Notice of Privacy Practices

Notice of Privacy Practices

This Notice of Privacy Practices describes how we use and disclose your protected health information (PHI) and your rights regarding your PHI.

What is Protected Health Information (PHI)?

PHI is your personal health information that identifies you and is created, used, or maintained by a healthcare provider or healthcare plan. It includes information about your medical history, conditions, treatments, and medications. When your PHI is maintained electronically, it is called electronic protected health information (ePHI). This notice applies to all of your PHI and ePHI that we have provided or received.

Use and Disclosure With Patient Acknowledgement of This Notice

  • Treatment, Payment, and Healthcare Operations: This includes activities such as scheduling appointments, discussing treatment options with you, communicating with other healthcare providers involved in your care, and billing for services.

Use and Disclosure Without Patient Acknowledgement of This Notice

We may use or disclose your PHI without your acknowledgment or authorization for the following purposes:

  • Public Health Activities: We may report certain information to public health authorities as required by law to help prevent or control disease, injury, or disability. This may include reporting communicable diseases, suspected abuse or neglect, or threats to safety.
  • Appointment Reminders: We may contact you to remind you of your appointment. If you do not wish to receive appointment reminders or communications about treatment alternatives and health-related products and services, please notify us in writing at the address listed at the end of this notice. Upon receiving your written request, we will not use or disclose your information for these purposes.
  • Health Oversight Activities: We may disclose your PHI to health oversight agencies for audits, investigations, inspections, or licensing purposes. These disclosures are necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.
  • Law Enforcement: We may disclose your PHI to law enforcement officials as required by law or in certain limited circumstances, such as when responding to a court order or warrant.
  • Judicial and Administrative Proceedings: We may disclose your PHI in response to a court order or subpoena.
  • Coroners and Medical Examiners: We may disclose your PHI to coroners or medical examiners to investigate deaths

Authorization for Use or Disclosure

We may disclose your health information to family members or friends with your verbal agreement, or if you do not object when given the opportunity. We may also infer your agreement based on circumstances, such as when you bring a family member or friend into the treatment room. For all treatment sessions, you have the opportunity to decline accompaniment with your guest(s). In emergencies or when you're incapacitated, we may use our professional judgment to disclose information in your best interest, limited to what is relevant to their involvement in your care.

For minor children, we may disclose health information to both custodial and non-custodial parents unless restricted by a court order. Should circumstances warrant sole parent disclosure, please notify us at the start of treatment in writing.

We will not use or disclose your health information for any purpose other than those identified without your explicit written authorization. We will not disclose information regarding mental health treatment, drug and alcohol abuse, HIV/AIDS, or sexually transmitted diseases, nor will we share your medical information with employers, liability insurers, attorneys, or educational authorities without your written consent. Your information will not be used for marketing or sold to third parties without your authorization. Any other uses and disclosures will only occur with your written permission, which you can revoke in writing at any time, although we cannot retract any prior disclosures made with your consent.

Your Rights Regarding Your PHI

You have the following rights regarding the PHI that we maintain:

  • Right to Inspect and Copy: You have the right to inspect and obtain a copy of your medical records, including your medical and billing records. To request a copy of your records, please complete and submit an AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION to Quinn Orthopedic Physical Therapy. We may charge a reasonable fee for copying and mailing costs.
  • In certain limited circumstances, we may deny your request to inspect and copy records. If your request is denied, you may request a review of the denial. If permitted by law, a licensed healthcare professional who was not involved in the original decision will review your request, and we will comply with the outcome of the review.
  • Right to Amend: If you believe the information in your medical records is incorrect or incomplete, you have the right to request an amendment. To request a correction, please complete and submit a MEDICAL RECORD AMENDMENT/CORRECTION FORM to Quinn Orthopedic Physical Therapy.
  • We may deny your request if it is not in writing or does not include a valid reason. Additionally, we may deny requests to amend information if it was not created by us (unless the creator is no longer available), if it is not part of the health information we maintain, if you are not permitted to inspect and copy it, or if it is already accurate and complete.
  • Right to an Accounting of Disclosures: You have the right to request a list of the times we have disclosed your PHI for purposes other than treatment, payment, healthcare operations, and certain limited exceptions. To request an accounting of disclosures, please submit a written request to Quinn Orthopedic Physical Therapy specifying the time period (no longer than six years and not before April 14, 2003).
  • Your request should indicate the format in which you prefer the list (e.g., paper or electronic). The first list you request within a 12-month period will be provided free of charge; however, we may charge for subsequent requests. You will be informed of any costs before they are incurred, and you may choose to withdraw or modify your request at that time.
  • Right to Request Restrictions: You have the right to request restrictions on the use or disclosure of your health information for treatment, payment, or healthcare operations. You may also request a limitation on the information we disclose to someone involved in your care or the payment for your care, such as a family member or friend. For example, you may request that we do not disclose information about a specific surgery you underwent.
  • While we are not required to agree to your request, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment or is otherwise required by law. To request a restriction, complete and submit the Request for Restriction on Use/Disclosure of Medical Information and/or Confidential Communication Form to Quinn Orthopedic Physical Therapy. We will provide you with this form upon request.
  • Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information in a certain way or at a certain location. To request confidential communications, please complete and submit the REQUEST FOR RESTRICTION ON USE/DISCLOSURE OF MEDICAL INFORMATION AND/OR CONFIDENTIAL COMMUNICATION form to Quinn Orthopedic Physical Therapy and specify how or where you wish to be contacted.

    • Our Duties

    We are required by law to maintain the privacy of your PHI and provide you with this Notice of Privacy Practices. We are also required to comply with the terms of this Notice. We reserve the right to change the terms of this Notice at any time. We will make any new provisions effective for all PHI that we maintain. All changes in this Notice will be prominently displayed in our office.

    How to File a Complaint

    If you believe your privacy rights have been violated, you can file a written complaint with us or with the Secretary of Health and Human Services.

    More information is available about complaints online at the government’s website: http://www.hhs.gov/ocr/hipaa

    This Notice of Privacy Practices informs you about how we collect, use, and disclose your protected health information (PHI). This Notice does not constitute a contract, and our failure to strictly comply with it will not be considered a legal breach. Your sole remedy for any non-compliance is to file a written complaint with the Secretary of the U.S. Department of Health and Human Services. You understand that you waive the right to file lawsuits for breach of contract, confidentiality, privacy, identity misappropriation, consumer protection violations, negligence, or violations of state law arising from our non-compliance with this Notice.

    Contact Information

    All questions concerning this Notice, or requests made pursuant to it, should be addressed in writing to:

    Quinn Orthopedic Physical Therapy
    20823 Stevens Creek Blvd, Suite 200
    Cupertino, California 95014

    Effective Date

    This Notice is effective April 14, 2003 and revised July 8, 2024. It applies to all PHI contained in your medical records maintained by us.