Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
MovementX is committed to protecting the confidentiality of its patients’ personal health information. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your personal health information and your rights concerning your personal health information. This Notice is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (“HIPAA”). [KR5]
We are required by law to (i) maintain the privacy of your personal health information; (ii) provide you with this Notice stating our legal duties and privacy practices with respect to your personal health information; (iii) abide by the terms of this Notice as it remains in effect; and (iv) notify you following a breach of your personal health information that is not secured in accordance with certain security standards.
We reserve the right to change the terms of this Notice and to make the provisions of the new Notice effective for all personal health information that we maintain. If we change the terms of this Notice, the revised Notice will be made available upon request and posted on our website. Copies of the current Notice may be obtained by contacting our Privacy Officer.
Keaton Ray, COO / Owner, firstname.lastname@example.org, 818-371-9651
Fred Gilbert, CPO / Owner, email@example.com, 205-516-9502
Download Our Graphic Guide to Your Privacy Rights
 Uses and Disclosures
Uses and Disclosures That May Be Made Without Your Consent
TREATMENT: We may use and disclose your personal health information as necessary for your treatment. Doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history, etc.
PAYMENT: We may use and disclose your personal health information as necessary for payment purposes. We may use your information to prepare a bill to send to you or to the person responsible for your payment.
APPOINTMENTS AND SERVICES: We may contact you to provide appointment reminders or information about your treatment or other health-related benefits and services that may be of interest to you. You have the right to request, and we will accommodate reasonable requests by you, to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voicemail or sent to a particular address, we will accommodate reasonable requests.
HEALTH CARE OPERATIONS: We may use and disclose your personal health information as necessary to support the day-to-day activities and management of MovementX. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
 OTHER USES AND DISCLOSURES: We are also permitted and/or required by law to make certain other uses and disclosures of your personal health information without your authorization for the following:
- Family and Friends: We may disclose your personal health information to a family member or friend who is involved in your medical care or to someone who helps pay for your care. We may also use or disclose your personal health information to notify (or assist in notifying) a family member, legally authorized representative or other person responsible for your care of your location, general condition or death. If you are a minor, we may release your personal health information to your parents or legal guardians when we are permitted or required to do so under federal and applicable state law.
- Third Parties: We may disclose your personal health information to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement with them to safeguard your information. Examples of these third parties include, but are not limited to, accreditation agencies, management consultants, quality assurance reviewers, collection agencies, transcription services, etc.
- Required by Law: We may use or disclose your personal health information to the extent the use or disclosure is required by law. Any such use or disclosure will be made in compliance with the law and will be limited to what is required by the law.
- Public Health Activities: We may disclose your personal health information for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report child abuse or neglect
- To report reactions to medications or problems with products
- To notify people of recalls of products they may be using
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
- To notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when otherwise required by law to the make the disclosure.
- Health Oversight Activities: We may disclose your personal health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits; investigations, proceedings or actions; inspections; and disciplinary actions; or other activities necessary for appropriate oversight of the health care system, government programs and compliance with applicable laws.
- Law Enforcement: We may disclose your personal health information to law enforcement in very limited circumstances, such as to identify or locate suspects, fugitives, witnesses or victims of a crime, to report deaths from a crime, and to report crimes that occur on our premises.
- Judicial and Administrative Proceedings: We may disclose information about you in response to an order of a court or administrative tribunal as expressly authorized by such order.
- To Avert a Serious Threat to Health or Safety: We may use or disclose your personal health information when necessary to prevent a serious and imminent threat to your health or safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat of harm.
- Disaster Relief Efforts: We may use or disclose your personal health information to an authorized public or private entity to assist in disaster relief efforts. You may have the opportunity to object unless it would impede our ability to respond to emergency circumstances.
- Coroners, Medical Examiners and Funeral Directors: We may disclose personal health information consistent with applicable law to coroners, medical examiners and funeral directors only to the extent necessary to assist them in carrying out their duties.
- Organ and Tissue Donation: We may disclose personal health information consistent with applicable law to organizations that handle organ, eye or tissue donation or transplantation, only to the extent necessary to help facilitate organ or tissue donation or transplantation.
- Research: Under certain circumstances, we may also use and disclose information about you for research purposes. All research projects are subject to a special approval process through an appropriate committee.
- Workers’ Compensation: We may disclose your personal health information as authorized by law to comply with workers’ compensation laws and other similar programs established by law.
- Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed forces, we may release your personal health information as required by military command authorities or to the Department of Veterans Affairs. We may also disclose your personal health information to authorized federal officials for intelligence and national security purposes to the extent authorized by law.
- Correctional Institutions: If you are or become an inmate of a correctional institution or are in the custody of a law enforcement official, we may disclose to the institution or law enforcement official information necessary for the provision of health services to you, your health and safety, the health and safety of other individuals and law enforcement on the premises of the institution and the administration and maintenance of the safety, security and good order of the institution. 
Uses and Disclosures Based Upon Your Written Authorization
MARKETING: We must obtain your written authorization  to use and disclose your personal health information for most marketing purposes.
SALE OF PERSONAL HEALTH INFORMATION: We must obtain your authorization for any disclosure that constitutes the sale of your personal health information.
PSYCHOTHERAPY NOTES: We must obtain your authorization for most uses and disclosures of psychotherapy notes (private notes of a mental health professional kept separately from a medical record). 
OTHER USES AND DISCLOSURES: Other uses and disclosures of your personal health information, not described above, will be made only with your written authorization. You may revoke your authorization, at any time, in writing, except to the extent that we have taken action in reliance on the authorization.
Rights That You Have Regarding Your Personal Health Information (PHI)
ACCESS TO YOUR PHI: You have the right to a copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your legal representative.
AMENDMENTS TO YOUR PHI: You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests must be in writing, signed by you or your legal representative, and must state the reasons for the amendment/correction request.
RECEIVE CONFIDENTIAL COMMUNICATIONS FROM US BY ALTERNATIVE MEANS/LOCATIONS: You have the right to request that we communicate with you in a certain way or at a certain location. Your request must be in writing and specify how and where you would like to be contacted. We will accommodate all reasonable requests.
MANAGE DISCLOSURE OF RESTRICTIONS ON CERTAIN USES AND DISCLOSURES OF YOUR PHI: You have the right to ask us not to use or disclose any part of your personal health information for purposes of treatment, payment or healthcare operations. While we will consider your request, we are only required to agree to restrict a disclosure to a health plan for purposes of payment or healthcare operations (but not for treatment) if the information applies solely to a healthcare item or service for which we have been paid out of pocket in full. If we agree to a restriction, we will not use or disclose your personal health information in violation of that restriction unless it is needed to provide emergency treatment.  We will not agree to restrictions on personal health information uses or disclosures that are legally required or necessary to administer our business. All restriction requests must be in writing and signed by you or your legal representative.
ACCOUNTING OF CERTAIN DISCLOSURES OF YOUR PHI: You have the right to receive an accounting of how and to whom your personal health information has been disclosed. All accounting requests must be in writing and signed by you or your legal representative.
OBTAIN A PAPER COPY OF THIS NOTICE: You have the right to obtain a paper copy of this Notice upon request, even if you agreed to accept this Notice electronically. 
We will not use or share your information if state law prohibits it. Some states have laws that are stricter than the federal privacy regulations, such as laws protecting HIV/AIDS information or mental health information. If a state law applies to us and is stricter or places limits on the ways we can use or share your health information, we will follow the state law. If you would like more information about any applicable state laws, please ask our Privacy Officer.
Questions or Complaints
If you have any questions or want more information about this Notice or how to exercise your personal health information rights, you can do so by contacting:
Compliance Officer: Keaton Ray, COO / Owner, firstname.lastname@example.org, 818-371-9651
Chief People Officer: Fred Gilbert, CPO / Owner, email@example.com, 205-516-9502
Mailing Address: 1327 SE Tacoma St, Unit 122 Portland OR 97202-6639
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Office for Civil Rights: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201 or OCRComplaint@hhs.gov. 
You will not be penalized or otherwise retaliated against for filing a complaint.
Effective Date: 2/20/2018