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.


“Federal law” - means the Health Insurance Portability and Accountability Act and related privacy rules, which requires MOVE mobile therapy LLC to keep your health information private. MOVE Mobile Therapy LLC is not allowed to use or disclose it unless we receive your permission or unless permitted by law. Federal law requires MOVE Mobile Therapy LLC to give you this Notice of our legal duties and privacy practices. This Notice is to inform you of uses and disclosures of your health information that MOVE Mobile Therapy LLC may make. It also informs you of your rights and our duties with regard to this health information.


MOVE Mobile Therapy LLC must follow the terms of this Notice. MOVE Mobile Therapy LLC reserves the right to change the terms of this Notice and make the new Notice provisions apply to all health information MOVE Mobile Therapy LLC keeps. This includes health information MOVE Mobile Therapy LLC had prior to any change in this Notice. MOVE Mobile Therapy LLC must promptly change this Notice when there is a material change to our uses or disclosures, your rights, our duties and other related circumstances. To receive such Notices by email, you should tell the contact listed at the end of this Notice.


USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

Federal law permits MOVE Mobile Therapy LLC to use and disclose protected health information for purposes of treatment, payment, and health care operations as those terms are defined under federal law. MOVE Mobile Therapy LLC will comply with any state or federal law that is more restrictive as to our uses and disclosures of protected health information. There are also times when federal law permits or requires MOVE Mobile Therapy LLC to use or disclose your information without your written permission. Additionally, where appropriate, MOVE Mobile Therapy LLC may disclose protected health information to a group health plan or plan sponsor in accordance with federal law.


Permitted Disclosures

MOVE Mobile Therapy LLC may not make all of the uses and disclosures listed here, but federal law permits use or disclosure of your information without your permission:

  • When MOVE Mobile Therapy LLC disclose your information to you.
  • To third party non-MOVE Mobile Therapy LLC associates that perform services for MOVE Mobile Therapy LLC or on our behalf.
  • Where disclosure is required by law.
  • To a public health authority authorized by law to collect or receive your information to
  • prevent or control disease, injury or disability or when reviewing reports of child abuse or for the conduct of other authorized public health activities and responsibilities.
  • To a health oversight agency for such activities.
  • For judicial and administrative proceedings.
  • To a law enforcement official for a law enforcement purpose.
  • To a medical examiner for the purpose of identifying a deceased person, determining the cause of death, or other duties authorized by law.
  • To organ donor organizations in order to aid in such donations.
  • For certain research purposes authorized by and subject to federal law.
  • To avert a serious threat to health or safety.
  • To government officials regarding military personnel and certain domestic and foreign government officials for certain functions authorized by federal law.
  • To comply with workers' compensation and other similar programs.


Required Disclosures

MOVE Mobile Therapy LLC must disclose your information when required by the Secretary of the Department of Health and Human Services to make sure MOVE Mobile Therapy LLC complies with federal law. MOVE Mobile Therapy LLC is also required, with certain exceptions, to provide you with access to inspect and obtain a copy of your information that MOVE Mobile Therapy LLC keeps. See "Federal Law Provides You with the Right to Inspect and Copy Protected Health Information" below.


INDIVIDUAL RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO REQUEST RESTRICTIONS: You have the right to request that restrictions be placed on certain uses and disclosures of your information. MOVE Mobile Therapy LLC is not required to agree. If MOVE Mobile Therapy LLC does agree, MOVE Mobile Therapy LLC may not use or disclose any of your information except where you need emergency treatment. MOVE Mobile Therapy LLC may end an agreement to restrict as allowed by federal law. If you wish additional information, you should write to the contact listed at the end of this Notice.


FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO ALTERNATIVE CONFIDENTIAL COMMUNICATION OF PROTECTED HEALTH INFORMATION: If you choose to have your information sent to you by a means of your choice or to an address of your choice, MOVE Mobile Therapy LLC will do so if the request is reasonable. You must clearly state that disclosure of all or any part of your information could endanger you if not sent per your choice. Any such request should be sent in writing to the contact listed at the end of this Notice. If you wish additional information, you should write to the contact listed at the end of this Notice.


FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO INSPECT AND COPY PROTECTED HEALTH INFORMATION: You have the right to inspect and copy your information, certain information relating to civil, criminal, or administrative proceedings, and certain information prohibited by law from disclosure. Any request should be sent in writing to the contact listed at the end of this Notice. If you wish additional information, you should write to the contact listed at the end of this Notice.


FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right, even if you have agreed to receive notice by email, to get a paper copy of this Notice. All requests should be in writing and sent to the contact listed at the end of this Notice.


FEDERAL LAW PROVIDES YOU WITH THE RIGHT TO FILE A COMPLAINT. If you believe your privacy rights have been violated, you have the right to complain to us by writing to the contact listed at the end of this Notice. Federal law prohibits retaliation against you for filing such a complaint. The contact listed at the end of this Notice is also available to provide you information regarding questions you have or other information concerning this Notice.


THE CONTACT TO WHOM YOU SHOULD ADDRESS YOUR COMPLAINT IS:

Brandi Renfro

Florida PT30252

MOVE mobile therapy LLC

78 Sunburst Ct

Ponte Vedra, FL 32081

(904) 395-5335


The effective date of this notice is 01/01/2020. Form revised 09/06/2020.



Under section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are self-paying for a medical service a Good Faith Estimate, or estimate of the cost of your health care services. If you receive a bill of at least $400 more than your Good Faith Estimate, you can dispute the bill. Health care facilities are required to include the following information in your Good Faith Estimate:

  1. Client’s name
  2. Client’s date of birth
  3. Diagnosis codes
  4. Payment method
  5. Provider name
  6. Provider’s National Provider Identifier
  7. Company’s National Provider Id
  8. Tax ID number
  9. Location of services
  10. Estimated cost of services
  11. Client signature and date of signature
  12. List of treatment codes that may be charged
  13. Cost of each treatment code that may be charged
  14. Notice that the client is not obligated or required to obtain any of the listed services from the provider


Move Mobile Therapy LLC provides all self-pay clients with a Good Faith Estimate. These are scanned into each client’s electronic chart and the hard copy is left with each client.