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.
Under the Health Insurance Portability and Accountability Act of 1996, Strong Roots Physical Therapy, LLC is required to provide you with this notice of protected health information Practices regarding our legal duties, policies, and procedures in place to protect and maintain the privacy of your health information, and to make you aware of our duties and your rights.
We are required to maintain the privacy of your individually identifiable protected health information. Your individually identifiable health information is information received or created by us or other health care providers that relates to: your past, present, or future health or condition; the provision of your health care; or any payments you have made or will make in the future for the provision of health care, that holds identifying information about you, or could reasonably be used to identify you. If there is ever any breach of this protected health information, we are required to notify you.
While we are required to abide by the terms of the notice currently in effect, we reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information that it maintains. If a material change is made, we will promptly notify you by distributing the new notice upon your next visit.
Uses and disclosures to carry out treatment, payment, or health care operations
We are permitted to disclose your health information for the provision of care you are receiving from us. We are also permitted to disclose your health information to other healthcare providers to coordinate care or assist with your care and treatment outside of physical therapy. An example of this would be your pediatrician disclosing your health information to us, or visa-versa, to coordinate care for your physical therapy needs.
We are also permitted to disclose your protected health information for purposes of billing for our services. We can use and share your protected health information to bill and get payment from health plans or other entities. This information may be released to an insurance company, third party payor, or other authorized entity involved in the payment of your medical bill and may include copies of portions of your medical record which are necessary for payment of your account. For example, we may give information to your health insurance plan so it will pay for your services.
Lastly, we may disclose your protected health information for health care operations activities. This includes activities such as conducting quality assessment and improvement activities, patient safety activities, reviewing the competence or qualification of health care professionals, evaluating practitioner and provider performance, training, accreditation, certification, and credentialing activities.
Uses and disclosures for which an authorization or opportunity to agree or object is not required
Under the privacy regulations we are permitted to use or disclose your protected health information without your written authorization or the opportunity for you to agree or object in the following situations:
Uses and disclosures required by law. We may use or disclose your protected health information to the extent that such use or disclosure is required by law.
Uses and disclosures for public health activities. We may use or disclose your protected health information to a public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability.
Victims of abuse or neglect. We may also disclose your health information to a public health authority or appropriate government authority authorized by law to receive reports of child abuse or neglect.
Uses and disclosures for health oversight activities. We are permitted to disclose your protected health information to a health oversight agency for oversight activities authorized by law.
Disclosures for judicial and administrative proceedings. We are permitted to disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal, in response to a subpoena, or other lawful process.
Disclosure for law enforcement purposes. We may disclose your protected health information to a law enforcement official when required to do so by law.
Coroners, medical examiners, funeral directors. We may disclose your health information to coroners, medical examiners, and funeral directors for purposes of identifying a cause of death or as necessary for them to carry out their duties with respect to a decedent.
Research. We may disclose your health information for research provided that the study has been approved by an institutional review board that has determined your privacy rights and related interests will not be harmed.
Serious threats to health or safety. Your information may be disclosed if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Armed Forces Personnel. Your information may be disclosed for specialized government functions where activities are deemed necessary by appropriate military command authorities to assure the proper execution of the military mission.
Uses and disclosures for which authorization is required
Under the privacy regulations we must obtain your written authorization to use or disclose your protected health information for marketing purposes, except if the marketing is through face-to-face communications or for promotional gifts of nominal value provided by us. We are also required to obtain your written authorization for any sale of protected health information. Any other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization at any time in writing, however, such revocation will not have any effect on uses or disclosures of your health information prior to our receipt of the revocation.
Uses and disclosures for which the opportunity to agree or object is required
Under the privacy regulations we may use or disclose your health information to a family member, other relative, or close personal friend, or any other person identified by you if the information will assist the person in administering your health care. We may disclose this information if you are present and agree to the disclosure or if you do not express an objection. If you are not present, we will use our professional judgment to determine whether the disclosure is in your best interest, and if so, disclose only the information that is directly relevant to the person’s involvement with your care or payment.
Your rights concerning your protected health information
You have a right to request restrictions on the use and disclosure of your health information for treatment, payment, and health care operations. However, we are not required to agree with such a restriction unless the restriction is for disclosure to a health plan and the purpose of the disclosure is for carrying out payment or health care operations and you have already paid us in full. If however, we agree to a restriction, it is binding on us.
You have a right to access, inspect, and amend your health information or record. We may deny your request to amend if it is determined that the health information at issue was not created by us, is not part of our record set, is not available for inspection due to the information being compiled in reasonable anticipation of, or for use in, civil, criminal, or administrative action or proceeding, or if the information is accurate and complete.
You have a right to an accounting of disclosures of your protected health information made in the six (6) years prior to the date on which the accounting is requested. This accounting will not include disclosures to carry out your treatment, payment, and health care operations; disclosures to you about your own health information; disclosures pursuant to a valid authorization; disclosures to people involved in your health care; or disclosures permitted by the privacy regulations. The accounting will include the dates of the disclosure, the name of the entity or person who received the protected health information, a brief description of the protected health information disclosed, and a statement of the purpose of the disclosure.
Lastly, you have a right to receive a copy of this notice upon request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201. To file a complaint with us, please contact the Compliance Officer at (380) 289-7277. All complaints must be submitted in writing to the practice at 1135 Four Lakes Drive, Matthews, NC 28105.
Effective Date 6/18/26
Location: 1135 Four Lakes Drive Matthews, NC 28105
Phone: 380-289-7277
Email: chelseacrist@strong-roots-pt.com