payment, health care operations, and certain other disclosures exempted by law.
Right to Correct Medical Record. You may ask us to correct your health information that you think is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
Right to Medical Record Copy. You can ask to see or get an electronic or paper copy of your medical record and other health information about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Right to Request Restrictions. You can ask us not to use or share certain health information for treatment, payment, or health care operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer, and we will say “yes” unless a law or health insurer contract requires us to share that information.
Right to Request Confidential Communications. You can ask us to contact you in a specific way (e.g., cell phone or personal email) or send mail to a different address. We will accommodate all reasonable requests.
Right to Act on your behalf. If you have given someone medical power of attorney or are your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before taking any action.
Right to a Copy of this Notice. You can request a paper copy of this notice at any time, even if you have agreed to receive this notice electronically.
4. COMPLAINTS
If you feel we have violated your rights, you may file a complaint in writing with our Privacy Officer. If we cannot resolve your complaint to your satisfaction, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. For more information, visit www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Contact Information:
Charles Eickelberg, Privacy Officer privacy@ibptherapy.com
INFINITY & BEYOND PEDIATRIC THERAPY
765 ELA RD STE 301, Lake Zurich, IL 60047
(847) 320-0200
5. CHANGES TO THIS NOTICE
We have the right to change the terms of this notice at any time, and the changes will apply to all information we have about you. A copy of any new notice will be available upon request, in our office, and on our website.
EFFECTIVE DATE
The effective date of the “NOTICE OF PRIVACY PRACTICES” is February 20, 2022.
