Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Effective Date: January 1, 2017 — This notice is required by the Health Insurance Portability and Accountability Act (HIPAA)
Uses and Disclosures
We may use and disclose your Protected Health Information (PHI) without your authorization for the following purposes:
✔ Treatment
We may use and share your health information to provide, coordinate, or manage your healthcare and related services. This includes sharing information with other healthcare providers who are treating you.
✔ Payment
We may use and disclose your health information to obtain payment for services provided to you, including billing your insurance company or other payer.
✔ Healthcare Operations
We may use and disclose your health information for our business operations, such as quality assessment, training, and administrative activities necessary to operate our practice.
Your Rights
You have the following rights regarding your health information:
✔ Access Your Records
You have the right to inspect and obtain a copy of your medical records. We may charge a reasonable fee for copies.
✔ Request Amendments
If you believe information in your record is incorrect or incomplete, you may request that we amend it.
✔ Request Restrictions
You may request restrictions on certain uses and disclosures of your health information, though we are not always required to agree.
✔ Request Confidential Communications
You may request that we communicate with you in a specific way or at a specific location.
✔ Receive an Accounting of Disclosures
You may request a list of disclosures we have made of your health information for purposes other than treatment, payment, and operations.
Our Responsibilities
Tristar Physical Therapy is required by law to:
✔ Maintain the Privacy of Your PHI
We are required to protect the privacy of your health information and to follow the terms of this notice.
✔ Provide This Notice
We must provide you with this notice of our legal duties and privacy practices regarding your health information.
✔ Notify You of Breaches
We must notify you if a breach occurs that may have compromised the privacy or security of your information.
We reserve the right to change the terms of this notice and make the new notice effective for all health information we maintain. Current notices will be posted in our office and on our website.
Contact Us
If you have questions about this Notice of Privacy Practices or wish to exercise any of your rights, please contact:
Tristar Physical Therapy
Email: privacy@tristarpt.com
Phone: (423) 317-7772
Address: 325 W Morris Blvd. STE B, Morristown, TN 37813
If you believe your privacy rights have been violated, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.