Please read the following carefully. This Notice of Privacy Practices (“Notice”) describes the privacy practices regarding your medical information of Quality Physical Therapy, Inc, and all employees, staff, other personnel, and affiliates (“Quality Physical Therapy” or “BioSynchronistics”). Privacy practices refer to the ways we may use and disclose your medical information and certain obligations we have regarding the use and disclosure of your medical information.

This notice also describes your rights regarding using and disclosing your medical information and how you can obtain access to this information. We at Quality Physical Therapy, Inc. pledge to give you the highest quality health care and to have a relationship with you that is built on trust. This trust includes our commitment to respect the privacy and confidentiality of your health information. This Notice also applies to the therapists on the Quality Physical Therapy, Inc. staff if they see you at a Quality Physical Therapy, Inc. site (they will give you their own Notice if they see you in their private office).

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This Notice is being given to you because federal law gives you the right to be told ahead of time about:

1. How Quality Physical Therapy, Inc. will handle your medical information
2. Quality Physical Therapy, Inc.’s legal duties related to your medical information
3. Your rights with regard to your medical information. Patient-specific information is confidential and shall be made available only in conformity with all applicable state and federal laws and regulations regarding the confidentiality of patient records, including but not limited to 42 CFR Part 2 and 45 CFR Parts 160 and 164 (HIPAA Privacy and Security rules) if applicable.

Please note that treatment at Quality Physical Therapy, Inc.’s Outpatient Clinics and/or any facility or offices provides additional protections, as noted throughout this Notice. The Notice applies to your health information created and/or maintained at any Quality Physical Therapy, Inc. facility or office, including any information we receive from other healthcare providers or facilities.

Your health information includes individually identifiable information related to your past, present or future health, treatment or payment for health care services.

Our Responsibilities to You

We are required by law to maintain the privacy of your health information (sometimes referred to as “Protected Health Information” or “PHI”), to provide you with this Notice of our legal duties and privacy practices with respect to your health information, and to comply with the terms of our Notice currently in effect. We are required by law to notify you following a breach of privacy of your PHI. If you are a minor or otherwise incapacitated, we will notify your parent/guardian, or other person responsible for you. Patient Privacy at Quality Physical Therapy, Inc., your privacy is a priority. We follow federal and state guidelines to maintain the confidentiality of your medical (protected health) information.

Protected Health Information

PHI is any information about your past, present or future health care, or payment for that care that could be used to identify you. Members of our workforce and our business associates may only access the minimum amount of Protected Health Information that they need to complete their assigned tasks.

Use and Disclosure of PHI

When you visit any Quality Physical Therapy, Inc.’s facility or office, we use and disclose your protected health information to treat you, to obtain payment for services, and to conduct normal business known as health operations. We may also share information with a contracted business associate who must meet our privacy requirements. How we use and disclose your information includes:

• We do not need your authorization for the following uses and disclosures. Any uses and/or disclosures may be made by paper and/or electronic methods.
• Treatment – We document each visit. This documentation may include your evaluation, daily notes, test results, diagnoses and medications. This allows your therapists and other clinical staff to provide the best care to meet your needs.
• Payment – We document the services and supplies you receive at each visit so that you, your insurance company, or another third party can pay us. We may tell your health plan about upcoming treatment or services that require its prior approval or to determine if your plan covers that treatment. We may also give information to someone who helps pay for your care.

We may also use information to:

• Recommend treatment alternatives
• Tell you about health benefits and services
• Communicate with other, healthcare providers, physician practices, and/or any other business associates for treatment, payment or health care operations.
• Send appointment reminders
• Communicate with family or friends involved in your care with your permission, or if they are involved in your care or payment for your care. We may use or share your health information to notify a family member or other person responsible for you of your location, general medical condition or death. If you are present and are able to make health care decisions, we will try to find out if you want us to share this information with your family members or others. If you are in an emergency situation and not able to make your wishes known, we will use our best judgment to decide whether to share information. If it is thought to be in your best interest, we will only share information that others really need to know.

There are other times when we are permitted or required to disclose medical information without your signed permission. These situations include:

1) Public health activities, such as:
a) To report health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability
b) To report child abuse and neglect, elder abuse, disabled persons abuse, or rape or sexual assault to public health authorities or other government authorities authorized by law to receive such reports
c) To report information about products and services under the jurisdiction of the U.S. Food and Drug Administration
d) To notify people of recalls of products they may be using
e) To report information to your employer and/or the Massachusetts Industrial Accident Board as required under laws addressing work-related illnesses and injuries or workplace medical surveillance
f) Massachusetts Immunization Information System (immunization registry)

2) Health oversight activities, such as disclosing PHI to a health oversight agency that oversees the health care system or government benefit programs (such as Medicare or Medicaid) or fraud investigations
3) As required by state and federal laws and regulations
4) For judicial or administrative proceedings, in response to a legal order or other lawful process
5) If required by law or for law enforcement
6) To coroners, medical examiners and funeral directors
7) For organ donations, if you are an organ donor
8) To avert serious threat to public health or safety
9) To prevent or lessen a serious danger to you or to others
10) For specialized government functions such as national security and intelligence
11) As authorized by and as necessary to comply with workers compensation laws
12) To a correctional institution if you are an inmate
13) For research following strict review to ensure protection of information
14) For an examination ordered by a court or detention facility
15) For Quality Improvement Purposes.
16) As required by law and not already referred to in the preceding categories, Quality Physical Therapy, Inc. will not release any physician records maintained outside of this medical office without your authorization to release information or a proper judicial order. In order for us to disclose Highly Confidential Information for a purpose related to treatment, payment, or healthcare operations, we must obtain your separate, specific written consent unless we are otherwise permitted by law to make such disclosure. There are some limited exceptions to these rules when your permission is not necessary before the use/disclosure can occur (including, by way of example, but not limited to, disclosure for research purposes). If you are an emancipated minor, or we are treating you as a mature minor without parental consent as allowed under Massachusetts law, certain information relating to your treatment or diagnosis may be considered “Highly Confidential Information” and, as a result, will not be disclosed to your parent or guardian without your consent. Your consent is not required, however, if a therapist reasonably believes your condition to be so serious that your life or limb is endangered. Under such circumstances, we may notify your parents or legal guardian of the condition and will inform you of any such notification. Please note that if you are a parent or legal guardian of an emancipated minor, certain portions of the emancipated minor’s medical record (or, in certain instances, the entire medical record) may not be accessible to you. Other uses and disclosures not previously described may only be done with your signed authorization. You may revoke your authorization in writing at any time.

Contacting You

In order for Quality Physical Therapy, Inc. to service your account or collect any amounts you owe, Quality Physical Therapy, Inc., its agents, and its business associates may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. Quality Physical Therapy, Inc., its agents, and its business associates may also contact you by sending text messages or emails using any email address you provide to Quality Physical Therapy, Inc. Methods of contact may include the use of pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable.

As a patient of Quality Physical Therapy, Inc., you have the right to:

• Notwithstanding the foregoing section, request that we restrict how we use or disclose your medical information (we are not required to abide by your request). All requests must be made in writing. If you request a limitation on disclosure to a family member, we may not be able to bill your family’s health plan, and you will be financially responsible for paying us for your care. You may not ask us to restrict disclosure that we are legally required to make. However, if you pay for service(s) in full and out of pocket, and you request that we not share any information about the services to your health plan for purposes of carrying out payment or health care operations, we will comply with your request unless otherwise instructed by law.
• Request that we use a specific telephone number or address to communicate with you. You may request, and we will accommodate, a reasonable written request for you to receive PHI by alternate means of communication or alternative locations.
• Inspect and make a written request, by you or your authorized representative, to receive a copy of your medical record information (fees will apply, unless the record is requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act or any federal or state needs-based program, upon reasonable documentation regarding such purpose).
• Request an amendment to your medical information (reason required) in writing. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.
• Register a complaint with Quality Physical Therapy, Inc or with the Secretary of the Department of Health and Human Services. To register a complaint with us you may contact the Privacy Officer at 508-347-8141. We will not retaliate against you if you file a complaint with us or the Secretary.
• You may revoke any authorization at any time in writing. However, such revocation does not apply to uses or disclosures made in reliance on authorization given prior to revocation.
• Notification in the event of a breach of you PHI Medical Records Retention In accordance with Massachusetts law, Quality Physical Therapy, Inc. maintains physical therapy and occupational therapy medical records for 10 years after the patient’s discharge or after the final treatment. After such period has elapsed the medical records will be destroyed in a manner consistent with state and federal privacy laws.

Please note that Quality Physical Therapy, Inc. is not required by law to notify you prior to destruction of medical records. If you wish to receive a copy of your medical record information, you must do so within the time limits described in this Notice.

How to Contact Us

If you have questions about this notice or if you would like to exercise your rights because you feel your privacy rights have been violated you may contact:

Privacy Officer
Quality Physical Therapy, Inc.
135 Main Street
Sturbridge, MA 01566
508-347-8141
Info@QualityPhysicalTherapy.com

All complaints will be investigated, and you will not suffer retaliation for filing a complaint. You may also file a complaint with the Secretary of Health and Human Services in Washington, D.C. We reserve the right to change privacy practices and make the new practices effective for all the information we maintain. We will post a copy of this Notice in all our registration areas for public viewing and on our website at https://QualityPhysicalTherapy.com

You may also request a copy of this Notice at any time.

This Notice applies to the following organization:
Quality Physical Therapy, Inc.