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HIPAA Privacy Notice

Notice of Privacy Practices

Effective Date:  May 13, 2019

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information.  Please review it carefully.

The terms of this Notice of Privacy Practices (“Notice”) apply to Harmony in Motion, its affiliates and its employees.  Harmony in Motion will share protected health information (PHI) of patients as necessary to carry out treatment, payment, and health care operations as permitted by law.

We are required by law to maintain the privacy of our patients’ PHI and to provide patients with notice of our legal duties and privacy practices with respect to PHI.  We are required to abide by the terms of this Notice for as long as it remains in effect.  We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all PHI maintained by Harmony in Motion.  We are required to notify you in the event of a breach of your unsecured PHI.  We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health insurance Portability and Accountability Act (HIPAA).  A copy of any revised Notice of Privacy Practices or information pertaining to a specific State law may be obtained by mailing a request to the Privacy Officer at the address below.


Authorization and Consent:  Except as outlined below, we will not use or disclose your protected health information for any purpose other than treatment, payment, or health care operations unless you have signed a form authorizing such use or disclosure.  You have the right to revoke such authorization in writing, with such revocation being effective once we actually receive the writing; however, such revocation shall not be effective to the extent that we have taken any action in reliance on the authorization, or if the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.

Uses and Disclosures for Treatment:  We will make uses and disclosures of your PHI as necessary for your treatment.  Doctors, 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.

Uses and Disclosures for Payment:  We will make uses and disclosures of your PHI as necessary for payment purposes.  During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you.  We may also use your information to prepare a bill and send it to your or to the person responsible for your payment.

Uses and Disclosures for Health Care Operations:  We will make uses and disclosures of your PHI as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance we may use and disclose your PHI for purposes of improving clinical treatment and care.

Individuals Involved in Your Care:  We may from time to time disclose your PHI to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for your or paying for your care.  If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited PHI with such indivicudals without your approval.

Business Associates:  Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc.  At times it may be necessary for us to provide your PHI to one or more of these outside persons or organizations who assist us with our health care operations.  In all cases, we require these associates to appropriately safeguard the privacy of your information.

Appointments and Services:  We may contact you to provide appointment updates 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 PHI 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.  With such requests, you must provide an appropriate alternative address or method of contact.  You also have the right to request that we not send you any future marketing materials and we will use our best efforts to honor such requests.  You must make such requests in writing, including your name and address, and send such writing to the Privacy Officer at the address below.

Research:  In limited circumstances, we may use and disclose your PHI for research purposes.  In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of your information.

Other Uses and Disclosures:  We are permitted and/or required by law to make certain other uses and disclosures of your PHI without your consent or authorization for the following:

• Any purpose required by law

• Public health activities such as required reporting of immunizations, disease, injury, birth and death, or in connection with public health investigations

• If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect or domestic violence

• To the food and drug administration to report adverse events, product defects, or to participate in product recalls.

• To your employer when we have provided health care to you at the request of your employer

• To a government oversight agency conducting audits, investigations, civil or criminal proceedings

• Court or administrative ordered subpoena or discovery request

• To law enforcement officials as required by law 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 required or authorized by law

• To coroners and/or funeral directors consistent with the law

• If you are a member of the military, we ma also release your PHI for national security or intelligence activities

• To workers’ compensation agencies for workers’ compensation benefit determination.


Marketing:  We must obtain your authorization for any use or disclosure of your PHI for marketing, except if the communication is in the form of (1) face-to-face communication with you, or (2) a promotional gift of nominal value.

Sale of Protected Information:  We must obtain your authorization prior to receiving direct or indirect remuneration in exchange for your health information; however such authorization is not required where the purpose of the exchange is for:

Public health activities:

• Research purposes, provided that we receive only a reasonable, cost-based fee to cover the cost to prepare and transmit the information for research purposes

• Treatment and payment purposes

• Health care operations involving the sale, transfer merger or consolidation of all or part of our business and for related due diligence

• Payment we provide to a business associate for activities involving the exchange of PHI that the business associate undertakes on our behalf (or the subcontractor undertakes on behalf of a business associate) and the only remuneration provided it is for the performance of such activities.

• Providing you with a copy of your health information or an accounting of disclosures.

• Disclosures required by law

• Any other exceptions allowed by the Department of Health and Human Services.


Access to Your Protected Health Information:  You have the right to copy and/or inspect much of the PHI that we retain on your behalf.  For PHI information that we maintain in any electronic designated record set, you may request a copy of such health information in a reasonable electronic format if readily producible.  Requests for access must be made in writing and signed by you or your legal representative.  You may obtain a Medical Release Form from your therapist.  You will be charged a reasonable copying fee and actual postage and supply costs for your PHI.  If you request additional copies you will be charged a fee for copying and postage.

Amendments to Your Protected Health Information:  You have the right to request in writing that PHI that we maintain about you be amended or corrected.  We are not obligated to make requested amendments but we will give each request careful consideration.  All amendment requests must be in writing, signed by you or legal representative, and must state the reasons for the amendment/correction  request.  If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary.

Accounting for Disclosures of Your Protected Health Information:  You have the right to receive an accounting of certain disclosures made by use of your PHI.  Requests must be made in writing and signed by you or your legal representative.  Customary retrieval/copying charges apply.

Restrictions on Use and Disclosure of Your Protected Health Information:  You have the right to request restrictions on uses and disclosures of your PHI for treatment, payment, or health care operations.  We are not required to agree to most restriction requests, but will attempt to accommodate reasonable requests when appropriate.  You do, however, have the right to restrict disclosure of your PHI to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the PHI pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid Harmony in Motion in full.  If we agree to any discretionary restrictions, we reserve the right to revolve such restrictions as we see appropriate.  We will notify you if we remove a restriction imposed in accordance with this paragraph.  You also have the right to withdraw, in writing, any restriction by communicating your desire to do so to the individual responsible for medical records.

Right to Notice of Breach:  We take the confidentiality of our patient’s information very seriously and we are required by law to protect the privacy and security of your PHI through appropriate safeguards.  We will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to protect yourself.

Paper Copy of this Notice.  You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice.  To do so, please contact your therapist.

Complaints:  If you believe your privacy rights have been violated, you can file a complaint in writing with the Privacy Officer of Harmony in Motion.  You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services at the address below.  There will be no retaliation for filing a complaint.

Office of Civil Rights – Department of HHS, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, NY  10278

Phone: 212.264.3313      Fax: 212.264.3039    TDD: 212.264.2355

For Further information:  If you have questions, need further assistance, or would like to submit a request pursuant to this Notice, you may contact the Harmony in Motion Privacy Officer by phone at 717.906.8232 or at the following address:  1225 Ritner Highway, Carlisle, PA 17013.

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