FOR APPTS CALL: 703-205-1233

ACE Physical Therapy & Sports Medicine Institute, LLC

ACE Physical Therapy & Sports Medicine Institute, LLC.

  • 2841 Hartland Rd. # 401B · Falls Church, VA 22043 · (703) 205-1233·
  • 131 Elden Street #308 · Herndon, VA 20170 · (703) 205-1233·
  •  19465 Deerfiled Ave, #311, Leesburg, VA 20176 ·(703) 205-1233·
  •  12011 Lee Jackson Memorial Hwy, #101, Fairfax, VA 22030· (703) 205-1233·
  •  2877 Duke Street, Alexandria, VA 22314· (703) 205-1233·
  •  8230 Boone Blvd, #202, Tysons Corner, VA 22182  · (703) 205-1233·
  •  1701 Clarendon Blvd, #110, Arlington, VA 22209  · (703) 205-1233·


Effective Date: August 1, 2006



If you have any questions about this notice, please contact the office. Each time you visit a hospital, physician, physical therapist or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing related information. This notice applies to all of therecords of your care generated by the office, whether made by office personnel, medical staff, or your personal doctor.

Our Responsibilities

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.

Uses and Disclosures

How we may use and disclose Health Information about you.
The following categories describe examples of the way we use and disclose health information:

For Treatment: We may use health information about you to provide you treatment or services. We may disclose health information about you to doctors, medical staff, or other office personnel who are involved in taking care of you at the office. For example: the physical therapist treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. We may also provide your primary healthcare provider, your treating physician or other subsequent health care provider with copies of various reports that should assist him or her in treating you.

For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your treatment so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.

For Health Care Operations: Members of the clinical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine health information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, and other personnel. And we may combine health information we have to see where we can make improvements. We may remove information that identifies you fromthis set of health information to protect your privacy.

We may also use and disclose health information:

  • To business associates we have contracted with to perform the agreed upon service and billing for it;
  • To remind you that you have an appointment for medical care;
  • To assess your satisfaction with our services;
  • To tell you about possible treatment alternatives;
  • To tell you about health–related benefits or services;
  • For conducting training programs or reviewing competence of health care professionals.

When disclosing information, primarily appointment reminders and billing/collections efforts, we may leave messages on your answering machine/voice mail.

Business Associates: There are some services provided in our organizationthrough contracts with business associates. Examples include transcriptionservices for our medical records, vendor/technicians for our computer softwaresystem. When these services are contracted, we may disclose your healthinformation to our business associates so that they can perform the job we’veasked them to do and bill you or your thirdpartypayer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Individuals Involved in Your Care or Payment for Your Care: We mayrelease health information about you to a friend or family member who is involvedin your medical care or who helps pay for your care. In addition, we may disclosehealth information about you to an entity assisting in a disaster relief effort so thatyour family can be notified about your condition, status and location.

Organized Health Care Arrangement: This facility and its medical staffmembers have organized and are presenting you this document as a joint notice.Information will be shared as necessary to carry out treatment, payment andhealth care operations. Physical Therapists, Physicians and caregivers may haveaccess to protected health information in their offices to assist in reviewing pasttreatment as it may affect treatment at the time.

Affiliated Covered Entity: Protected health information will be made available to hospital personnel at local affiliated hospitals as necessary to carry outtreatment, payment and health care operations. Caregivers at other facilities mayhave access to protected health information at their locations to assist inreviewing past treatment information as it may affect treatment at this time.Please contact the Facility Privacy Official for further information on the specificsites included in this affiliated covered entity.

As required by law, we may also use and disclose health information for thefollowing types of entities, including but not limited to:

  • Food and Drug Administration
  • Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability
  • Correctional Institutions
  • Workers Compensation Agents
  • Military Command Authorities
  • Health Oversight Agencies
  • National Security and Intelligence Agencies
  • Protective Services for the President and Others

Law Enforcement/Legal Proceedings: We may disclose health information forlaw enforcement purposes as required by law or in response to a valid subpoena.

StateSpecific Requirements: Many states have requirements for reportingincluding populationbasedactivities relating to improving health or reducinghealth care costs. Some states have separate privacy laws that may applyadditional legal requirements. If the state privacy laws are more stringent thanfederal privacy laws, the state law preempts the federal law.

Your Health Information Rights
Although your health record is the physical property of the healthcare practitioneror facility that compiled it, you have the Right to:

Inspect and Obtain a Copy: You have the right to inspect and obtain a copyof the health information that may be used to make decisions about your care.Usually, this includes medical and billing records, but does not includepsychotherapy notes. We may deny your request to inspect and obtain a copy incertain very limited circumstances. If you are denied access to healthinformation, you may request that the denial be reviewed by our Medical Director.We will comply with the outcome of the review.

    • Amend: If you feel that health information we have about you is incorrect or incomplete, you have the right to request an amendment, for as long as theinformation is kept by or for the office. We may deny your request for anamendment and if this occurs, you will be notified of the reason for the denial.
    • An Accounting of Disclosures: You have the right to request an accountingof disclosures. This is a list of certain disclosures we make of your healthinformation for purposes other than treatment, payment or health care operationswhere an authorization was not required.

Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment orhealth care operations. You also have the right to request a limit on the healthinformation we disclose about you to someone who is involved in your care or thepayment for your care, like a family member or friend. For example, you couldask that we not use or disclose information about certain treatment you had. Weare not required to agree to your request. If we do agree, we will comply withyour request unless the information is needed to provide you emergencytreatment.

  • Request Confidential Communications: You have the right to request thatwe communicate with you about medical matters in a certain way or at a certainlocation. For example, you may ask that we contact you at work instead of yourhome. The facility will grant reasonable requests for confidential communicationsat alternative locations and/or via alternative means only if the request issubmitted in writing and the written request includes a mailing address where theindividual will receive bills for services rendered by the facility and relatedcorrespondence regarding payment for services. Please realize, we reserve theright to contact you by other means and at other locations if you fail to respond toany communication from us that requires a response. We will notify you inaccordance with your original request prior to attempting to contact you by othermeans or at another location.
  • A Paper Copy of This Notice: You have the right to a paper copy of thisnotice. You may ask us to give you a copy of this notice at any time. Even if youhave agreed to receive this notice electronically, you are still entitled to a papercopy of this notice. You may print or view a copy of the notice through ourwebsite at:, by clicking on the Notice of Privacy Practices link.

To exercise any of your rights, please obtain the required forms from our officeand submit your request in writing.


We reserve the right to change this notice and the revised or changed notice willbe effective for information we already have about you as well as any informationwe receive in the future. The current notice will be posted in the office andinclude the effective date.


If you believe your privacy rights have been violated, you may file a complaintwith our main office by contacting the main number and asking for the clinicmanager. All complaints must be submitted in writing. You will not be penalizedfor filing a complaint.


Other uses and disclosures of health information not covered by this notice or thelaws that apply to us will be made only with your written permission. If youprovide us permission to use or disclose health information about you, you mayrevoke that permission, in writing, at any time. If you revoke your permission, wewill no longer use or disclose health information about you for the reasonscovered by your written authorization. You understand that we are unable to takeback any disclosures we have already made with your permission, and that weare required to retain our records of the care that we provided to you.

Telephone Number: 703-205-1233