privacy (hipaa) information

HIPPA Stack Of Forms

HIPAA Compliance

Last updated: July 2020

Concentra makes all reasonable efforts to comply with HIPAA — the Health Insurance Portability and Accountability Act of 1996 – and privacy regulations and State privacy laws and regulations. We take these matters very seriously and have instituted numerous internal and external measures to maximize compliance. The following related pages detail our full HIPAA and privacy program:

  • HIPAA Information — General discussion about protected health information (PHI) and Concentra’s role in protecting it 
  • Notice of Privacy Practices — Describes your guaranteed rights under HIPAA and how Concentra can user your protected health information (PHI)
  • Confidentiality Statement — Detailed, legal description of the requirements protecting the privacy of our patients’ health information 
  • Internet Privacy Policy — Our company’s specific statement on protecting personally identifiable information (PII) that's communicated through this medium
    Privacy Concerns Woman Typing Records

    Privacy (HIPAA) Concerns

    For HIPAA-related issues or questions, please contact us at 800.819.5571.

      Forms for Patient Rights

      The following forms are to be used in connection with patient’s guaranteed rights under HIPAA:
      Please note: Completed Access or Consumer Authorization Forms should be submitted to the Medical Records Custodian for the center where the patient was seen. Please use our Location Finder tool on this site for center contact information (phone, mailing, address, fax). Please contact the Privacy Office ([email protected]) if the visit was at a closed facility.

      • Access Records Request— This form is used for the patient (or his/her personal representative) to request access to the patient’s protected health information (PHI).
      • Consumer Authorization Request:— This form is used for a patient (or his/her personal representative) to authorize/direct PHI to a designated individual/entity.
      • Amend Records Request — This form is used to request an amendment to clinical information contained in a patient’s medical record. Acceptance/denial of an amendment request is addressed by the applicable clinical staff at the treating location. The Privacy Office provides the clinical review determination to the requestor, but is not involved in the determination process. NOTE: Clerical errors are not requests for amendment and should be addressed to the treating location staff.
      • *Confidential Handling Request — This form is used to request an alternate method of communication (that is, a different email, phone number, or address) other than what is on the file for confidentiality reasons. It should NOT be used for Access or Authorization requests.
      • *Restriction Request — This form is used to limit or restrict protected health information (PHI) from being disclosed (this form does not apply to workers’ compensation) to specified individuals.
      • Complaint Form — Please contact center leadership where you received services to submit a privacy related complaint/concern. You can also contact the HIPAA Hotline at 800-819-5571 to express your privacy related complaint/concern. For non-privacy related customer service matters, please contact the Concentra Customer Care line at 1-866-944-6046.
      • Disclosure Accounting  Request — This form is used for a patient to request a list of disclosures of his/her protected health information (PHI) other than the type of disclosures bulleted within the form that are not required to be part of a disclosure accounting request.

      *These rights may be limited for certain services, such as workers compensation.