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HIPAA Omnibus Notice of Privacy Practices

Revised 2013

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.

This Notice of Privacy Practices is NOT an authorization. This Notice of Privacy Practices describes how we, our Business Associates and their subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past" present or future physical or mental health condition and related health care services.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician" our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred, DME vendors, referring physicians, family practitioner, home health providers, laboratories, workers' comp adjusters and nurse case managers, etc. to ensure that the healthcare provider has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay, surgery, MRI or other diagnostic test, injection procedures, injection series, physical therapy, etc., may require that your relevant protected health information be disclosed to the health plan to obtain approval for the procedure.

Our right to revise privacy practices: As permitted by aw" we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. The revised policies and practices will be applied to all protected health information that we maintain and will be available at our facility for your request.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include" but are not limited to "quality assessment" employee review" and training of medical students" licensing" and conducting or arranging for other business activities. In addition" we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information" as necessary" to contact you to remind you of your appointment" and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. If we use or disclose your protected health information" we will provide you the choice to opt out of those activities. You may also choose to opt back in.

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as required by law" public health issues as required by law" communicable diseases" health oversight" abuse or neglect" food and drug administration requirements" legal proceedings" law enforcement" coroners" funeral directors" organ donation" research" criminal activity" military activity and national security" workers' compensation" inmates" and other required uses and disclosures. Under the law" we must make disclosures to you upon your request. Under the law" we must also disclose your protected health information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Section 164.500.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Other Permitted and Required Uses and Disclosures will be made only with your consent" authorization or opportunity to object unless required by law. Without your authorization" we are expressly prohibited to use or disclose your protected health information for marketing purposes. We may not sell your protected health information without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information. We will not use or disclose any of your protected health information that contains genetic information that will be used for underwriting purposes.

You may revoke the authorization" at any time" in writing" except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS
The following are statements of your rights with respect to your protected health information.

  • You have the right to inspect and copy your protected health information (fees may apply) - Pursuant to your written request" you have the right to inspect or copy your protected health information whether in paper or electronic format. Under federal law" however" you may not inspect or copy the following records: Psychotherapy notes" information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law" information that is related to medical research in which you have agreed to participate" information whose disclosure may result in harm or injury to you or to another person" or information that was obtained under a promise ofconfidentiality.
  • You have the right to request a restriction of your protected health information - This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment" payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to your requested restriction except if you request that the physician not disclose protected health information to your health plan with respect to healthcare for which you have paid in full out of pocket.
  • You have the right to request to receive confidential communications - You have the right to request confidential communication from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively (i.e., electronically).
  • You have the right to request an amendment to your protected health information - If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. You have the right to receive an accounting of certain disclosures - You have the right to receive an accounting of disclosures, paper or electronic, except for disclosures: pursuant to an authorization, for purposes of treatment, payment, healthcare operations; required by law, that occurred prior to April 14, 2003, or six years prior to the date of the request.
  • You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice electronically. We reserve the right to change the terms of this notice and we will notify you of such changes on the following appointment. We will also make available copies of our new notice if you wish to obtain one.
  • You have the right to receive notice of a breach.

COMPLAINTS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Compliance Officer of your complaint. We will not retaliate against you for filing a complaint.

Ashley Smith
410-529-0989

HIPAA Compliance Officer
Phone
email

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. We are also required to abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number. Please sign the accompanying "Acknowledgment" form. Please note that by signing the Acknowledgment form you are only acknowledging that you have received or been given the opportunity to receive a copy of our Notice of Privacy Practices.

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Here's What Our Patients Are Saying

"Erin and Tim were a God-send! They really helped me get my broken foot and sprained ankle back into good working order. I am very thankful for all their knowledge and expertise! The whole staff was wonderful! Gold Medal PT is a great place to come for PT! Thank you, everyone, for your help. I really appreciate it. Hope you all have a great summer. I know I will!"

JP

"Excellent as always, highly recommend. Love how you treat the problem and think of ways to do it and not just go through the motions."

KK

"Gold Medal Physical Therapy stood by me every step of the way from surgery to rehab to half marathon training. Thank you."

JE

"My care at Gold Medal was wonderful! I am out of pain and know how to prevent further injury. Thank you."

DH

"My running is becoming pain free. :) The staff is awesome!"

LK

"I have to tell you that I am learning new and better ways of preventing my back pain."

MR

"My experience here has been wonderful. Everyone I had contact with has been great. I would recommend anyone to come here."

GN

"Gold Medal has been helping me tremendously. I have suffered for 23 years and finally feel some relief. I would recommend highly."

NR

"Sarah is awesome! A + + + all the way! Thank you for a positive and successful experience."

GB

"Gold Medal is awesome! They took super care of me and my foot!"

ED

"The staff has been great. I especially appreciate the flexibility in rescheduling an appointment with little lead time."

JB

"My back has lost the pain that sent me here and I appreciate all that you did for me."

GM

"Gold Medal is great. Everyone from the front desk, insurance, techs and therapists are great and always very helpful."

SL

"The staff is awesome. Friendly and courteous everytime I come in. Schedule times are always flexible."

MM

"This was my first therapy experience. You all set the 'bar' so high! What a great experience. Everyone was so nice & friendly! Thank you for making therapy a great experience!"

JFT

"I was very pleased with my whole experience with Gold Medal. All the therapists and staff were wonderful. I would highly recommend Gold Medal to anyone who needs therapy. Thanks."

JMZ

"I love coming here when I have back problems. The staff is very friendly and lovely. You feel great and special when you come here. Tracey is great. She does magic."

JUG

"It helped a lot for me to understand why I was doing the exercises I was doing. Dave was GREAT at explaining the exercises and re-assessing me doing them. The office staff was great. They were always friendly and knowledgeable. I will recommend Gold Medal to anyone! Thank you!!"

JMP

"I am very pleased with my physical therapy. I love all the therapists (especially Al). I feel like I made a lot of progress. Thanks to all of you."

JTP

"I was very pleased with my whole experience with Gold Medal. All the therapists and staff were wonderful. I would highly recommend Gold Medal to anyone who needs therapy. Thanks."

MZ

"This was my first therapy experience. You all set the "bar" so high! What a great experience. Everyone was so nice & friendly. Thank you for making therapy a great experience!"

FT

"I am pleased with the professional operation - reminder calls, flexibility when I have run late. "No problem" & "No worries" are very reassuring as a patient & reduces stress. Thanks very much for everything!"

CV

"The entire staff worked so great with me. The experience was beyond just therapy. If anyone asked I would tell them to run to Gold Medal Physical Therapy. Thank you and God bless."

FM

"You guys have been amazing. The staff is fantastic, helpful, knowledgeable and took great care of me. Thanks to all of you."

AS

"Very knowledgeable, and very skilled in their craft. They always help me, and I feel better. I have great confidence in Kevin and his team at Gold Medal Physical Therapy. They are in a class by themselves."

Art Modell

"I got surgery on my ankle and once it was time for PT, you guys took great care of me. Thank you all!"

LM

"I came to you with very little movement in my arm. I'm back to moving my arm and working with children without pain and the fear that I could be hurt by a simple pull from a little hand. The entire staff has been fantastic!"

SA

"I've been to many physical therapy offices, your office is the best by FAR. More hands on by the therapist."

DT

"Keep up the good work! Everything was very prompt, friendly, and smooth!"

AC

"Thank you to all your wonderful staff for the help in achieving my goal of healing and getting better. Great therapists and staff! Thanks and good luck to everyone."

KS

"I came in with a problem and it was quickly diagnosed & therapy prescribed. I am 100% cured."

PB

"You did GREAT!!! Tracey and Al are both wonderful. They have given me my independence back. Their expertise, kindness and caring are so "over the top" that it is difficult to explain. Thanks."

CN

"I truly enjoyed everyone who has taken care of me. You guys are awesome!!"

AC

"Problems with pain, movement and strength due to carpal tunnel in both wrists. I now have "happy" hands that work."

MG

"Thank you for making me feel better. The staff at Bel Air are wonderful. They are all very nice, patient, kind and professional."

DK

"Jill was awesome! The receptionist was super friendly and organized. The entire staff was highly professional & always had a smile on their face.... a totally caring environment. The facilities were beautifully decorated, seems silly, but a real plus. Made you feel like you were in a Spa - not PT. Love Gold Medal!! I would recommend you guys to anyone without reservations."

JH

"I came to GMPT after I realized I couldn't zip up my dress. Yeeks!!!! The improvement in my ROM and strength is significant. Thanks to everyone's effort, I was able to rappel down a 17 story building with my frozen shoulder."

WL

"I came in with a lower back injury that was preventing me from running. Thanks to Tracey, I was able to finish my 34th half marathon."

KR

"Both Jeremy and Jill have been extremely helpful and very very pleasant! I would NOT hesitate to tell everyone to come to Gold Medal. My treatments have been outstanding."

KD

"I've been very pleased all the way around - with both the professional knowledge & physical treatment as well as the personal friendliness of all the staff. I felt personally very well cared for. Many thanks."

MW

"Staff was exceptional. Always a pleasure to deal with!!"

TM

"I had knee replacement surgery this year and had a great experience at Gold Medal. I worked with Bryan the most, and I think he is excellent!! Thank you all so much."

PS

"The care I received from Dave was excellent. My arm is 100% better. The staff was also excellent."

DG

"I was able to regain my ankle strength to the same level as my good ankle. This is the third joint issue you have treated me for and all 3 times I have been ver pleased with the results. Thank you."

LO

"I have received great care from Dave. He is most knowledgable in his field of therapy. I will definitely recommend all who have a need to call Gold Medal."

BY

"Terrific! I learned a lot and you helped me recover from sciatic problems. Plus, everyone is so nice."

JJ

"It took a year and a half, but I am much stronger, with less pain and some good habits. Great people."

GF

"You were all so incredibly kind to me when I struggled through my pain. As I moved on to different treatment and several second opinions, I learned that not everyone shares their knowledge as you did nor do they share their support & kindness as everyone did in Perry Hall and at the Brick Bodies site."

LP

"This has been the best PT experience. The best staff, the best service, and the very best care. Thank you!"

RD

"The staff members are attentive, diligent and so very friendly. My therapist, Bryan, listened to my concerns, was sympathetic, and focused on the therapy needed on that day. He also helped me understand exercises were important to do at home."

JV

"I can not believe the care I have received. Everyone has been kind, thoughtful and professional. You can be sure that I will recommend friends to Gold Medal. Thank you for your care."

AS

"I usually saw Jill for my herniated disc in my lower back, and also saw Jennifer several times. Both are exceptional therapists, always mindful of my pain level, and never pushed too far. Thank you so much."

CW

"I came to GMPT because of pain in my back and down my right arm. Jill put me on a plan that really improved my back, neck and arm. It makes it easy to come when you are treated as a person and not just an appointment."

RP

"I'm always raving about the staff at Gold Medal and everything they've done for me. I had been dealing with back pain for years, and finally sought treatment. After a few weeks at Gold Medal, I was walking pain free and standing up straight, which made my mother very happy! I recommend GMPT to all of my friends!"

Kelly Griffin
Play Action Sports/
Top of the Bay Sports/ iLAX

"Everyone at GMPT has been absolutely great. I was more than pleased with the care, patience, knowledge and encouragement from the staff. Thanks to Jennifer and Jeremy for all their help. I appreciate it so much!"

LG

"Everyone was attentive and professional. My questions were taken seriously and answered sincerely. I would definitely recommend GMPT to my family & friends."

PS

"The staff did great, very professional and courteous. Therapy was very good. I'm leaving feeling much better and greatly improved with my movement and overall feeling. Great Job. I'll recommend your staff any time."

MB

"Outstanding care & customer service. Continue with the course you are on!"

SE

"I felt the office was very nice and helpful. Therapy staff very good, explains everything and listens to patient. Great with children."

JM

"Great! Everyone very friendly. Impressed with level of expertise & knowledge."

BM

"Fabulous! Always a nice welcome and great people, and a lot of physical improvement. Thanks for everything!"

KM

Read More Testimonials »

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410-638-5525 or 410-529-0989

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Are you looking for a new career opportunity?

Do you desire to join a Values Based local Employer?

Are you seeking a like-minded Team of Health & Wellness professionals?

COME JOIN THE GOLD MEDAL TEAM!

Tech Positions - seeking organized, detailed and dependable person(s) - good customer service skills a must! Experience helpful, but will train. Candidate would be willing to work flexible shifts at any location. Daytime/Evening hours.

Please email resumes to Ashley - asmith@goldmedalpt.com or fax 410-529-0993


Medical Billing Specialist - We are looking for an Experienced Billing Specialist. Must have prior knowledge with Insurance companies, payment posting and collections, as well as ICD and CPT knowledge for our Perry Hall location.

Email resume to Ashley - asmith@goldmedalpt.com or fax 410-638-5558


Physical Therapy Bel Air

Gold Medal Physical Therapy
407 E. Churchville Rd
Suite 102
Bel Air, MD 21014
410-638-5525

Physical Therapy Perry Hall

Gold Medal Physical Therapy
8640 Ridgely's Choice Drive
Suite L-1
Perry Hall, MD 21236
410-529-0989


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