When you submit a request for more information regarding physical therapy or injury prevention programs you are asked for your first and last name, your date of birth, your email and phone number, whether you would like in person or remote care, and for any information regarding why you are seeking care. When you purchase an online course you are asked for your first name, last name, date of birth, email address, phone number and for any pertinent injury/medical history that is important for your safety. All payments are made through Paypal.
Renaissance Physical Therapy Arts + Wellness uses collected information for the following general purposes: to communicate with you if necessary, to notify you of any upcoming events and online classes, to update you on any new products or services. The information collected is used to improve the quality of services and the content of our website. The information collected is not shared with other organizations except when you give us permission under the following circumstances:
It is necessary to share information in order to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations having potential threats to the physical safety of any person, violations of Terms of service or as otherwise required by law.
To transfer information about you if our company is acquired by or merged with another company. In that event, you will be notified before information about you is shared.
Renaissance Physical Therapy Arts + Wellness uses third party vendors and hosting partners to provide the necessary technology to run www.renaissanceptarts.com and any affiliate websites.
Disclosure: Personally Identifiable information may be disclosed to authorities, under special circumstances, such as to comply with subpoenas or when your actions violate the Terms of Service.
Changes: This policy may periodically be updated. You will be notified about significant changes in the way we address personal information by sending a notice to the primary email specified in your renaissanceptarts.com account or by placing a prominent notice on our website.
Our email system does not meet the requirements of cyber security for electronic medical records. If you choose to disclose personal health information through text message, phone, Skype or email communication with Renaissance Physical Therapy Arts + Wellness, we cannot guarantee the security or confidentiality of any personal health information shared. To ensure your privacy, it is highly recommended that you only use email communication to schedule an in-person consultation for more sensitive information. Renaissance Physical Therapy Arts + Wellness also offers an online HIPAA compatible portal for demographic information, medical history, scheduling and payment options.
Renaissance Physical Therapy Arts + Wellness
HIPAA Notice of Privacy Practices
Effective Date: September 14th, 2010
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact:
Renaissance Physical Therapy Arts + Wellness
732 Valley Road, Suite 102
Montclair, NJ 07043
1. Summary of Rights and Obligations Concerning Health Information. Renaissance Physical Therapy Arts + Wellness is committed to preserving the privacy and confidentiality of your health information, which is required both by federal and state law. We are required by law to provide you with this notice of our legal duties, your rights, and our privacy practices, with respect to using and disclosing your health information that is created or retained by Renaissance Physical Therapy Arts + Wellness. Each time you visit, a written record of your visit is created. Typically, this record contains your symptoms, examination and test results, assessment of your condition, a record of your treatment interventions, and a plan for future care or treatment. We have an ethical and legal obligation to protect the privacy of your health information, and we will only use or disclose this information in limited circumstances. In general, we may use and disclose your health information to:
• plan your care and treatment
• provide treatment by us or others
• communicate with other providers involved in your care, such as referring physicians
• receive payment from you or a third party responsible for your medical bills
• make quality assessments and work to improve the care rendered and the outcomes achieved, known as health care operations
• make you aware of services and treatments that may be of interest to you
• comply with state and federal laws that require us to disclose your health information
We may also use or disclose your health information where you have authorized us to do so.
Although your health record belongs to Renaissance Physical Therapy Arts + Wellness., the information in your record belongs to you. You have the right to:
• ensure the accuracy of your health record
• request confidential communications between you and your physician and request limits on the use and disclosure of your health information
• request an accounting of certain uses and disclosures of health information made about you.
We are required to:
• maintain the privacy of your health information
• provide you with notice, such as this Notice of Privacy Practices, as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of our most current Notice of Privacy Practices
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions effective for all your health information that we maintain.
Should our information practices change, a revised Notice of Privacy Practices will be available upon request. If there is a material change, a revised Notice of Privacy Practices will be distributed to the extent required by law. We will not use or disclose your health information without your authorization, except as described in our most current Notice of Privacy Practices.
2. We may use or disclose your medical information in the following ways:
Treatment. We may use and disclose your protected health information to provide, coordinate and manage your care. This may include consulting with other health care providers about your health care or referring you to another health care provider for treatment including physicians, nurses, and other health care providers involved in your care. For example, we may release your protected health information to a specialist to whom you have been referred to ensure that the specialist has the necessary information he or she needs to diagnose and/or treat you. We will inform you of this and get your authorization to do so.
Health Care Operations. We may use and disclose your health information to assist in the operation of our practice. For example, information in your health record can be used to assess the care and outcomes in your case and others like it as part of a continuous effort to improve the quality and effectiveness of the healthcare and services provided. Your health information may be used to conduct cost-management and business planning activities. This information could be provided to other health care entities for their health care operations.
Business Associates. Renaissance Physical Therapy Arts + Wellness sometimes contracts with third-party business associates for services. Examples include medical billing services, designers, consultants, and legal counsel. Your health information may be disclosed to our business associates so that they can perform the job we have asked them to do. To protect your health information, business associates are required to appropriately safeguard your information.
Appointment Reminders. Information in your medical record may be used to contact you as a reminder that you have an appointment. You may be called the day before your appointment and a message may be left for you on your voice mail. However, you may request that you can only be reached at a specific number or that messages will not be left and we will endeavor to accommodate all reasonable requests.
Treatment Options. Your health information may be disclosed in order to inform you of alternative treatments.
Release to Family/Friends. Only with your authorization will your health information be disclosed to a family member, other relative, close personal friend or any other person you identify, if it is relevant to that person’s involvement in your care or in paying for your care. Health information regarding the well-being of minors will be disclosed, as required by New Jersey law, to parents of guardians to make for the protection and safety of the minors.
Health-Related Benefits and Services. Your health information may be used to tell you about health-related benefits or services that may be of interest to you. Products and services that may be beneficial to your healthcare outcome may be recommended.
Newsletters and Other Communications. Your personal information may be used in to communicate to you via newsletters (including electronic newsletters), mailings, or other means regarding treatment options, health related information, disease management programs, wellness programs, promotions or other community based initiatives or activities which Renaissance Physical Therapy Arts + Wellness is offering.
Disaster Relief. Your health information may be disclosed in disaster relief situations, where disaster relief organizations seek your health information to coordinate your care, or to notify family and friends of your location and condition. You will be given the opportunity to agree or object to such a disclosure.
Marketing. As required by law we must receive your written authorization using or disclosing your health information for marketing purposes. Under no circumstances will patient lists or your health information be sold to a third party without your written authorization.
Public Health Activities. Your medical information may be disclosed for public health activities. These activities generally include the following:
• licensing and certification carried out by public health authorities
• prevention or control of disease, injury, or disability
• reports of births and deaths
• reports of child abuse or neglect
• notifications to people who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
• organ or tissue donation; and
• notifications to appropriate government authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required by law, or if you agree to the disclosure, or when authorized by law and in our professional judgment disclosure is required to prevent serious harm.
Food and Drug Administration (FDA). We may disclose to the FDA and other regulatory agencies of the federal and state government health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing monitoring information to enable product recalls, repairs, or replacement.
Research. We may disclose your health information to researchers when the information does not directly identify you as the source of the information or when a waiver has been issued by an institutional review board or a privacy board that has reviewed the research proposal and protocols for compliance with standards to ensure the privacy of your health information.
Workers Compensation. We may disclose your health information to the extent authorized by you and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Law Enforcement. We may release your health information:
• in response to a court order, subpoena, warrant, summons, or similar process of authorized under state or federal law
• to identify or locate a suspect, fugitive, material witness, or similar person
• about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement
• about criminal conduct
• to coroners or medical examiners
• in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime
• to authorized federal officials for intelligence, counterintelligence, and other national security authorized by law; and
• to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.
Personal Representative. If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with respect to disclosures of your health information. If you become deceased, we may disclose health information to an executor or administrator of your estate to the extent that person is acting as your personal representative.
Limited Data Set. We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research, public health, and health care operations. We may not disseminate the limited data set unless we enter into a data use agreement with the recipient in which the recipient agrees to limit the use of that data set to the purposes for which it was provided, ensure the security of the data, and not identify the information or use it to contact any individual.
3. Authorization for Other Uses of Medical Information. Uses of medical information not covered by our most current Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization. You should be aware that we are not responsible for any further disclosures made by the party you authorize us to release information to. If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain our records of the care that we provided to you.
4. Your Health Information Rights. You have the following rights regarding medical information we gather about you:
A. Right to Obtain a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.
B. Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes medical records.
To inspect and copy medical information, you must submit a written request to us. We will supply you with a form for such a request. If you request a copy of your medical information, we may charge a reasonable fee for the costs of labor, postage, and supplies associated with your request.
If your medical information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. We may charge you a reasonable fee limited to the labor costs associated with transmitting the electronic health record.
C. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we retain the information.
To request an amendment, your request must be made in writing and submitted to us. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
• was not created by us, unless the person or entity that created the information is no longer available to make the amendment
• is not part of the medical information kept by or for Renaissance Physical Therapy Arts + Wellness;
• is not part of the information which you would be permitted to inspect and copy
• is accurate and complete
If we deny your request for amendment, you may submit a statement of disagreement. We may reasonably limit the length of this statement. Your letter of disagreement will be included in your medical record, but we may also include a rebuttal statement.
D. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of your health information. In your accounting, we are not required to list certain disclosures, including:
• disclosures made for treatment, payment, and health care operations purposes or disclosures made incidental to treatment, payment, and health care operations, however, if the disclosures were made through an electronic health record, you have the right to request an accounting for such disclosures that were made during the previous 3 years
• disclosures made pursuant to your authorization
• disclosures made to create a limited data set
• disclosures made directly to you.
To request an accounting of disclosures, you must submit your request in writing to us. Your request must state a time period which may not be longer than six years and may not include dates before April 1, 2017. Your request should indicate in what form you would like the accounting of disclosures (for example, on paper or electronically by e-mail). We may charge you for the reasonable costs of providing the accounting of disclosures. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Under limited circumstances, mandated by federal and state law, we may temporarily deny your request for an accounting of disclosures.
E. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. If you paid out-of-pocket for a specific item or service, you have the right to request that medical information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we are required to honor that request. You also have the right to request a limit on the medical information we communicate about you to someone who is involved in your care or the payment for your care.
Except as noted above, we are not required to agree to your request. If we do agree we will comply with your request unless the restricted information is needed to provide you with emergency treatment. To request restrictions you must make your request in writing. In your request you must tell us:
• what information you want to limit
• whether you want to limit our use, disclosure, or both
• to whom you want the limits to apply
F. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by e-mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
G. Right to Receive Notice of a Breach. We are required to notify you by first class mail or by e-mail, if you have indicated a preference to receive information by e-mail, of any breaches of Unsecured Protected Health Information as soon as possible, but in any event, no later than 60 days following the discovery of the breach. “Unsecured Protected Health Information” is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information:
• a brief description of the breach, including the date of the breach and the date of its discovery, if known
• a description of the type of Unsecured Protected Health Information involved in the breach
• steps you should take to protect yourself from potential harm resulting from the breach
• a brief description of actions being taken to investigate the breach, mitigate losses, and protect against further breaches
• contact information, including a toll-free telephone number, e-mail address, Web site or postal address to permit you to ask questions or obtain additional information. In the event the breach involves 10 or more patients whose contact information is out of date we will post a notice of the breach on the home page of our Web site or in a major print or broadcast media. If the breach involves more than 500 patients in the state or jurisdiction, we will send notices to prominent media outlets. If the breach involves more than 500 patients, we are required to immediately notify the Secretary. We also are required to submit an annual report to the Secretary of a breach that involved less than 500 patients during the year and will maintain a written log of breaches involving less than 500 patients.
5. Complaints. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. All complaints must be submitted in writing and should be submitted within 180 days of when you knew or should have known that the alleged violation occurred. See the Office for Civil Rights website, www.hhs.gov/ocr/hipaa/ for more information. You will not be penalized for filing a complaint.