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This notice describes how medical information about you might be used and disclosed, and how you can get access to that information. Please read it carefully. General Information: Each time you are admitted and receive treatment at this office a record of the visit and services is made. This record generally will include authorization and consent forms, physician prescription, benefit profile of your insurance, workers compensation information, a subjective history, physical assessment, diagnostic reports such as range-of-motion or gait analysis, plan-of-care, progress reports, and daily notes. The file may also contain documentation of telephone conversations or e-mail correspondence you may have with your provider of services or any other correspondence pertaining to your case as provided by other parties including other healthcare practitioners, lawyers, case-workers, and insurance representatives. This information is included in your health record either manual and/or computerized and is used as a: • Source for documenting assessment, planning care and treatment, recording informed consent, recording progress, ongoing assessment of health status/progress/needs • Means of communicating among health professionals who evaluate you and/or provide care and treatment • Source to support billing for services and to meet requirements for third party payers • Legal document supporting the care, services, and treatment provided • A resource during surveys by the state, federal , and other agencies • A toll with which we can assess and continually work to improve care • A source to be used by students and a tool in educating health professionals Understanding what is in your record and how your health information is used will assist you to : ENSURE ACCURACY, BETTER UNDERSTAND who, what where, when, and why others may need access to your heath information, MAKE INFORMED DECISIONS when authorizing disclosure to others. Your Rights: The health record is the physical property of the organization that compiled it . The information belongs to you. You have the right to: • Request restriction on certain uses and disclosures of your information provided by 45CFR 164.522 • Inspect and copy your health record as provided for in 45CFR 164.524 • Amend your health record as provided in 45CFR 164.528 • Request alternate means of communication to obtain your health information 45 CFR 164.522(b) • Request an accounting of disclosures of Protected Health Information 45 CFR 164.528 • Revoke authorization to use or disclose health information except to the extent that action has already taken 45 CFR 164.508 (b) (5) • Report a problem - or if you have a question, or desire additional information you may contact:
• File a complaint if you think your privacy rights have been violated. Written complaints may be submitted to: INVIVO Wellness 1924 N. Farwell Av. Milwaukee, WI 53202 • You are also notified that you may file a complaint with the: Secretary of Health and Human Services, Office for Civil Rights Helene Nelson, 1 W. Wilson Street #650 Madison, WI 53702 INVIVO Wellness Physical Therapy Responsibility • Maintain the privacy of your health information, to use and disclose information only with your consent or authorization, unless there are exceptions described in this notice or otherwise allowed by related laws, rules, and regulations • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect, maintain, use, and disclose about you • Abide by this notice • Provide any amendment record along with other documents when information is disclosed • Notify you if you we are unable to agree to requested restriction’s • Accommodate reasonable requests you may have to communicate health information by alternate means or at alternate locations • Use or disclose your health information as required for statistical and funding purposes by INVIVO Wellness, Midwest Rehab Network Inc. (MRNI), the Center for Disease Control (CDC), and the Center for Medicare and Medicaide Services (CMS) INVIVO Wellness reserves the right to change our privacy practices and to make new practices known to you through our routine methods of communication to the latest address/contact provided. Examples of Disclosure for Treatment, Payment, and Health Operations Your health information will be used for the following: We will use your information for treatment. Information obtained by the physical therapist will be recorded in your chart. This information is used to plan your treatment and services as well as to document progress, events, plans of care, observations ad evaluation of care and treatment, information for consultants, diagnostic services or for other providers on transfer, hold, or discharge status. We will use your health information for payment. A bill may be sent to a third party such as Medicare, Health Maintenance Organization (HMO), and Insurance Companies, or to you. At least some health 8information may be provided to the payee that identifies your demographic information, the diagnosis, and additional health information to support billing. We will use your heath information for health care operations. INVIVO Wellness and staff will use the health/medical record information as needed to carry out the regular operations of the physical therapy department and the respective clinical needs of the treatment staff including the: • Collecting and reporting to MRNI and TAOS corporation • Use for specific quality assurance processes, committee meetings, on-site reviews for management, internal surveys quality assurance processes and reviews • Health record information needed for administrative reporting usually for internal Physical Therapy Department use and/or INVIVO Wellness Corporation. Uses of this information may or may not be specific to a patient’s name (i.e., collecting information regarding incidents and trends for management purposes Business Associates: INVIVO Wellness Physical Therapy Department may use outside providers for some of the services that we provide through contracts/agreements. Some examples of this may be orthotic consultation or Certified Pilates Instructor led classes. Patient Location: Patient location will be provided (unless there is an opposing designation in writing) to those individuals who are determined to be legally authorized representative to obtain the information, responsible party, emergency contact, and in case of conservatorship application, the attorney representing the client. Notification and Communication: INVIVO Wellness Physical Therapy may use or disclose health information to notify or assist in notifying representatives as identified as a responsible party/emergency contact. The latest available address will be utilized. It is understood the information may be provided to you for appointments, results of tests, general information that would not be confidential via telephone, including voice mail message, e-mail, fax, and written. The Physical Therapy Department may notify the responsible representatives of appointments, or special meetings to discuss care and treatment. INVIVO Wellness is not responsible for assuring the information is retained private once it is provided through agreed upon communication methods or when submitted to the name(s) of the responsible party/emergency contact. Research: Disclosure of health information for the purposes of research shall only be made after documented approval for the research. Names of the individual will not be included unless there is specific authorization. Funeral Directors and Coroner’s Office: In the event it is necessary we may disclose the health information to funeral directors and coroner’s office consistent with applicable laws as required for them to carry out their duties. Food and Drug Administration, Public Health, and other required reporting: We may disclose health information to the extent that it is required by law and in the best interest of the client and the requirements of the requesting agency. Workers Compensation and Employee Actions: Information may be disclosed to the extent only as required to carry out the required activities. The privacy of the resident/patient will be protected within the legal parameters of State. Law Enforcement: Disclosure of health information will be provided to the extent necessary to carry out health and safety of the individual (I.e., general description of the person applicable health condition, special marks, clothing type, other identification type, other identification data, and information as required by law based on the situation Effective Date: 04/01/2003 |
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INVIVO is conveniently open: Monday - Friday 10:00 - 7:00 p.m.
Please call to book an appointment or to set up a free -screening.