Functional Living Solutions Occupational Therapy
Notice of Privacy Practices
Effective Date: September 14, 2026
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.
Functional Living Solutions Occupational Therapy is committed to protecting the privacy of your health information. We are required by law to maintain the privacy and security of your protected health information, provide you with this Notice of Privacy Practices, and follow the terms of the notice that is currently in effect.
Get a Copy of Your Health Records
You may ask to see or receive a copy of your medical record and other health information we maintain about you. We will generally provide a copy or summary within the time required by law. We may charge a reasonable, cost-based fee when permitted by law.
Ask Us to Correct Your Health Record
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny your request in certain situations, but we will explain the reason in writing when required.
Request Confidential Communication
You may ask us to contact you in a specific way, such as calling a particular phone number or sending information to a particular address. We will accommodate reasonable requests.
Ask Us to Limit What We Use or Share
You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are not required to agree to every request.
If you pay for a healthcare service in full out of pocket and ask us not to share information about that service with your health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law.
Get a List of Certain Disclosures
You may request a list of certain times we have shared your health information. This is sometimes called an accounting of disclosures.
Get a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Choose Someone to Act for You
If you have given someone medical power of attorney, or if someone is your legal guardian or personal representative, that person may exercise your rights and make choices about your health information as allowed by law.
File a Complaint
You may file a complaint if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
You may complain directly to Functional Living Solutions Occupational Therapy using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
Your Rights
For certain health information, you may tell us your preferences about what we share. For example, you may tell us whether you want us to:
- Share information with family members, friends, or others involved in your care
- Share information in a disaster-relief situation
If you are unable to tell us your preference, such as during an emergency, we may share information if we believe it is in your best interest and permitted by law.
We generally will not use or disclose your health information for marketing purposes or sell your health information without your written authorization when authorization is required by law.
Your Choices
HIPAA allows us to use and disclose your health information for certain purposes without obtaining written authorization from you.
Treatment
We may use or share your health information to provide, coordinate, or manage your healthcare. For example, we may share information with your physician or another healthcare professional involved in your treatment.
Payment
We may use and share your health information to bill and receive payment for services provided to you. For example, we may provide information to Medicare, an insurance company, workers compensation carrier, auto insurer, or other payer when necessary to process a claim.
Healthcare Operations
We may use or share your information for activities necessary to operate our practice. Examples include quality improvement, compliance activities, business planning, auditing, credentialing, and reviewing the quality of care.
Business Associates
We may share information with companies or individuals who perform services for our practice, such as billing companies, electronic medical record vendors, accountants, technology providers, or other contractors. When required by HIPAA, these organizations must agree to appropriately protect your health information.
Required by Law
We may share your health information when required by federal, state, or local law.
Public Health and Safety
We may disclose health information for certain public health or safety activities permitted by law, including:
- Reporting certain diseases or injuries
- Reporting suspected abuse, neglect, or domestic violence when legally required
- Preventing or reducing a serious threat to health or safety
- Reporting adverse events involving certain products or medical devices
Workers Compensation
We may disclose health information as permitted or required for workers compensation claims or similar programs.
Legal and Government Requests
We may disclose health information when permitted or required for:
- Court or administrative proceedings
- Law enforcement purposes
- Health oversight activities
- Government functions
- Coroners or medical examiners
- Other purposes specifically permitted by law
How We May Use and Share Your Health Information
Uses or disclosures of your health information not described in this notice generally require your written authorization. If you provide authorization, you may revoke it in writing at any time, except to the extent that we have already relied on the authorization.
Other Uses and Disclosures
Uses or disclosures of your health information not described in this notice generally require your written authorization. If you provide authorization, you may revoke it in writing at any time, except to the extent that we have already relied on the authorization.
Our Responsibilities
We may change the terms of this Notice. Any revised notice may apply to health information we already have as well as information we receive in the future. The current Notice will be available at our office, upon request, and on our website at www.FunctionalLivingSolutionsOT.com.
Changes To This Notice
For questions about this Notice, concerns about your privacy, or to file a complaint, contact:
Privacy Officer
Breanne Shampaine
Functional Living Solutions Occupational Therapy
355 S TelegraphMonroe, MI
Phone: 734-328-1609
Fax: 734-328-1622
Email: info@FunctionalLivingSolutionsOT.com
Website: www.FunctionalLivingSolutionsOT.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Information about filing a complaint is available through HHS.