Notice of Privacy Practices
This Notice describes how medical information about you may be used and disclosed, and how you can get access to this information.
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.
Our Commitment to Your Privacy
The Performance Lab is required by law to maintain the privacy of your protected health information ("PHI"), to provide you with this Notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI. We are required to abide by the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your health care, including sharing information among the physicians, clinicians, and staff involved in your care and with other providers to whom we refer you.
Payment
We may use and disclose your PHI to obtain payment for the services we provide — for example, to verify coverage, obtain prior authorization, or bill your health plan.
Health Care Operations
We may use and disclose your PHI for operational purposes such as quality assessment, staff review and training, accreditation, licensing, and general administration.
Other Permitted Uses
We may also use or disclose your PHI, as permitted by law, for appointment reminders, treatment alternatives, health-related benefits and services, as required by law, for public health and safety activities, for health oversight, in judicial and administrative proceedings, to law enforcement under specific circumstances, for workers' compensation, and to comply with legal and regulatory requirements.
Uses and Disclosures Requiring Your Written Authorization
Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and any sale of PHI require your written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, which you may revoke at any time in writing, except to the extent we have already acted in reliance on it.
Your Rights Regarding Your Health Information
- Right to inspect and copy your PHI in a designated record set, subject to limited exceptions;
- Right to request an amendment of PHI you believe is incorrect or incomplete;
- Right to an accounting of certain disclosures we have made of your PHI;
- Right to request restrictions on certain uses and disclosures of your PHI;
- Right to request confidential communications by alternative means or at an alternative location;
- Right to a paper copy of this Notice, even if you have agreed to receive it electronically;
- Right to be notified following a breach of your unsecured PHI.
Our Responsibilities
We are required to maintain the privacy of your PHI, provide this Notice, follow the terms currently in effect, and notify you if we are unable to agree to a requested restriction. We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. Any revised Notice will be posted in our facility and on our website.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
Contact — Privacy Officer
To exercise any of your rights, ask questions about this Notice, or file a complaint, please contact our Privacy Officer:
Phone: (813) 212-1120 · Email: info@tpltampa.com
