Premier Physical Therapy-Lakes Region

Notice of Privacy Practices

You have the right to confidentiality of personal health information provided by you to us, and/or created by us in connection with health care services rendered to you.  In this regard, under applicable federal privacy laws, you have the right, subject to certain exceptions and limitations, to:

1. Receive a paper copy of the form of notice of our information practices;
2. See and copy your own health information;
3. Amend the health information in your file with this office, if it is inaccurate;
4. An accounting of disclosures, other than regarding treatment, payment and health care operations purposes.

1. May use your protected personal health information, without separate consent or authorization from you, for treatment, payment or facility operations in connection with services rendered by us, to you.  For example, we may provide your personal health information to your insurance plan, to support our request for reimbursement.
2. May be required to disclose your protected personal health information, without your written consent or authorization, if necessary to comply with mandatory laws, including responding to a valid subpoena.
3. May discuss your treatment with other practitioners or clinicians involved in your care.
4. May contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

                Uses and disclosures other than those referenced above will be made only with your written authorization and you may revoke such authorization, in writing, at any time.            

                Marketing Materials:  You will not receive any marketing materials from us, unless we first receive a separate written consent form, executed by you, allowing us to provide you with such information.

                Changes to the Notice:  This entity reserves the right to change the terms of this written notice and to make the new notice provisions effective for all protected health information that we maintain.  If we do so, we will provide you with a copy of the revised notice at the time of your receipt of health care services from this office, and we will post the notice, with the effective date, in a visible location in this office.

                Complaints:  You may complain to us and to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated.  If you have any questions about this, or wish to file a complaint with this office, you may contact Erica Pond at 207-647-2727, or Department of Human Services at 207-287-5102 .  You will not be retaliated against in any way, for the filing of a complaint.

                   This facility is required by law to abide by the terms of this notice currently in effect.