NOTICE OF PRIVACY PRACTICES SUMMARY

Physical Therapy Plus

This notice is a summary of how your protected health information is used and disclosed and how you can obtain access to this information. You may review a complete copy of our Full Notice of Privacy Practices by calling 315.476.3176 or e-mailing ptplus@ptpluscny.com.

Uses and Disclosures of Health Information

We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive from us.

Subject to certain requirements, we may be required by law to give out health information without your authorization for public health purposes, emergencies, or in specific law enforcement circumstances.

In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

We may change our policies at any time. Before we make any significant change in our policies, we will change our notice and post the new notice in the reception area of our office. You can also request a copy of our notice at any time. For more information about our privacy practices, contact the person listed below.

Your Rights

Although your health record is the physical property of Physical Therapy Plus, the information it contains belongs to you. You have the right to:

· Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522

· Obtain a paper copy of the Notice of Privacy Practices upon request

· Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524

· Amend your health record as provided in 45 CFR 164.528

· Obtain an accounting of disclosures of your health information (45 CFR 164.528)

· Request communications of your health information by alternative means or at alternative locations

· Revoke your authorization to use or disclose health information except to the extent that action has already

been taken

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

Complaints

If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.

Our Legal Duty

We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice and in our full Notice of Privacy Practices. If you have any questions or complaints, please contact Mr. John Jablonka, PT, 207 Pine St., Syracuse, NY 13210 Phone 315.476.3176 or email jj@ptpluscny.com