THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Alinea Performance is committed to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the confidentiality of your health information. We realize that these laws are complicated, but we must provide you with the following important information.
We may use and disclose your PHI to provide, coordinate, or manage your physical therapy care. For example:
We may use and disclose your PHI to obtain payment for services we provide to you. For example:
We may use and disclose your PHI in connection with our healthcare operations. For example:
We may use or disclose your PHI without your authorization in the following situations:
You have the right to inspect and copy your PHI that we maintain. To do so, you must submit a written request. We may charge a fee for the costs of copying, mailing, or other associated supplies.
You have the right to request an amendment of your PHI if you believe it is incorrect or incomplete. Your request must be in writing and include a reason that supports your request.
You have the right to request an accounting of disclosures of your PHI made by us. Your request must be in writing.
You have the right to request a restriction or limitation on the PHI we use or disclose about you. We are not required to agree to your request except when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
You have the right to a paper copy of this notice. You may ask us to give you a copy at any time.
We reserve the right to change this notice and make the new notice apply to PHI we already have as well as any information we receive in the future. We will post a copy of our current notice in our facility and on our website. The notice will contain the effective date.
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact:
Privacy Officer: Joseph Rosi II
Phone: 813-560-0635
Address: 10129 Westpark Preserve Blvd Tampa, FL 33625
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose PHI about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.
