Springs Rehabilitation, P.C.

Notice of Privacy Practices

Effective Date: April 14, 2003

THIS NOTICE DESCRIBES HOW SPRINGS REHABILITATION, PC MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Springs Rehabilitation, PC is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Springs Rehabilitation, PC or received by Springs Rehabilitation, PC from other healthcare providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice. Springs Rehabilitation, PC will abide by the terms of this Notice, or the Notice currently in effect at the time of the use or disclosure of your protected health information.

Springs Rehabilitation, PC reserves the right to change the terms of the Notice and to make any new provisions effective for all protected health information that we maintain. Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of the current Notice from our office at any time.

Uses and Disclosures of Your Protected Health Information not Requiring Your Consent

Springs Rehabilitation, PC may use and disclose your protected health information, without your written consent or authorization, for certain treatment, payment and healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration and all other records concerning individuals who are receiving, or who at any time have received services for mental illness, developmental disabilities, alcoholism, or drug dependence. There are also restrictions on disclosing HIV test results.

For Treatment:

  • Providing, coordinating, or managing healthcare and related services by one or more healthcare providers;
  • Consultations between healthcare providers concerning a patient;
  • Referrals to other providers for treatment;
  • Referrals to nursing homes, foster care homes, or home health agencies.

For example, Springs Rehabilitation, PC may determine that you require the services of a specialist. In referring you to another doctor, Springs Rehabilitation, PC may share or transfer your healthcare information to that doctor.

For Payment:

  • Activities undertaken by Springs Rehabilitation, PC to obtain reimbursement for services provided to you;
  • Determining your eligibility for benefits or health insurance coverage;
  • Managing claims and contacting your insurance company regarding payment;
  • Collection activities to obtain payment for services provided to you;
  • Reviewing healthcare services and discussing with your insurance company the medical necessity of certain services or procedures, coverage under your health plan, appropriateness of care, or justification of charges;
  • Obtaining pre-certification and pre-authorization of services to be provided to you.

For example, Springs Rehabilitation, PC will submit claims to your insurance company on your behalf. This claim identifies you, your diagnosis, and the services provided to you.

For Healthcare Operations:

  • Contacting healthcare providers and patients with information about treatment alternatives;
  • Conducting quality assessment and improvement activities;
  • Conducting outcomes evaluation and development of clinical guidelines;
  • Protocol development, case management, or care coordination;
  • Conducting or arranging for medical review, legal services, and auditing functions.

For example, Springs Rehabilitation, PC may use your diagnosis, treatment, and outcome information to measure the quality of the services that we provide, or assess the effectiveness of your treatment when compared to patients in similar situations.

Springs Rehabilitation, PC may contact you, by telephone or mail, to provide appointment reminders. You must notify us if you do not wish to receive appointment reminders.

We may not disclose your protected health information to family members or friends who may be involved with your treatment or care without your written permission. Health information may be released without written permission to a parent, guardian, or legal custodian of a child; the guardian of an incompetent adult; the healthcare agent designated in an incapacitated patientís healthcare power of attorney; or the personal representative or spouse of a deceased patient.

There are additional situations when Springs Rehabilitation, PC is permitted or required to use or disclose your protected health information without your consent or authorization. Examples include the following:

Springs Rehabilitation, PC will not make any other use or disclosure of your protected health information without your written authorization. You may revoke such authorization at any time, except to the extent that Springs Rehabilitation, PC has taken action in reliance thereon. Any revocation must be in writing.

Your Rights Regarding Your Protected Health Information

You are permitted to request that restrictions be placed on certain uses or disclosures of your protected health information by Springs Rehabilitation, PC to carry out treatment, payment, or healthcare operations. You must request such a restriction in writing. We are not required to agree to your request, but if we do agree, we must adhere to the restriction, except when your protected health information is needed in an emergency treatment situation. In this event, information may be disclosed only to healthcare providers treating you. Also, a restriction would not apply when we are required by law to disclose certain healthcare information.

You have the right to review and/or obtain a copy of your healthcare records, with the exception of psychotherapy notes, or information compiled for use (or in anticipation for use) in a civil, criminal, or administrative action or proceeding. Springs Rehabilitation, PC may deny an access under other circumstances, in which case you have the right to have such a denial reviewed. We may charge a reasonable fee for copying your records.

You may request that Springs Rehabilitation, PC send protected health information, including billing information, to you by alternative means or to alternative locations. You may also request that Springs Rehabilitation, PC not send information to a particular address or location or contact you at a specific location, perhaps your place of employment. This request must be submitted in writing. We will accommodate reasonable requests by you.

You have the right to request that Springs Rehabilitation, PC amend portions of your healthcare records, as long as such information is maintained by us. You must submit this request in writing, and under certain circumstances the request may be denied.

You may request to receive an accounting of the disclosures of your protected health information made by Springs Rehabilitation, PC for six years prior to the date of the request, beginning with disclosures made after April 14, 2003. We are not required, however, to record disclosures we make pursuant to a signed consent or authorization.

You may request and receive a paper copy of this Notice, if you had previously received or agreed to receive the Notice electronically.

Any person or patient may file a complaint with Springs Rehabilitation, PC and/or the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with Springs Rehabilitation, PC, please contact the Privacy Officer at the following:

Privacy Officer
Springs Rehabilitation, PC
2960 N. Circle Drive, Ste. 125
Colorado Springs, CO 80909
(719) 634-7246

It is the policy of Springs Rehabilitation, PC that no retaliatory action will be made against any individual who submits or conveys a complaint of suspected or actual non-compliance or violation of the privacy standards.