This information describes how medical information about you may be used and disclosed and how you can get access to this information.


We understand that medical information about you and your health is personal and we are committed to protecting that information. We create a medical record of the care and services you receive at our practice in order to provide you with quality care and to comply with certain legal requirements.

This Notice of Privacy Practices describes how we may use and disclose medical information about you, including demographic information, that may identify you and your related health care services in order to treat you, obtain payment for our services, to perform the daily health care operations of our practice, and for other purposes permitted or required by law. This notice also describes your rights to access and control your medical information. We are required by law to abide by the terms of this Notice of Privacy Practices.

Written Acknowledgement
We will ask you to sign a written acknowledgement stating that you have been shown a copy of this notice. This only serves to verify that we have given you the notice to read and the opportunity to ask any questions you may have about it. If you like, you may have a copy of the notice to take with you.

Uses and Disclosures

Treatment. Your health information may be used by staff members to disclose to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, copies of your medical information will be sent to the physician who referred you to our clinic. Videotapes, digital, or other images may be recorded to document your care. Orthopedic Physical Therapy, Inc. will retain the ownership rights to these photographs, videotapes, digital or other images and store them in a secure manner that will protect your privacy. They will be kept for the time period required by law or outlined in Orthopedic Physical Therapy’s policy. Images that identify you will be released and/or used outside the institution only upon written authorization from you or your legal representative.

Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage, or from credit card companies you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health Care Operations. Your health information may be used as necessary to support the day-to-day activities and management of Orthopedic Physical Therapy, Inc. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Work-Related Injury or Illness. Your health information may be disclosed to your employer if it concerns a work-related illness or injury and if you are covered under your employers’ Workers’ Compensation insurance or other health and disability insurance. We may also disclose your health information in order to comply with Workers’ Compensation laws and other similar legally established programs.

Law Enforcement. Your health information may be disclosed to law enforcement investigations, and to comply with government-mandated reporting.

Public Health Reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Other Uses and Disclosures Require Your Authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information

Appointment Reminders. Your health information may be used or disclosed to remind you of your appointment, by mail, telephone, or e-mail. Messages may be left on an answering machine, at a number you provide. Our message will include the name of our practice or the name of our physical therapist, as well as the date and time for your appointment, or a reminder that an appointment needs to be scheduled.

Information About Treatment. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.

Individual Rights

You have certain rights under the federal privacy standards. These include:

  • The right to request restrictions on the use and disclosure of your protected health information
  • The right to receive confidential communications concerning your medical condition and treatment
  • The right to inspect and copy your protected health information
  • The right to amend or submit corrections to your protected health information
  • The right to receive an accounting of how and to whom your protected health information has been disclosed
  • The right to receive a printed copy of this notice

Orthopedic Physical Therapy, Inc. Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.

We are also required to abide the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice during any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.


If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Privacy Officer
Orthopedic Physical Therapy, Inc.
2000 Bremo Road, Suite 202
Richmond, VA 23226

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address.

You will not be penalized or otherwise retaliated against for filing a complaint.

Contact Person

The name and address of the person you may contact for further information concerning our privacy practices is:

Privacy Officer
Orthopedic Physical Therapy, Inc.
2000 Bremo Road, Suite 202
Richmond, VA 23226
PH: (804) 285-0148


EFFECTIVE DATE. This notice is effective on or after 1/1/2017.