INTRODUCTION

Welcome to RehabHands Therapy, LLC’s Privacy Policy. We understand that health information about you and your health care is personal. We are committed to protecting health information about you. The Health Insurance and Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires all medical information used or disclosed by us in any form whether electronically, on paper, or orally, are kept properly confidential. This act gives you the patient or patient’s representative significant rights to understand and control how your information is used. HIPAA provides penalties for covered entities that misuse health information. 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.

OUR RESPONSIBILITIES

We are required by law to:

• Maintain the privacy of your protected health information (“PHI”).

• Provide you with this notice of our legal duties and privacy practices.

• Abide by the terms of this notice.

• Notify you if there is a break of your unsecured PHI.

• We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request and available on our website. YOU ARE HEREBY ADVISED THAT YOUR CONTINUED USE OF OUR SERVICES CONSTITUTES YOUR ACCEPTANCE OF ANY AMENDMENTS TO AND THE MOST RECENT VERSION OF THIS PRIVACY STATEMENT.

INFORMATION WE COLLECT

We collect and maintain various types of information including:

• Personal Information: your name, address, phone number, and email address.

• Health Information: Information related to your medical history, diagnosis, treatment plans, progress notes, and any other relevant health data.

• Payment Information: If applicable, payment details for billing and insurance purposes.

USES AND DISCLOSURES of PHI

We may use and disclose your PHI for the following purposes:

• Treatment: We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes sharing information with other healthcare professionals involved in your care.

• Payment: We may use and disclose your PHI for billing and payment purposes, such as submitting claims to your insurance company.

• Healthcare Operations: We may use and disclose your PHI for our healthcare operations, which include activities necessary to support our treatment and payment functions, quality improvement activities, and compliance with legal and regulatory requirements.

• Required by Law: We may use and disclose your PHI when required by federal, state, or local law.

• Public Health: We may disclose your PHI to public health activities, such as reporting communicable diseases, and to prevent or control serious threats to public health or safety. This includes reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

• Health Oversight: We may disclose your PHI to government agencies that oversee healthcare providers and services.

• Legal Proceedings: We may disclose your PHI in response to a court order or subpoena, and in some circumstances, for legal proceedings.

• Law Enforcement Purposes: We may disclose your PHI for law enforcement purposes, including reporting crimes occurring on my premises.

• Research: In certain situations, we may use or disclose your PHI for research purposes when an institutional review board or privacy board has approved the research and established protocols to ensure the privacy of your PHI.

• Appointment Reminders: We may use and disclose your PHI to contact you to remind you that you have an appointment with us.

• “Session Notes”: We keep session notes and any use of disclosure of such notes requires your Authorization unless the use or disclosure is: for our use in treating you, for our use in training or supervising associates to help them improve their clinical skills, for our use in defending ourselves in legal proceedings instituted by you, for use by Secretary of Health and Human Services to investigate my compliance with HIPAA, required by law and the use or disclosure is limited to the requirements of such law, required by law for certain health oversight activities pertaining to the session note, required by a coroner who is performing duties authorized by law, required to help avert a threat to health and safety of others.

YOUR RIGHTS

You have the following rights regarding your protected health information, which you can exercise by presenting a written request to your provider.

• Right to Request Restrictions: You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to a written requested restriction. We may say “no” if we believe it would affect your health care. If we agree to a restriction, we must abide by it unless you agree in writing to remove it.

• Right to Request Objection to Disclosure to Family, Friends, and Others: We may provide protected health information to a family member, friend or other person that you indicated is involved in your care or the payment for your health care. You have the right to request in writing that we do not disclose your protected health information to family members, friends, or other individuals involved in your care or payment for your care.

• Right to Inspect and Copy: You have the right to inspect and request electronic or paper copies of your medical records other than “session notes”. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request. We may charge a reasonable fee for copying.

• Right to Amend: If you believe your protected health information is incorrect or incomplete, you have the right to request an amendment. We will review your request and either approve or deny it.

• Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures of your PHI that we have made. We will respond to your written request within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years, unless you request a shorter time. There is no charge, unless more than one request is made in the same year, we will charge you a reasonable cost based fee for each additional request.

• Right to Request Restrictions: You may request restrictions on certain uses and disclosures of your PHI, but we are not required to agree to them.

• Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI in a certain way or at a specific location.

• Right to a Paper Copy of This Notice: You have the right to request a paper copy of this notice at any time. You have the right to request a copy of this notice by email. Even if you have agreed to receive this Notice via email, you also have the right to request a paper copy.

INFORMATION SHARING

• Marketing Purposes: As a health care provider, we will not use or disclose your PHI for marketing purposes

• Sales of PHI: As a health care provider, we will not sell your PHI in the course of my business.

• Data Security: We maintain strict measures to protect your information from unauthorized access, disclosure, alternation, or destruction. Our staff is trained to uphold confidentiality and security of your information.

CONTACT INFORMATION

If you have questions, comments, or concerns about our Privacy Statement, please contact us at (480) 500 - 8559.

PLEASE RETAIN THIS PAGE FOR YOUR RECORDS

Acknowledgement of Receipt of Privacy Notice

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.