Lewisboro Physical Therapy, PC
NOTICE OF PRIVACY PRACTICE

In accordance with recent Health Insurance Portability and Accountability Act (HIPAA) regulations, this notice is to inform our patients of how your protected health information (PHI) will be used and disclosed by Lewisboro Physical Therapy.

The information you provide on your patient data form requires your acknowledgement, but not direct consent (although we ask for it) for release of information for the following purposes:

1. communication with your referring physician(s) or other practitioners involved in your case as it pertains to your physical therapy treatment
2. communication with case managers
3. verifying insurance benefits
4. obtaining insurance required pre-certifications or authorizations as dictated by individual and provider contracts with the insurance carrier
5. claims processing
6. internal review and outcome reports (names withheld)

You will be asked to update and acknowledge your personal information for the current course of treatment prior to your initial encounter or evaluation. This will be asked of you each time you return for a new course of physical therapy.

You have the right to request the withholding of certain pieces of information, however this is with the understanding that withholding certain PHI or insurance information may interfere with effective physical therapy care or insurance claims processing. You also have the right to inspect and amend your PHI, or request copies or an accounting of disclosures.

Release of any PHI for the following purposes is by your explicit direction and signature:

1. Release of medical records to attorneys, physicians other than referring practitioners, other health professionals, personal trainers, or other third parties or agencies. This does not include court ordered subpoena of record.
2. Marketing of Lewisboro Physical Therapy through written, oral or pictorial (photo) communication.
3. Insurance company requests (Worker’s Compensation or No Fault) for litigious purposes.

Staff members will use, disclose or discuss PHI only as necessary in the performance of their duties as employees of this practice and in accordance to the office HIPAA policy and as applicable by law.

We reserve the right to amend this notice and will post such changes in the lobby. If you have any questions regarding our privacy policies, or if you feel your privacy rights have been violated, please contact Marg Caltabiano, Office Manager.