This notice describes how medical information about you may be used and disclosed, and how you
may get access to this information. Please review it carefully. If you have any questions about this
notice, please contact our Privacy Officer at our practice.
Each time you visit Point Performance your medical record is updated to document your symptoms,
exam and test results, diagnosis, treatment and recommendations for future treatment. We are
required by law to ensure that your medical information is kept private, to give you this Notice of
Privacy Practices, and to follow the terms of the notice that are currently in effect. We may change the
terms of our notice at any time. You may request a revised copy of this notice by asking for it at your
next appointment or contacting our Privacy Officer.
HOW POINT PERFORMANCE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following describes different ways Point Performance may use and disclose your medical
information. We have included examples of each. Your protected health information may be used and
disclosed by your physician, Point Performance staff, and others outside of Point Performance involved
in providing health care services to you.
Treatment. We may use your medical information to provide, coordinate or manage your medical
treatment or services. For example, information obtained by our physicians, physical therapists, and medical assistants will be recorded and used to determine the best course of treatment for you. This information may be shared with other healthcare providers involved in your healthcare diagnosis or treatment.
Payment. We may use and disclose your medical information to receive payment for your healthcare
services. For example, we may send a bill to you, an insurance company, or a third party that includes
information about you and your health care services. We may also communicate with your health
insurance carrier for prior approval for a treatment or to determine if a treatment is covered under
your plan. We may contact you by phone to discuss your account.
Health Care Operations. We may use and disclose your medical information to support the business
activities of the practice. These activities may include equality assessment activities, employee review
activities, training of staff or students, and conducting or arranging for other business activities. We
may also use a sign-in sheet at the registration desk where you will be asked to sign your name and
indicate which physician you are seeing. We may call you by name in the waiting room when your
physician is ready to see you.
Business Associates: We may use a third party or business associate to perform various functions
necessary to the practice (e.g., billing and IT support/software). We require all business associates to
sign contracts stating they will protect your information.
Appointment Reminders. We may use and disclose medical information when we contact you by
phone or mail to remind you of an appointment.
As Required By Law. We will disclose medical information when required to do so by federal, state or
local law, in response to a court order, valid subpoena, warrant, summons or similar process.
Military and Veterans. We may release medical information of patients in the armed forces as
required by military command authorities.
Workers’ Compensation. We may release your medical information to comply with workers’
Public Health. We may disclose your medical information for public health reasons. Some common
reasons for disclosure are to:
· Prevent or control disease, injury or disability;
· Report births and deaths; Report child neglect or abuse;
· Report reactions to medications and/or problems with products (i.e. FDA reporting);
· Notify people of recalls of products they may be using;
· Notify a person who is at risk for exposure to a disease or may be at risk for contracting or spreading a disease or condition;
· Notify the appropriate government authority if we think a patient has been the victim of neglect, abuse, or domestic violence.
We will only make this disclosure if you agree or when we are required or authorized by law.
Law Enforcement. When legal requirements are met, we may release your medical
information if asked to do so by a law enforcement official:
· For legal processes that are required by law;
· Concerning victim(s) of a crime;
· Regarding a death we believe may have occurred as a result of a crime;
· If a crime occur on the premises of Point Performance
· During a medical emergency when it is likely that a crime has occurred.
Coroners, Medical Examiners and Funeral Directors. Medical information may be released to a
coroner or medical examiner for identification purposes or to determine the cause of death. As
authorized by law, we may release medical information to funeral directors to permit the
funeral director to carry out his or her duties.
Inmates: If you are an inmate of a correctional institution or in the custody of a law
enforcement official, we may release your medical information to the correctional institution or
law enforcement official.
Emergencies/Communication Barriers: we may disclose your health information in the event
of an emergency health situation or if significant communication barriers exist and the
physician determines, using professional judgment, that you intend to consent to use or
disclosure under the circumstances. Your physician will attempt to obtain your consent as soon
as possible after the delivery of treatment. If your physician is required by law to treat you, he
or she may disclose your health information with or without your consent.
Family and Others Involved in your Care or Payment for your Care: Using our best judgment,
we may disclose health information about you to a family member, relative or friend involved in
your medical care or the payment of your care.
Organ and Tissue Donation: If you are an organ donor, we may release your medical
information to organizations engaged in the procurement, banking or transplantation of organs
in order to aid in the organ or tissue donation and transplantation.
Research: We may disclose medical information to researchers if an institutional review board
has approved the research proposal and protocols are in place to ensure the privacy of your
YOUR MEDICAL INFORMATION AND YOUR RIGHTS
Your health record is the physical property of your healthcare provider. The information,
however, belongs to you. You have the following rights:
Right to Inspect and Copy: You have the right to inspect and obtain a copy of your medical
record. This typically includes medical and billing records. If you would like to inspect your
medical information, please submit your written request to our Privacy Officer or request
access to the patient portal. If you would like to request a copy of your medical information,
please submit your written request to the practice.
Right to Request a Restriction: You have the right to request restrictions on the use and
disclosure of your medical information. You may request that any or part of your health
information be restricted for the purpose of treatment, payment, healthcare operations, or
disclosure to family or friends. We are not required to agree to your request. If your physician
determines that it is in your best interest to use and disclose this information, your request will
be denied. If your physician approves your request, we will not use or disclose your health
information unless it is needed to provide emergency treatment or required by law.
To request a restriction, please submit your written request to our Privacy Officer. Your
request must include:
· The information you wish to restrict
· If you want to limit Point Performance use, disclosure, or both
· To whom the limits should apply
Right to Obtain an Accounting of Disclosures: You have the right to request an accounting of
certain disclosures we have made (if any) of your health information, which do not fall under
the routine disclosures stipulated for payment, treatment and/or healthcare operations or for
which you have not additionally authorized in writing. To request an accounting of such
disclosures, please submit your written request to our Privacy Officer. Your request must
include a time period of not longer than six years. Please indicate in your request how you
would like this information provided to you, for example, on paper, electronically, etc. We will
provide you one free copy. You will be charged for any additional accountings. We will notify
you of the cost involved with additional requests. At that time, you may choose to withdraw or
modify your request before any costs are incurred.
Right to Confidential Communications from Point Performance. We will accommodate
reasonable requests for confidential communications. We reserve the right to condition your
request based on information you provide regarding your management of payment and our
ability to reach you at an alternative address or other method of contact. To request
confidential communications, please send your written request to our Privacy Officer and
specify how or where you wish to be contacted.
Right to Have your Physician Amend your Protected Health Information: This means you may
request an amendment of protected health information about you in a designated record set
for as long as we maintain this information. In certain cases we may deny your request for an
amendment. If we do so, you have the right to file a statement of disagreement with us and we
may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
Please contact our Privacy Officer to determine if you have questions about amending your
Right to Obtain an Electronic Copy of This Notice Upon request, and at any time, we will
provide you with an electronic copy of this Notice. To request a paper copy of this notice,
please contact our Privacy Officer.
If you believe your privacy rights have been violated, contact our Privacy Officer, without fear of
retribution. All complaints must be submitted in writing and will be handled confidentially. The
Privacy Officer will contact you within 10 business days of receipt of your complaint.
Should you feel further assistance is warranted, you may contact the Office for Civil Rights/U.S.
Department of Health and Human Services at 200 Independence Avenue, S.W., Rm 509F HHH
Building, Washington, D.C. 20201 or call the Office of Civil Rights (OCR) at 1-800-368-1019.