Law Enforcement We may release Health Information if asked by a law enforcement official if the information is: In response to a court order, subpoena, warrant, summons, or similar process; Limited information to identify or locate a suspect, fugitive, material witness, or missing person; About the victim of a crime even if under certain very limited circumstances we are unable to obtain the person's agreement; About a death we believe may be the result of criminal conduct; About criminal conduct on our premises; In an emergency to report a crime, the location of the crime or victims, or the identify, description, or location of the person who committed the crime.
Coroners, Medical Examines, and Funeral Directors We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities We may release Health Information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others We may disclose Health Information to authorized federal officials SO they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations.
Inmates or Individuals in Custody If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be made if necessary; For the Institution to provide you with health care; To protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.
You have the following rights regarding Health Information we have about you:
Right to Inspect and Copy You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information you must make your request, in writing, to E.T.C. Physical Therapy P.O. Box 320, Belton, MO 64012.
Right to Amend If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to E.T.C. Physical Therapy P.O. Box 320, Belton, MO 64012.
Right to an Accounting of Disclosures You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to E.T.C. Physical Therapy P.O. Box 320, Belton, MO 64012.
Right to Request Restrictions You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to E.T.C. Physical Therapy P.O. Box 320, Belton, MO 64012. We are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to Request Confidential Communication 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 contact you only by mail or at work. To request confidential communication, you must make you request, in writing, to E.T.C. Physical Therapy P.O. Box 320, Belton, MO 64012. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice You have the right to a paper copy of this notice. You may ask us to give you copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and HumanServices. To file a complaint with our office, contact E.T.C. Physical Therapy at 816-331-9111. All complaints must be made in writing. You will not be penalized for filing a complaint.
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