HEALTH INFORMATION PRIVACY NOTICE
This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access to This Information. Please Review This Document Carefully.
About Protected Health Information (PHI):
In this Notice, “we”, “our” or “us” means Dynamic Physical Therapy and our workforce of employees, contractors and volunteers. “you” and “your” refers to each of our patients who are entitled to a copy of this Notice.
We are required by federal and state law to protect the privacy of your health information. For example, federal health information privacy regulations require us to protect information about you in the manner that we describe here in this Notice. Certain types of health information may specifically identity you. Because we must protect this health information, we call this Protected Health Information---or “PHI”. In this Notice, we tell you about:
• How we use your PHI
• When we may disclose your PHI to others
• Your privacy rights and how to use them
• Our privacy duties
• Who to contact for more information or a complaint
Some of the ways we use (within the organization) or disclose (outside of the organization) your Protected Health Information
We will use your PHI to treat you. We will use your PHI and disclose it to get paid for your care and related services. We use or disclose your PHI for certain activities that we call “health care operations”. We will also use or disclose your PHI as required or permitted by law. We will give you examples of each of these to help explain them but space does not permit a complete list of all uses or disclosures. This is one reason why you can contact us and ask us questions.
1. Treatment
We use and disclose your PHI in the course of your treatment. For instance, once we have completed your evaluation or re-evaluation we send a copy or summary of our report to your referring physician. We also maintain records detailing the care and services you receive at our facility so that we can be accurate and consistent in carrying out that care in an optimal manner; that record also assists us in meeting certain legal requirements. These records maybe used and/or disclosed by members of our workforce to assure that proper and optimal care is rendered.
2. Payment Involving a Third Party Payer
After we treat you we will, typically, bill a third party for services you received. We will collect the treatment information and enter the data into our computer and then process a claim either on paper or electronically. The claim form will detail your health problem, what treatments you received and it will include other information such as your social security number, your insurance policy number and other identifying pieces of information. The third party payer may also ask to see the records of your care to make certain that the services were medically necessary. When we use and disclose your information in this way is helps us to get paid for the care and treatment you receive.
3. Payment Exclusive of a Third Party Payer (fully self-pay)
If you choose to pay for your services, in full, without involving a third party (insurer, employer, etc.) you may request that we do not disclose any information regarding your services for payment purposes. You will be provided with a Good Faith Estimate (GFE) for all self-paid visits or treatments, regardless of the reason. Exception: You will not receive a GFE if you are enrolled in Medicare Part A, B, or C, Medicaid, TRICARE, Veterans Affairs, or Indian Health Services.
4. Health Care Operations
We also use and disclose your PHI in our health care operations. For example our therapists meet periodically to study clinical records to monitor the quality of care at our facility. Your records and PHI could be used in these quality assessments. Sometimes we participate in student internship programs and we use the PHI of actual patients to test them on their skills and knowledge. Other operational use may involve business planning and compliance monitoring, as well as investigating and resolving complaints.
5. Special Uses
We also use or disclose your PHI for purposes that involve your relationship to us as a patient. We may use or disclose your PHI to:
• Update your workers compensation case worker or employer (you may not opt out of disclosure if you are a WC patient, if your state does not require your authorization).
• Remind you of appointments
• Carry out follow ups on home programs that you have been taught
• Advise you of new or updated services or home supplies
• Release equipment and/or supplies to your designee
• Carry out follow ups on your home programs or discharge planning
• Advise you of new or updated services or home supplies via telecommunication or via a newsletter
• Carry out research that does not directly identify you
• Communicate via electronic means at your request or with your authorization. We will only use secure transmission due to the risk of unauthorized access. We highly recommend securing communications involving sensitive information.
• Conduct marketing functions, including providing nominal promotional gifts.
• Contact you regarding fundraising projects that we are engaged in.
Note: If we receive direct or indirect financial remuneration from a third party for marketing a product or item, or for any fundraising we are engaged in, we will advise you in advance and offer you the opportunity to opt out of receiving any of these materials. We will obtain written authorization before using PHI for marketing purposes when required by law.
6. Uses & Disclosures Required or Permitted by Law
Several laws and regulations govern our use of your PHI, which may either require or permit us to use or disclose it. Here is a list of the federal health information privacy regulations describing required or permitted uses and disclosures:
Permitted without Authorization:
• If you do not object verbally, we may share some of your PHI with a family member or friend who participates in your care.
• We may use your PHI in an emergency if you are not able to communicate.
• If we receive certain assurance that protect your privacy, we may use or disclose your PHI for research purposes. This facility will always obtain your authorization, even though it is permitted without it.
• If you are a workers' compensation patient, we may update your workers' compensation case worker or employer, unless state law requires your authorization.
Required Without Authorization:
• When required by law; for example, when ordered by a court to turn over certain types of your PHI, we must comply
• For public health activities, such as reporting a communicable disease or reporting an adverse reaction to the Food and Drug Administration
• To report neglect, abuse or domestic violence
• When government regulators or their agents need to determine whether we comply with applicable rules and regulations
• For judicial or administrative proceedings such as a response to a valid subpoena
• When properly requested by law enforcement officials or in response to other legal requirements, such as reporting gunshot wounds
• To advert a health hazard or to respond to a threat to public safety such, as an imminent crime against another person
• Deemed necessary by appropriate military command authorities if you are in the Armed Forces
• In connection with certain types of organ donor programs
Required Use and Disclosure Exception:
• When there are substance use disorder records, you must authorize the release of any disorder history or treatment records according to 42 CFR Part 2 (Substance Use Disorder Records) unless required by federal law.
Part 2 permits disclosure without your authorization only in limited circumstances, such as:
· Medical emergencies
· Scientific research under strict safeguards
· Audits or program evaluations
· Court orders that meet specific legal requirements
· Reporting suspected child abuse or neglect as required by law
· Crimes committed on program premises or against program staff
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7. Your Authorization May Be Required
In the circumstances noted in number six above, we have the right to use and Disclose your PHI; however, if you change your mind at a later date, you may revoke your authorization or opt out of the disclosure, if permitted by law.
8. Your Privacy Rights and How to Exercise Them
Note: his facility will provide patients with a written Notice regarding the risks of transmitting protected health information (PHI) via unsecured email or messaging platforms. Patient authorization will be obtained before initiating or responding to any such electronic communication.
You have specific rights under our federally required privacy program. Each of them is summarized below:
• Your Right to Request Limited Use or Disclosure
You have the right to request that we do not use or disclose your PHI in a particular way. However, we are not obligated to comply with your request. If we do agree to your request, we must abide by the agreement. We will exercise this right by requiring your request to be in writing.
• Your Right to Confidential Communication
You have the right to receive confidential communications from us at a location or phone number that you specify. We reserve the right to request that your request be in writing, including the alternative address or phone number, and confirmation that it will not interfere with your payment method. We will exercise this right by requiring your request to be in writing.
• Your Right to Inspect and Copy Your PHI
You have the right to inspect and copy your PHI. If we maintain our records on paper, that will be the format used; however, if we maintain our records electronically, you have the right to review and/or obtain copies in an electronic format. Should we decline, we must provide you with a resource person to assist you in reviewing our decision to refuse. We must respond to your request within 10 days, as required by our state's prevailing law. We may charge reasonable fees for copying and labor time related to copying, and we may need an appointment for record inspection. We have the right to ask for your request in writing and will exercise that right.
• Your Right to Revoke Your Authorization
If you have authorized us to use or disclose your PHI, you may revoke that authorization at any time in writing. Please understand that we relied on the validity of your permission before the revocation and used or disclosed your PHI within its scope.
• Your Right to Amend Your PHI
You have a right to request an amendment of your record. We reserve the right to request the request in writing, and we will exercise this right. We may deny the request if the record is accurate and/or if this facility did not create the record. If we accept the amendment, we must notify you and make an effort to inform others who have the original record.
• Your Right to Know Who Else Sees your PHI
You have the right to request an accounting of certain disclosures that we have made over the past six years. We do not have to account for all disclosures, including those made directly to you, those involving treatment, payment, or healthcare operations, those to family or friends involved in your care, and those involving national security. You have the right to request an annual accounting. We reserve the right to request written confirmation and to charge for any accounting requests that occur more than once per year. We must notify you of any charges, and you have the right to withdraw your request or pay to proceed.
• Your Right to be Informed of a Breach of Your Protected Health Information
We are required to notify the patient by first-class mail or by email (if indicated a preference to receive information by email) of any breaches of unsecured Protected Health Information as soon as possible, but in any event, no later than 30 days or as soon as possible following the discovery of the breach. "Unsecured Protected Health Information" is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The Notice is required to include the following information:
A description of the breach, including the date of the breach and the date of its discovery, if known.
A description of the type of unsecured protected health information involved in the breach.
Instructions regarding the measures the patient should take to protect him/her from potential harm resulting from the breach.
Correction action Dynamic Physical Therapy has/will take to investigate the breach, mitigate losses, and protect the patient from further breaches.
Dynamic Physical Therapy 's contact information, including a toll-free telephone number, email address, website, or postal address, to facilitate additional questions.
• Your Right to Complain
You have the right to complain if you feel your privacy rights have been violated. You may complain directly to us by contacting our HIPAA officer, noted in Section 10, or to the following:
U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you if you file a complaint about us. Your complaint should provide sufficient specific detail to enable us to investigate your concern.
• Your Right to Receive a Copy of the Privacy Notice
We are obligated to provide our patients with a copy of our Notice of Privacy Practices and to post the Notice in a conspicuous place and on our website, so patients can readily review it. We reserve the right to modify the Notice to comply with policy, rules, or regulatory changes. We are obligated to provide new notices to current and subsequent patients as changes are made. We are required to maintain each version of a Privacy Notice for a minimum of six (6) years.
· Your Right to Expect Protection of Any Substance Use Disorder or Treatment Records According to 42 CFR Part 2 (Substance Use Disorder Records)
Dynamic Physical Therapy is required by federal law to protect the privacy of your substance use disorder (SUD) treatment records. These records are protected by 42 CFR Part 2, which provides additional confidentiality safeguards beyond those required by HIPAA. Part 2 protects any information that identifies you as having a substance use disorder or receiving SUD treatment services from us, including your diagnosis, treatment, medications for SUD, appointment information, billing records, and any other information that could identify you as a patient of a SUD program. We may not use or disclose your SUD treatment records without your written consent unless federal law allows it. Part 2 permits disclosure without your consent only in limited situations, such as:
· Medical emergencies
· Scientific research under strict safeguards
· Audits or program evaluations
· Court orders that meet specific legal requirements
· Reporting suspected child abuse or neglect as required by law
· Crimes committed on program premises or against program staff
You may authorize us to disclose your SUD treatment information to others, including for treatment, payment, or healthcare operations. Your authorization must meet the requirements of 42 CFR Part 2. You may revoke your authorization at any time unless we have already acted on it.
Any recipient of your SUD treatment information is prohibited from redisclosing it unless you give written permission or the disclosure is otherwise permitted by Part 2. Federal law does not protect information if you voluntarily disclose it to others who are not bound by Part 2. You have the right to:
· Request restrictions on how your SUD information is used or disclosed.
· Request an accounting of disclosures of your Part 2–protected information.
· Receive a copy of this Notice and any updates.
· File a complaint if you believe your privacy rights have been violated, and we are prohibited from retaliation against you for filing a complaint.
9. Some of Our Privacy Obligations and How We Perform Them
• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you 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 provide you with a copy.
• 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.
If we change our Notice of Privacy Practices we will provide our revised Notice to you when you next seek treatment from us.
10. Contact Information
If you have questions about this Notice, or if you have a complaint or concern, please contact:
Dynamic Physical Therapy, HIPAA Officer
Address: 5775 N. Union Blvd
Colorado Springs, CO 80918
Phone: 719-434-7044
Effective Date: This revised notice takes effect on 2-16-2026
SMS Terms of Service
We have found that sometimes text messaging is the easiest way to communicate with our patients and offer this option for scheduling-related communications. By opting in to SMS , you are agreeing to receive SMS messages from Dynamic Physical Therapy. This includes SMS messages for appointment scheduling and appointment reminders. Message frequency varies. Message and data rates may apply. Message HELP for help. Reply STOP to any message to opt out.