Notice of Privacy Practices

Introduction

At Melissa Hales Pelvic Health & Wellness we are committed to treating and protecting your medical information. The creation of a medical record detailed the care and services you receive helps us provide you with quality health care. This Notice of Privacy Practices describes the health information we collect and show the ways in which that information can be used. You must sign and date the Notice of Privacy Practices before we being treatment.

Understanding your Health Information

Each time you visit Melissa Hales Pelvic Health & Wellness, a record of your visit is made. Usually, this record contains information about your symptoms, test results, examination, diagnosis, prognosis, plan of care and treatments provided. This information is often referred to as your health or medical record.

Your Rights

Although your medical/health record is the property of Melissa Hales Physical Therapy & Wellness, the information belongs to you.  You have the right to:

  • Obtain a copy of the Notice of Privacy Practices upon request

  • Inspect and copy your medical record

  • Make changes in your medical record

  • Make a list of who your medical record was shared with

  • Request communication of your medical record in certain places (for example, you may want us to call you at work instead of home)

  • Request a restriction on certain uses and sharing of your information

  • Request your permission for use or sharing of your medical record except to the extent where action has already been taken

Our Responsibilities

Melissa Hales Pelvic Health & Wellness is required to:

  • Maintain the privacy of your medical record

  • Provide you with this notice as to our legal duties and privacy practices with respect to the medical records we collect and maintain about you

  • Abide by the terms of this notice

  • Notify you if we were unable to agree to a request restriction

  • Accommodate reasonable requests you may have to communicate your medical records by alternate locations

We reserve the right to change our practices and to make the new provisions effective for all the medical records we maintain.

We will not use or share your medical record without permission, except as described in this notice. We will also discontinue the use of the Notice of Privacy Practices and share your medical record after we have received notice in writing that you have revoked your permission. 

Use and Sharing of Health Information for Treatment, Payment and Health Operations

The law allows us to use your medical records without your permission for treatment, payment, and business operations. The following are some examples: patient billing, third party billing, quality of care and improved services, other specialty care, caregiver/ family member notification/communication, research, organ and tissue donation, marketing, fundraising, Food and Drug Administration (FDA), Workers Compensation, law enforcement, and public health.

Federal law makes provision for your medical records to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member of business associate believes in good faith that we have engaged in unlawful conduct of have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

For More Information or to Report a Problem

If you have any questions or require additional information, please contact Melissa Hales Pelvic Health & Wellness at (224)310-9802 or email melissa@melissahales.com.