Effective Date: August 12, 2024

NOTICE OF PRIVACY PRACTICES

WE ARE COMMITTED TO YOUR PRIVACY - Our practice is dedicated to maintaining the privacy of your individual and identifiable information. During the course of your business with us, it will be necessary for us to share aspects of your care and health insurance with specific parties. Federal law prohibits us from doing this without your consent. We are required by law to maintain the confidentiality (of health insurance information that identifies you) from parties other than yourself and your insurance company. We are also required by law to inform you of the parties who may have access to your medical information. This process may include the collection of such information as: your full legal name, home / mailing address, date of birth, social security number, insurance identification numbers, treatment for other related and previous conditions, etc. Please trust that this information will be treated in the safest of manners and will not be shared or disclosed unless as otherwise noted below. This information is never shared with any party outside our facility without your written consent except as noted below and will only be accessed by our staff in order to facilitate your care and or payment for our services.

WE WILL COLLECT INFORMATION FOR MANY PURPOSES - Each time you visit our practice a record will be maintained of specific information regarding the particulars of that session. This information may include (but is not limited to): medical record maintenance, treatment that was provided, subjective information you provided us regarding your state of being and the state of the condition, assessment information related to the progression of your condition, billing information, communication with insurance companies etc. When communication is made with your insurance company we will maintain a record of these communications either in your medical record or billing record.

HOW MAY WE USE AND DISCLOSE YOUR HEALTH INFORMATION

• FOR TREATMENT: We will collect subjective and objective data about you that will be used for your treatment. As part of your care, we may disclose information about your treatment to your referring provider, your insurance company, or anyone else who is directly connected with the treatment of this condition. This information may be provided in verbal and / or written format. It will only be provided in the event that these parties can identify you with three specific criteria.
• FOR PAYMENT - We may disclose information about your treatment and services to bill and collect from you, your insurance company or a third-party payer related to your insurance company (i.e.: payment management company or a Health Savings Reimbursement Account). This may involve our disclosing information about past and expected future services that have been or will be provided by our facility for this current condition.
• FOR HEALTH CARE OPERATIONS AND PERFORMANCE IMPROVEMENT - We may use the information in your record to help us improve your care as well as the care of other individuals with similar conditions. This may also include the training of new staff within our facility. In this case, no specific information regarding your identity will be utilized.
• INDIVIDUALS INVOLVED IN YOUR CARE - We may disclose information about you to friends and family members who are involved in your medical care or who help to pay for care. In these cases, the information released is restricted to those individuals who provide proof of their ability to obtain said information.
• STATE-SPECIFIC REQUIREMENTS - Many states have requirements for reporting including population-based activities related to improving health and reducing health care costs.

WHAT ARE YOUR HEALTH INFORMATION RIGHTS

• INSPECT AND COPY - You have the right to inspect your medical record and request a copy at any time. By law, we may deny your right to view or copy this record in certain limited circumstances and, in such a case, would need to supply you with a written denial within 7 days of your request. In this event, you may submit a formal letter of appeal to the State Board of Medicine, and they will assign an independent third party whose decision would be final.
• AMEND - If you feel that the information that we have about you is incorrect or incomplete, you have the right to ask us to amend the information. Such a request would need to be submitted in writing to our Director of Medical Records and must state the information to be changed and the purpose for making said change. We do have the right to deny this request and would be required to inform you in writing of our decision not to make the requested amendment.

1. REQUEST RESTRICTIONS - You have the right to request a restriction or limitation on the health information we use or disclose about you. Please keep in mind that such a request may alter or affect your treatment outcomes or financial responsibility as related to this condition. THIS INFORMATION MUST BE NOTED IN THIS SECTION AT THIS TIME. In order for any change in this restriction to occur, a new and overriding HIPPA agreement must be filed with our office.
2. RECEIVE A PAPER COPY OF THIS NOTICE - You have the right to verbally request a copy of this written notice at any time.
3. CHANGES TO THIS NOTICE - We reserve the right to change this notice at any time. The revised or changed notice will be effective for the information that we have on hand as well as any information that we receive in the future. The revised notice would be made available to you immediately upon its release and would ultimately be binding over any previous release.
4. COMPLAINTS - If you believe your privacy rights have been violated, you have the following options: (these must be completed in the order listed)
   Contact our office right away
   Phone: 847-378-4970
   
   Writing: Cadence Physical Therapy Co, 1691 Weiland Rd, Buffalo Grove, Illinois 60089
   Inform the Office Manager of your complaint. Request a written summary of your conversation with the Office Manager as well as a written summary of his/her proposed solution to your complaint. If you feel that your complaints were not handled accordingly, you may contact the Illinois Division of Professional Regulation at 312-814-6910.