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.
In this Notice of Privacy Practices (“Notice”), we use terms like “we,” “us” or “our” to refer to XRHealth USA Inc., its physicians, employees, staff, and other personnel. All of the sites and locations of XRHealth USA Inc. follow the terms of this Notice.
This Notice describes how we may use and disclose your protected health information(“health information”) . This Notice also outlines our legal duties for protecting the privacy of your health information and it explains your rights concerning your health information. This Notice is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (“HIPAA”).
We will create a record of the services we provide you, and this record will include your health information. We need to maintain this information to ensure that you receive quality care and to meet certain legal requirements related to providing you care. We understand that your health information is personal, and we are committed to protecting your privacy and ensuring that your health information is not used inappropriately.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Specifically, you have the right to request the following:
Inspect and get a copy of your medical record
Ask us to correct your medical record
Request confidential communications
Ask us to limit what health information we use or share
Get a list of those with whom we’ve shared information
Get a copy of this Notice
Choose someone to act for you
File a complaint if you feel your rights are violated
1330 Beacon Street Suite 209, Brookline, MA 02446
To exercise any of your rights described above, please contact:
Privacy Officer: Michal Zuckerman
ph: +1 855-878-4193
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your health information in the situations described below, contact us via the contact information provided above. Tell us what you want us to do, and we will follow your instructions unless a law prohibits us from doing so.
In these cases, you have both the right and choice to tell us to:
If you do not, or are not able, to tell us your preference, for example if you are unconscious, we may go ahead and share your health information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. In these cases, we never share your health information unless you give us written permission:
Our Uses and Disclosures Without Your Authorization
Patient authorize and direct XRHealth to release (verbally or in writing) confidential medical information to any person, entity, government agencies, insurance carriers, or others who are financially liable to XRHealth for charges for medical treatment, and for quality management, utilization review, transfer of medical care, and follow up purposes. Patient understand that a copy of this document may be used with the same effectiveness as an original. By agreeing to this document, you consent to any type of communication of your medical information with other treating providers as part of the coordination of your care.
How do we typically use or share your health information?
We typically use or share your health information in the following ways:
For Treatment: We may use your health information to provide you with medical treatment or services. For example, your health information will be disclosed to the nurses who participate in your care. We may also disclose your health information to your physician or another health care provider to be sure those parties have all the information necessary to diagnose and treat you.
For Payment: We may use and disclose your health information to others so they will pay us or reimburse you for your treatment. For example, a bill may be sent to you, your insurance company, or a third-party payer. The bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment. We may share your health information with pharmaceutical company patient assistance programs and patient support organizations in order to assist you in obtaining payment for your care or payment for certain parts of your care.
For Health Care Operations: We may use and disclose your health information in order to support our business activities. For example, we may use your health information for quality assessment activities, training of medical students, necessary credentialing, and for other essential activities. We may ask you to sign your name to a sign-in sheet at the registration desk and we may call your name in the waiting room when we call you for your appointment. We may disclose your health information to a third party that performs services, such as billing and collection, on our behalf. In these cases, we will enter into a written agreement with the third party to ensure they protect the privacy of your health information.
For Appointment Reminders: We may use and disclose your health information in order to contact you and remind you of an upcoming appointment for treatment or health care services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We may use and disclose your health information for public health activities, including the following:
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Work with medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies. This disclosure may be necessary to identify a deceased person or determine the cause of death. We may also disclose health information, as necessary, to funeral directors to assist them in performing their duties.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Other Uses and Disclosures Require Your Authorization
If we wish to use or disclose your health information for a purpose not set forth in this Notice, we will seek your authorization. Specific examples of uses and disclosures of health information requiring your authorization include: (i) most uses and disclosures of your health information for marketing purposes; (ii) disclosures of your health information that constitute the sale of your health information; and (iii) most uses and disclosures of psychotherapy notes (private notes of a mental health professional kept separately from a medical record). You may revoke an authorization in writing at any time, except to the extent that we have already taken action in reliance on your authorization.
We will not use or share your health information if state law prohibits it. Some states have laws that are stricter than the federal privacy regulations, such as laws protecting HIV/AIDS information or mental health information. If a state law applies to us and is stricter or places limits on the ways we can use or share your health information, we will follow the state law. If you would like to know more about any applicable state laws, please ask us using the contact information provided above.
Changes to this Notice
We reserve the right to change the terms of this Notice at any time. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Each version of the Notice will have an effective date listed on the first page. Updates to this Notice are also available at our web site, www.xr.health.
Education: Doctor of Physical Therapy from University of Michigan-Flint
Years in Practice: 10
Education: Bachelor’s in Psychology and a Masters in Social Work from Grand Valley State University
Years in Practice: 14
Education: Master of Science in Occupational Therapy from Eastern Michigan University
Years in Practice: 19