Notice of Privacy Practices for Shira Racoosin Physical Therapy, PLLC

Effective Date: 01/01/2025

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.

Shira Racoosin Physical Therapy, PLLC (“us,” “we,” “our”), is committed to protecting the confidentiality of our patients’ protected health information (PHI). This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your PHI and your rights concerning your PHI. This Notice is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (HIPAA).

Shira Racoosin Physical Therapy, PLLC is required by law to maintain the privacy of protected health information, to provide individuals with notice of its legal duties and privacy practices, and to notify affected individuals following a breach of unsecured PHI. 

Shira Racoosin Physical Therapy, PLLC is required to abide by the terms of the Notice currently in effect. We reserve the right to change the terms of the Notice and to make the new notice provisions effective for all PHI that we maintain. If we change the terms of this Notice, the revised Notice will be made available upon request and posted on our website.

Use and Disclosure of Your Protected Health Information That May Be Made Without Your Consent 

We may use and/or disclose your protected health information for the following purposes:

- Treatment: We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.

- Payment: We may use and disclose your PHI to obtain payment for the services we provide to you. We may use and disclose your PHI to prepare and send a bill to you or to the person responsible for payment of your bill.

- Healthcare Operations: We may use and disclose your PHI for our healthcare operations, including quality improvement activities and administrative functions for Shira Racoosin Physical Therapy, PLLC.

Other:

- With family or legally authorized representative: We may disclose your PHI to a family member or legally authorized representative who is involved in your medical care. We may also use or disclose your PHI to notify (or assist in notifying) a family member, legally authorized representative or other person responsible for your care. If you are a minor, we may release your PHI to your parents or legal guardians when we are permitted or required to do so under federal and applicable state law.

- With third-party service providers: We may disclose your PHI to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement with them to safeguard your information. Examples of these third parties include, but are not limited to our third party practice management software provider, accreditation agencies, collection agencies, etc. 

- As required by law or judicial and administrative processes: We may disclose your PHI to comply with legal obligations such as worker’s compensation laws; or responding to subpoenas, court orders, or other judicial and administrative processes.

Use and Disclosure of Your Protected Health Information That May Be Made With Your Written Authorization:

Marketing: Your written authorization is required for us to use and disclose your PHI for most marketing purposes.

Your Individual Rights

Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI. All requests must be made in writing and signed by you or your legal representative.

Right to Amend: If you believe that your PHI is incorrect, you have the right to request an amendment. All requests must be made in writing and signed by you or your legal representative. Shira Racoosin Physical Therapy, PLLC is not required to make requested amendments, but will give careful consideration to each request. 

Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI.

Right to Request Restrictions: You possess the right to request that we refrain from using or disclosing specific portions of your PHI for treatment, payment, or healthcare operations. While we will carefully consider your request, it is important to note that we are obligated to agree to restrict a disclosure to a health plan only for purposes of payment or healthcare operations, and not for treatment. This agreement applies exclusively to healthcare services for which full out-of-pocket payment has been made. If a restriction is agreed upon, we commit to not using or disclosing your PHI contrary to that restriction, except in cases where emergency treatment is required. It is essential to understand that we cannot agree to restrictions on the use or disclosure of PHI when such actions are legally mandated or necessary for the administration of our business. All requests for restrictions must be submitted in writing and signed by you or your legal representative.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location.

Right to Obtain a Paper Copy of this Notice: You have the right to obtain a paper copy of this Notice upon request, even if you agreed to accept this Notice electronically.

Complaints

If you believe your privacy rights have been violated as applicable to your PHI maintained by Shira Racoosin Physical Therapy, PLLC, you may file a complaint by contacting shira@shiraracoosin.com. You will not be retaliated against for filing a complaint.

Contact

For questions or for further information regarding our privacy practices, you can contact:

Shira Racoosin Physical Therapy, PLLC

Phone: 301-578-6178

Email: shira@shiraracoosin.com