Alliance Therapy Services, Inc.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATIOIN. PLEASE REVIEW IT CAREFULLY.
Alliance Therapy Services, Inc.’s LEGAL DUTY
Alliance Therapy Services, Inc. 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, Alliance Therapy Services, Inc. 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.
Alliance Therapy Services, Inc. may also use or disclose your personal health information without prior authorization for public health information purposes, for auditing purposes, for research studies, and for emergencies. We also provide information when required by law.
In any situation, Alliance Therapy Services, Inc.’s policy is to obtain your written authorization before disclosing your personal health information. If you provide 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. Alliance Therapy Services, Inc. may change its policy at any time. When changes are made, a new Privacy/HIPPA Policy 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 Privacy/HIPAA 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 youro personal health information for treatment, payment and administrative purposes except when specifically authorized by you, when required by law or in emergency circumstances. Alliance Therapy Services, Inc. will consider all such requests on a case-by-case basis, but the practice is not legally required to accept them.
CONCERNS AND COMPLAINTS
If you are concerned that Alliance Therapy Services, Inc. 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 U.S. Department of Health and Human Services. For further information on Alliance Therapy Services, Inc.’s health information practices or if you have a complaint, please contact the following person:
Security Officer: Angie Roussel
Address: 12320 Hwy. 44, Building 3-F, Gonzales, LA 70737
Phone: (225) 647-9505
Fax: (225) 647-9503