THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
What is this notice and why is it important?
This notice is required by law to inform you about your rights regarding your health information, how Move and Play LLC may use or disclose your health information, and how your health information will be protected.
Understanding your health information
Each time you work with a Move and Play LLC professional a record of your visit is made. This record may contain a description of symptoms, medical history, examination and test results, diagnosis, treatment, and/or a plan for future care. This information, often referred to as your medical record, may serve the following needs:
- Basis for planning your care and treatment
- Means of communication among the health professionals who may contribute to your care
- Legal documentation of the care you receive
- Means by which you or a third party payer (e.g. health insurance company) can verify that services you received were appropriately billed
Understanding what is in your record and how your health information is used helps you better understand how others may access and use your health information and make more informed decisions when authorizing disclosures to others.
Your health information rights
You have the following rights related to your medical records kept by Move and Play LLC professionals:
- Obtain a copy of this notice. You will receive a copy of this notice.
- Authorize use of your health information. Before a Move and Play LLC professional uses or discloses your health information, other than as required by law, he/she will obtain your written authorization, which you may revoke at any time to stop future use or disclosure.
- Access your health information. You may request a copy of the health information that your
- Move and Play LLC professional keeps in your medical record. Your request must be submitted in writing.
- Amend your health information. If you believe the information your Move and Play LLC professional has about you is incorrect or incomplete, you may request that it be corrected or added to. Your request must be in writing and must include the reason for the request.
- Request confidential communications. You may request that when we communicate with you about your health information, we do so in a specific way (e.g. at a certain address or phone number). We will make every reasonable effort to act in accordance with your request.
- Limit our use or disclosure of your health information. You may request in writing that we restrict the use or disclosure of your health information for treatment, health care operations, or any other purpose except when specifically authorized by you, when we are required by law, or in an emergency situation in order to treat you. Your Move and Play LLC professional will consider your request and respond, but he/she is not legally required to agree if he/she believes your request would interfere with the ability to treat you or collect payment for services.
- Receive an accounting of disclosures. You may request a list of disclosures of your health information that we have made for reasons other than treatment or health care. The likelihood of such disclosure is low, since no disclosures are made without your knowledge and permission other than those required by law. Disclosures that we make with your authorization will not be listed.
Our Responsibilities
We are required by law to protect the privacy of your health information, establish policies and procedures that govern behavior of our professionals, business office staff and business associates, provide this notice about our private practices, and abide by the terms of this notice.
We reserve the right to change our policies and procedures for protecting health information. When we make a significant change in how we use or disclose your health information, we will also change this notice. The new notice will be provided to you.
Except as required by law or emergencies, we will not use or disclose your health information without your authorization. You have the right to revoke such authorization at any time, which would limit future disclosures. A revocation would not affect any disclosure we have already made with your permission.
Examples of uses and disclosures for treatment and health care operations
- Facilitate treatment: We will use your health information to facilitate your treatment. For example: Information obtained by your therapist or provider will be recorded in your record and used to determine the course of your treatment. Your medical record may be sent to your insurance company to explain the need for treatment or provide additional information about your treatment.
- Public health: We may disclose your health information as required by law to public health or legal authorities charged with preventing or controlling disease, injury or disability.
- Averting serious threats to health and safety: We may use and disclose your health information, when necessary, to prevent a serious threat to your health or safety or to the health and safety of the public or another person. Any disclosure would be made only to someone able to help prevent the threat.
- Law enforcement: We may disclose your health information for law enforcement purposes as required by law or in response to a valid subpoena or court or administrative order.
For more information or to report a problem
If you have questions, would like additional information, want to request an updated copy of this notice, are concerned that a professional has violated your privacy rights, or you disagree with a decision made about access to your records, please contact Move and Play LLC .
You may also send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Room 509 HHH Building, Washington, DC 20201.