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Notice of Health Information Privacy Practices

Please review this notice carefully. 


This notice describes how Integrative Physical Therapy may disclose health information about you and how you can access this information. 


We understand that health information about you/your child is very personal. Integrative Physical Therapy takes your privacy rights very seriously. A Federal Law called HIPAA, the Health Insurance Portability and Accountability Act, was created to support your privacy and rights surrounding your health information. 


What is Health Information? Health information is recorded every time you seek treatment from a health care provider. Typically health information contains your symptoms, evaluation, diagnosis, treatment and plans for future care. 


Your rights regarding your Health Information:


You have the following rights regarding your health information: 

1. Get an electronic or paper copy of your medical record:  You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. 

2. Ask us to correct your medical record:  You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days. 

3. Request confidential communications:  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests. 

4. Ask us to limit what we use or share: You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it will affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. 

5. Get a list of those with whom we’ve shared information: You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make.) We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 

6. Get a copy of this privacy notice: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

7. Choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

8. File a complaint if you feel your rights are violated: If you feel we have violated your rights you can file a complaint with the U.S. Department of Health and Human Services by calling (877)-696-6775 or visiting


Your choices regarding your health information:


  1. For certain health information, you can tell us your choices about what we share with family, close friends or others involved in your care. 

  2. You can tell us your preference for sharing information in a disaster relief situation, in a hospital directory, or to contact you with fundraising efforts

  3. We will never share your information unless given permission for marketing purposes, sale of your information, and sharing of psychotherapy notes


How we may use and disclose (share) Health Information about you:


The following 3 categories: Treatment, Payment and Healthcare Operations are the most common ways Integrative Physical Therapy uses/shares your health information. 


For Treatment: We may use and disclose health information about you/your child to doctors, nurses, healthcare associates, physical therapy/nursing/medical students and/or other personnel who work within the Integrative Physical Therapy office network. We may also disclose health information if hospitalized, to your primary care physician, to a pharmacy to have a prescription filled pertaining to PT, to the hospital for x-rays or for other treatment purposes, or if you have been referred to another specialist for treatment. 


For Payment: We may use and disclose health information about you so that the services you received from us may be billed for payment collected. For example, we may need to give your health insurance plan information about your PT visit so they will pay us or reimburse you. 


For Healthcare Operations: We may use and disclose information about you internally to make sure that you received quality care. For example, we may use health information to review our services, to evaluate the performance of our personnel or to review your records if you have filed a complaint. 

Other ways we may use and disclose Health Information about you:


  1. Help with public health and safety issues: We can share health information about you for certain situations such as preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, preventing or reducing a serious threat to anyone’s health or safety

  2. Do research: We can share your information for health research

  3. Comply with the law: We will share information about you if state or federal law requires it, including with the Department of Health and Human Services

  4. Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations

  5. Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies

  6. Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you: for workers compensation laws, for law enforcement purposes or with a law enforcement agency, with health oversight agencies for activities authorized by law, or for special government functions such as military, national security, and presidential protective services

  7. Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena


Our Responsibilities:

  • We are required by law to maintain the privacy and security of your protected health information

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information

  • We must follow the duties and privacy practices described in this notice and give you a copy of it

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 


Minors (younger than 18 years of age) and persons with Guardians. If you are a minor or a person with a guardian obtaining healthcare, your parent or legal guardian may have the right to access your medical record and make certain decisions regarding the uses and disclosures of your health information. 


Changes to this notice. We reserve the right to revise or change this Notice. A dated copy will be available upon request as well as on our website.


For more information see: If you have any concerns you may contact privacy official  Michelle Downing via email: michelle@integrativeptvt or phone: (802) 557-1349

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