Effective Date: 11/01/2024

1. HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects your personal health information (PHI). Our clinic is committed to maintaining the confidentiality and security of your health information.

2. Your Rights Under HIPAA As a patient, you have the following rights:
❖ Right to Access: You can request to see and obtain copies of your health records.
❖ Right to Amend: You can request changes to your health information if you believe it is inaccurate or incomplete.
❖ Right to Disclosure Accounting: You can request a list of disclosures made about your health information.
❖ Right to Request Restrictions: You can request limits on how we use and share your information.
❖ Right to Confidential Communication: You can request that we communicate with you in a certain way or at a certain location.

3. Use and Disclosure of Health Information
Your health information may be used and disclosed for:
❖ Treatment: To provide you with appropriate medical care.
❖ Payment: To bill for services provided and obtain payment from your health plan.
❖ Healthcare Operations: For activities necessary to operate our practice, such as quality assurance and training.

4. Privacy Practices
We are dedicated to protecting your privacy and will:
❖ Maintain the confidentiality of your PHI.
❖ Provide you with a notice of our privacy practices.
❖ Train our staff on the importance of protecting your information.
❖ Implement safeguards to protect your PHI from unauthorized access.

5. Acknowledgment of Receipt
I have received and reviewed the HIPAA and Privacy Policy of OrthoPrime Physical Therapy, LLC. I understand my rights regarding my health information and the privacy practices of the clinic.

6. Contact Information
If you have any questions or concerns regarding your privacy or this policy, please contact:
Privacy officer: Upen Vyas PT, DPT, OMPT, OCS
17916 Farmington Road, Livonia, MI 48152. PH: 734-855-4046 Email: info@orthoprimept.com