This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Our Commitment to Your Privacy
Ashlee Gendron Physical Therapy PC is committed to protecting the privacy of your health information. We are required by both federal law (the Health Insurance Portability and Accountability Act, or HIPAA) and California state law (the Confidentiality of Medical Information Act, Civil Code §56) to maintain the privacy of your Protected Health Information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How We May Use and Disclose Your Health Information
Treatment
We may use and share your information to provide, coordinate, and manage your physical therapy care. For example, we may share relevant information with another healthcare provider involved in your treatment.
Payment
We may use and share your information to bill and collect payment for services. As an out-of-network provider, we do not submit claims to insurance companies on your behalf.
Healthcare Operations
We may use and share your information for internal business functions, including quality assessment, training, and administrative purposes necessary to operate our practice.
Other Uses and Disclosures
We may also use or share your health information in the following circumstances without your authorization:
- As required by federal, state, or local law
- For public health activities, such as reporting communicable diseases to health authorities
- To report suspected abuse, neglect, or domestic violence to authorized government agencies
- For health oversight activities, including audits and investigations by government agencies
- In response to a court order, subpoena, or other lawful legal process
- For law enforcement purposes as permitted or required by law
- To avert a serious and imminent threat to health or safety
- For workers' compensation programs as authorized by law
Uses and Disclosures Requiring Your Authorization
All other uses and disclosures of your health information not described above will be made only with your written authorization. This includes, but is not limited to:
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures for marketing purposes
- Sale of your health information
You may revoke any authorization you provide at any time, in writing. Revocation will not apply to information already disclosed in reliance on your prior authorization.
Your Rights Regarding Your Health Information
Access Your Records
You have the right to inspect and receive a copy of your health information. We may charge a reasonable fee for copies. Requests must be made in writing.
Request Amendments
You may request that we amend information you believe is inaccurate or incomplete. We may deny your request under certain circumstances and will explain any denial in writing.
Accounting of Disclosures
You may request a list of disclosures we have made of your health information, other than for treatment, payment, or operations, for the six years prior to your request.
Request Restrictions
You may request that we restrict how we use or disclose your information. We must honor a request to restrict disclosure to a health plan if you pay entirely out of pocket.
Confidential Communications
You may request we contact you at a specific phone number or address — for example, to avoid calling your home or workplace.
Paper Copy of This Notice
You have the right to request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Breach Notification
You have the right to be notified if your unsecured health information has been compromised in a breach.
Our Responsibilities
- Maintain the privacy and security of your health information
- Provide you with this notice of our privacy practices
- Follow the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Notify you if a breach of your unsecured health information occurs
We reserve the right to change the terms of this notice and to make new provisions effective for all health information we maintain. If we change this notice, we will post the revised version on our website and make it available upon request.
Minor Patients
For patients under 18 years of age, we generally communicate with and obtain consent from a parent or legal guardian. California law gives minors specific rights to consent to certain types of care without parental involvement, and to keep certain health information confidential from their parents in those cases. If you are a minor patient or are inquiring about a minor's care, please contact us with any questions about how this notice applies in your situation.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
16885 Via Del Campo Ct, Suite 110, San Diego, CA 92127
(760) 874-3309
ashlee@agphysicaltherapypc.com
Office for Civil Rights
200 Independence Ave SW
Washington, D.C. 20201
hhs.gov/ocr · 1-800-368-1019
Privacy Enforcement and Protection Unit
1300 I Street
Sacramento, CA 95814
oag.ca.gov/privacy
Privacy Contact
For questions about this notice or our privacy practices, please contact our Privacy Officer:
Ashlee Gendron Physical Therapy PC
16885 Via Del Campo Ct, Suite 110, San Diego, CA 92127
(760) 874-3309
ashlee@agphysicaltherapypc.com