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Privacy of Information Policies
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Privacy of Information Policies

Our Legal Duties

State and federal laws, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the HIPAA Omnibus Final Rule of 2013 require that we, Core Revitalizing Center (hereby referred to as CRC), keep your medical records private. Such laws require that CRC provide you with this notice informing you of our privacy of information policies, your rights, and our duties. We are required to abide by these policies until replaced or revised. We have the right to revise our privacy policies for all medical records, including records kept before policy changes were made. Any changes in this notice will be made available before changes take place.

The contents of the material disclosed to us in an evaluation, intake, physical therapy or counseling session are covered by the law as private information. We respect the privacy of the information you provide us, and we abide by the ethical and legal requirements of confidentiality and privacy of records.

Use of Information

Information about you may be used by the personnel associated with CRC for diagnosis, treatment planning, treatment, and continuity of care. We may disclose it to health care providers who provide you with treatment, such as doctors, physical therapists, nurses, mental health professionals, only after full permission is granted by you.

Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian or personal representative. It is the policy of CRC not to release any information about a client without a signed release of information except in certain emergency situations or exceptions in which client information can be disclosed to others without written consent. Some of these situations are noted below, and there may be other provisions provided by legal requirements.

Duty to Warn and Protect

When a client discloses intentions or a plan to harm another person or persons, the healthcare professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the healthcare professional is required to notify legal authorities and make reasonable attempts to notify the family of the client.

Public Safety

Health records may be released for the public interest and safety for public health activities, judicial and administrative proceedings, law enforcement purposes, serious threats to public safety, essential government functions, military, and when complying with workers compensation laws. Prior to the records being released, CRC will contact the client beforehand; including if a subpoena is received.


If a client states or suggests that he or she is abusing a child or vulnerable adult or has recently abused a child or vulnerable adult, or a child (or vulnerable adult) is in danger of abuse, the healthcare professional is required to report this information to the appropriate social service and/or legal authorities. If a client is the victim of abuse, neglect, violence, or a crime victim, and his or her safety appears to be at risk, CRC may share this information with law enforcement officials to help prevent future occurrences and capture the perpetrator.

Prenatal Exposure to Controlled Substances

Health care professionals are required to report admitted prenatal exposure to controlled substances that are potentially harmful.

Professional Misconduct

Professional misconduct by a healthcare professional must be reported by other health care professionals. In cases in which a professional or legal disciplinary meeting is being held regarding the health care professional’s actions, related records may be released in order to substantiate disciplinary concerns.

Judicial or Administrative Proceedings

Health care professionals are required to release records of clients when a court order has been placed.


Parents or legal guardians of non-emancipated minor clients have the right to access the client’s records.

Insurance Companies

Insurance companies are given information that they request regarding services to the client if the client submits for personal reimbursement of the provider’s fees. Information that may be requested includes the type of services, dates/times of services, diagnosis, treatment plan, description of impairment, the progress of therapy, and summaries.

Information about clients may be disclosed in consultations with other professionals in order to provide the best possible treatment.  In such cases, the name of the client, or any identifying information, is not disclosed. Clinical information about the client is discussed.

Direct Communication with Core Revitalizing Center

In the event CRC must telephone, email, or text the client for purposes such as appointment cancellations or reminders, or to give/receive other information, efforts are made to preserve confidentiality. Please notify us in writing where we may reach you by phone and how you would like us to identify ourselves. If this information is not provided to us, we will adhere to the following procedure when making phone calls: ask to speak to the client (or guardian) without identifying the name of the specialty or provider. If the person answering the phone asks for more identifying information, we will say that it is a personal call. We will not identify the reason for care or the provider’s name (to protect confidentiality). If we reach an answering machine or voicemail, we will follow the same guidelines. Email and text messages are a convenient way to communicate, but CRC cannot guarantee the security and confidentiality of electronic communication and is not liable for improper disclosure of confidential information that is not caused by CRC’s intentional misconduct. CRC will use encryption whenever possible when engaging in electronic communication.

Your Rights to Your Medical Record

You have the right to request to review or receive your medical files. The procedures for obtaining a copy of your medical information is as follows. You may request a copy of your records in writing with an original (not photocopied) signature. If your request is denied, you will receive a written explanation of the denial. Records for non-emancipated minors must be requested by their custodial parents or legal guardians. The charge for this service is $0.50 per page, plus postage.

▶You have the right to cancel a release of information by providing us with written notice. If you desire to have your information sent to a location different than our address on file, you must provide this information in writing.

▶You have the right to restrict what information might be disclosed to others.

▶You have the right to request that information about you be communicated by other means or to another location.

▶You have the right to disagree with the medical records in our files. You may request that this information is changed. Although we might refuse to change the record, you have the right to make a statement of disagreement, which will be placed in your file.

▶You have the right to know what information in your record has been provided to whom.

▶If you desire a written copy of this notice you may obtain it online or by contacting CRC.


If you have any complaints or questions regarding these procedures, please contact CRC. We will get back to you in a timely manner.

I hereby attest that I, as the client or legal guardian of the client, understand the privacy policies, limits of confidentiality, and their meanings and ramifications.


Legal Guardian:         



Signed by:          client   guardian  personal representative