Physical Therapy Practice Privacy Policy

Notice of Privacy Practices

Effective Date: [Date]

Our Commitment to Your Privacy

At [Practice Name], we are committed to maintaining the privacy of your protected health information (PHI). This notice describes how medical information about you may be used and disclosed and how you can access this information.

Information We Collect

• Personal identification information
• Medical history and conditions
• Treatment records and progress notes
• Insurance and payment information
• Communication records

How We Use Your Information

Treatment

• Coordinate your physical therapy care
• Consult with other healthcare providers
• Schedule appointments and follow-ups

Payment

• Bill for services provided
• Verify insurance coverage
• Process insurance claims

Healthcare Operations

• Quality assessment
• Staff training
• Business planning
• Compliance monitoring

Your Rights

You have the right to:

1. Access your health information
2. Request amendments to your records
3. Receive an accounting of disclosures
4. Request restrictions on information use
5. Choose how we communicate with you

Our Responsibilities

We are required to:

• Maintain the privacy of your health information
• Provide notice of our privacy practices
• Follow the terms of this notice
• Notify you of breaches of unsecured PHI

Contact Information

Privacy Officer: [Name] Phone: [Phone Number] Email: [Email Address]

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to information we already have as well as any information we receive in the future.

Acknowledgment

I acknowledge that I have received a copy of this Notice of Privacy Practices.

Patient Name: ________________ Signature: ___________________ Date: _______________________