Notice of Privacy Policy
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED, DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY
Your medical information (“PHI”) is the information collected by your physical therapists or other caregivers during the time you are being treated by the professionals at the clinic. It is private, and nobody without a legitimate need to know can access it. The law requires that the Alliance Physical Therapy Partners’ Provider (APTP Provider) maintain the privacy of your health information and provide you with notice of its legal duties and privacy practices (this “Notice”). In the unlikely event that your medical information is not secure, you will be furnished with notification. The Provider will not use or disclose your health information except as described in this Notice unless you tell us we can do so in writing. This Notice applies to all medical records generated during your participation in Alliance Physical Therapy Partners and affiliated entities programs and services.
TO WHOM THIS NOTICE APPLIES
This Notice is a joint notice for all Alliance Physical Therapy Partners affiliated entities, each of which follows the terms of this Notice and is referred to in this Notice as “we,” “us” or “our”. A complete listing of all the Alliance Physical Therapy Partners affiliated entities and their respective locations covered by this Notice is available online at www.alliancePTP.com, at the clinic or facility where you are receiving care or by calling (616) 356-5000. A change to the list does not constitute a material change in the practices described in this Notice. In addition, this Notice applies to all our employees, management, contractors, student interns, and volunteers.
EFFECTIVE DATE OF NOTICE
This Notice is effective as of January 1, 2026. We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the PHI we maintain within the scope of federal and state privacy laws. If our information practices materially change, we will amend our Notice. Any changes we make in our privacy practices will affect all PHI information we maintain. You are entitled to receive a revised copy of the Notice. You may call our Corporate Office at (616) 356-5000 or email us at compliance@allianceptp.com and requesting a copy. It will also be made available at each of our service locations and on the website.
The following categories describe the ways in which the Provider may use and disclose your health information:
Treatment: The Provider will use your health information in the provision and coordination of your healthcare. We may disclose all or any portion of your medical record information to your physician, consulting physician(s), nurses and other healthcare providers who have a legitimate need for such information in the care and continued treatment of the patient.
Payment: We may need to share a limited amount of your PHI to obtain payment for the services provided to you. Examples include:
- To Determine Eligibility – We may contact the company or government program that will be paying for your healthcare to determine your eligibility for benefits, copayments, coinsurance, or deductible.
- For Claims Submission – We will submit a claim to obtain payment for services provided to you. The claim form must contain certain information to identify you, your medical diagnosis, and the treatment provided to you.
Healthcare Operations: We may use and disclose your PHI to conduct our healthcare operations and to improve our quality of care. Healthcare operations include, but are not limited to, activities such as, case management and care coordination, outcome evaluation, and training programs including those in which students, trainees or healthcare practitioners learn under supervision.
Appointment Reminders: We may use and disclose medical information to remind you of an appointment you scheduled for treatment with us.
Billing and Collection Purposes: We may use or disclose your health information for the purpose of obtaining payment for services provided. You may be contacted by mail or telephone at any telephone number associated with you, including wireless numbers. Telephone calls may be made using pre-recorded or artificial voice messages and/or automatic dialing device (an “autodialer”). Messages may be left on answering machines or voicemail, including any such message information required by law (including debt collection laws) and/or regarding amounts owed by you. Text messages or emails using any email addresses you provide may also be used in order to contact you.
Business Associates: We contract certain services with business associates such as document destruction and document storage companies. Business associates are required by federal law to protect your PHI.
For Marketing Purposes: We may use your PHI to communicate about a product covered by your health plan or about treatment alternatives related to your care coordination or about health-related services or benefits that may interest you. We may also use your PHI for streamlined marketing communications, including, but not limited to, home exercise programs. Authorization is not required for face-to-face communication.
Person Involved in Your Care: We may share PHI about you with a friend, family member, personal representative, or any individual you identify who is involved in your care. We can also give this information to someone who will help or is helping to pay for your care. You have the right to request restrictions on these disclosures.
Parents and Legal Guardians of Minors: As permitted by federal and state law, we may disclose health information about minors to their parents or guardians.
Required by Law: We may use and disclose your PHI when that use or disclosure is required by law.
Public Health Activities: We may disclose PHI as required by law to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Health Oversight Activities: We may be required to disclose your PHI to appropriate health oversight agencies so they can monitor, investigate, inspect, discipline or license those who work in the healthcare system, or for government benefit programs
Workers’ Compensation: The Provider may release medical information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
Judicial and Administrative Proceedings: As permitted or required by law, we may disclose your PHI in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.
Report Abuse, Neglect or Domestic Violence: We may disclose your PHI to public authorities as required by law to report abuse or neglect.
For Law Enforcement Purposes: As permitted or required by law, we may disclose your PHI to a law enforcement official for certain law enforcement purposes, including, under certain limited circumstances, if you are a victim of a crime or to report a crime.
Serious Threat to Health or Safety: Consistent with applicable law and ethical standards of conduct, we may disclose your PHI if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Research & Development Purposes: We may use or release your PHI for research purposes. All research projects require special permission before they begin. This process may include asking you for authorization; however, in certain circumstances, your PHI may be used or released without your authorization. Under certain circumstances your PHI may also be used to develop software or other processes that may help Alliance serve its population better.
Acknowledgment of Receipt of Notice of Privacy Practices: We will request that you sign a separate form acknowledging that you were offered or received a copy of this Notice. If you elect not to sign the acknowledgment, one of our staff members will sign on your behalf attesting that the Notice was provided to you. A copy of the acknowledgment will be maintained in your patient record.
You have the following rights regarding your protected health information. You have the right to:
Confidential Communications: You have the right to receive confidential communications regarding your medical information. For example, you may request that the Provider contact you only at work or by mail. We will honor all reasonable requests.
Video Monitoring: We may utilize HIPAA compliant video cameras in the open gym area of this facility so as to ensure the safety of our patients at all times. Video recordings are never distributed, sold, or played on the internet, social media, or YouTube for general viewing. Videos will not be part of the medical record.
Right to Inspect, Copy, and Amend: You have the right to ask us in writing to correct health information about you that you think is incorrect or incomplete. We may deny your request, but we will provide a written response as to why.
Right to an Accounting: You have the right to obtain an accounting of the disclosures of your medical information made during the preceding six (6) year period.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your medical information. You can request that we not use or share certain health information for treatment, payment and operations activity. We are not required to agree with your request and may say no if it affects your care.
Other: You may request in writing that we not share your information with a health care plan for services that you have paid for out of pocket in full.
Obtaining a Notice of Our Privacy Practices: We provide you with our Notice to explain and inform you of our Privacy Practices. You may also take a copy of this Notice with you. Even if you have requested this Notice electronically, you may still request a paper copy at any time at one of our physical locations. You may also view or obtain a copy of our Notice at our website at www.allianceptp.com.
Right to Revoke Authorization: You have the right to revoke your authorization to use or disclose your medical information, except to the extent that action has already been taken in reliance on your authorization. A request to exercise any of these rights must be submitted, in writing, to Alliance Physical Therapy Partners – Privacy Officer, 625 Kenmoor Ave SE Ste 100, Grand Rapids, MI 49546.
California
Where applicable, this company complies with the California Consumer protections Acts. In addition to the rights stated within this notice, California residents have the right to:
- Request that covered businesses, and their direct service providers, to delete personal information collected about them. Deletion is not required if the covered business needs the personal information to complete the transaction for which it was collected; to comply with a legal obligation, such as a record retention requirement; to protect against malicious, deceptive, fraudulent, or illegal activity; or to identify and repair errors that impair existing and intended functionality.
- Opt out of the “sale” of their personal information.
- Not be discriminated against for exercising their CCPA rights.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions about this Notice, please contact our Compliance Officer at 625 Kenmoor Ave SE Ste 100, Grand Rapids, MI 49546 or (866) 647-6414 or e-mail compliance@allianceptp.com .
If you believe your privacy rights have been violated, you may file a complaint with the Office of Civil Rights, US Department of Health and Human Services, by sending a letter to 200 Independence Ave. S.W., Washington, D.C. 20201, call 1.877.696.6775 or visit www.hhs.gov/ocr/privacy/hipaa/complaint. You may also file a complaint with us by contacting our front desk.
All complaints must be submitted in writing. There will be no retaliation for filing a complaint.
CHANGES TO THIS NOTICE
The Provider will abide by the terms of the Notice currently in effect. The Provider reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all protected health information that it maintains. An updated version of the Notice may be obtained at the clinic and on the company’s website.
NOTICE EFFECTIVE DATE
This Notice is effective January 1, 2026.