BARCLAY PHYSICAL THERAPY
555 Barclay Circle, Suite 110 * Rochester Hills, MI 48307 * (248) 853-5853* Fax: (248) 853-5928
51517 Van Dyke * Shelby Twp., MI 48315 * (586) 739-4465 * Fax (586) 739-4751
NOTICE OF PATIENT INFORMATION PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR
DISCLOSED AND HOW YOU CAN GET ACCESS TO INFORMATION. PLEASE REVIEW IT CAREFULLY.
Barclay Physical Therapy's LEGAL DUTY
Barclay Physical Therapy is required by law to protect the privacy of your personal health information, provide this notice about our information practices and follow the information practices that are described herein.
USES AND DISCLOSURES OF HEALTH INFORMATION
Barclay Physical Therapy uses your personal health information primarily for treatment; obtaining payment for treatment; conducting internal administrative activities and evaluating the quality of care that we provide. For example, Barclay Physical Therapy may use your personal health information to contact you to provide appointment reminders, or information about treatment alternatives or other health related benefits that could be of interest to you.
Barclay Physical Therapy may also use or disclose your personal health information without prior authorization for public health purposes, for auditing purposes, for research studies and for emergencies. We also provide information when required by law.
In any other situation, Barclay Physical Therapy's policy is to obtain your written authorization before disclosing your personal health information. If you provde us with a written authorization to release your information for any reason, you may later revoke that authorization to stop future disclosures at any time.
Barclay Physical Therapy may change its policy at any time. When changes are made, a new Notice of Information Practices will be posted in the waiting room and patient exam areas and will be provided to you on your next visit. You may also request an updated copy of our Notice of Information Practices at any time.
PATIENT'S INDIVIDUAL RIGHTS
You have the right to review or obtain a copy of your personal health information at any time. You have the right to request that we correct any inaccurate or incomplete information in your records. You also have the right to request a list of instances where we have disclosed your personal health information for reasons other than treatment, payment or other related administrative purposes.
You may also request in writing that we not use or disclose your personal health information for treatment, payment and administrative purposes except when specifically authorized by you, when required by law or in emergency circumstances. Barclay Physical Therapy will consider all such request on a case by case basis, but the practice is not legally required to accept them.
CONCERNS AND COMPLAINTS
If you are concerned that Barclay Physical Therapy may have violated your privacy rights or if you disagree with any decisions we have made regarding access or disclosure of your personal health information, please contact our practice manager at the address listed below. You may also send a written complaint to the US Department of Health and Human Services. For further information on Barclay Physical Therapy's health information practices or if you have a complaint, please contact the following person:
Barclay Physical Therapy
Meena Narula, M.S.,P.T.
555 Barclay Circle, Suite 110 Rochester Hills, MI 48307
Telephone: (248) 853-5853 Fax: (248) 853-5928