P. (847) 599-9171

F. (847) 599-9124

1 South Greenleaf St

Suite I

Gurnee, IL 60031



frontdesk@creativerehab.net

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Health Insurance Portability & Accountability Act Privacy Notice
This notice describes how your medical information may be used and disclosed and how you can access your information. This notice may be modified at the discretion of Creative Rehab, Inc. without notice. Please read it carefully and feel free to ask questions.


Why do we collect information about you?
Treatment: Your medical information is collected to allow us to evaluate and treat you with following physical therapy standards of practice and create a customized program for your recovery.
Payment: Your insurance and personal information are collected to allow us to secure payment for our services and contact you as needed during and after your care with us
Clinic Operations: It also serves as a legal record of the care we provide and as a method we can use to improve our services to you and others in the future.


What information do we collect?
We collect specific information including your name, address, medical diagnosis, social security number, date of birth, emergency contact, employer, insurance company, and medical benefits as needed to secure payment and coordinate for treatment.


We also collect medical information pertinent to you including your medical diagnosis, current complaints, past medical history, activity history, personal rehab goals, pain levels and work activities. In addition, we evaluate each patient to measure and assess function and response to treatment to allow us to customize your rehabilitation program.


What information do we share?
Inside Creative Rehab:
Personal information as needed for billing, follow-up by clinical and support staff, and daily interactions with you as needed to provide quality care. Medical information may be shared between clinical staff as needed to optimize your clinical care through consultation and cross training.
Outside Creative Rehab:
Personal and medical information may be shared with other entities that are related to your care such as your insurance company, physician and case managers if applicable or by legal action. We may also share your information with an outside community resource if necessary to ensure your safety and security and the safety of others. Information provision to lawyers, secondary parties and consulting clinicians require an additional release of information signed by the patient/guardian.


What are your rights regarding your information?
•You have the right to request that we restrict our uses of your personal information. We will review your request but are not obligated to adhere to your restriction.
•You have the right to request confidential communication in a reasonable manner through a separate address/phone number.
•You have the right to review and obtain a copy of your personal information.
•You have the right to amend incorrect personal information. You may provide a written amendment that will be added to the medical record. The therapist will not modify the record in any manner.
•You have the right to find out whom your personal information has been disclosed to excluding disclosures that occur during regular clinic operations for clinical care, billing and follow-up.
•You have the right to receive a written copy of this note.

 

We closely protect your medical and insurance information collected before, during and after your care with Creative Rehab. The information we collect is essential to our operations and care for you, and we do not disclose information to non-essential entities. If you feel that your rights have been violated, please make a complaint in writing and forward it to our Patient Representative at 222 South Greenleaf, #101, Gurnee, IL, 60031

HIPAA