Notice of Privacy Practices

About This Notice

This Notice applies to health information created, received, or maintained in connection with services provided by Ariel Stern Pelvic Health Physical Therapy.

In this Notice, "the Practice," "we," "us," and "our" refer to Ariel Stern Pelvic Health Physical Therapy and Dr. Ariel Stern, PT, DPT.

We are committed to protecting the privacy and security of your health information. This Notice explains your privacy rights, your choices regarding certain disclosures, how we may use or share health information, our legal responsibilities, and how to contact us with privacy questions or complaints.

Your Rights

You have certain rights regarding the health information maintained by the Practice, including the right to:

• Inspect or obtain an electronic or paper copy of your medical record.
• Request correction of information you believe is inaccurate or incomplete.
• Request confidential communications.
• Ask us to restrict certain uses or disclosures.
• Receive an accounting of certain disclosures of your health information.
• Receive a paper copy of this Notice.
• Choose someone legally authorized to act on your behalf.
• File a privacy complaint without retaliation.

Obtain a Copy of Your Medical Record

You may request access to or a copy of your medical record and other health information maintained by the Practice. Requests may be submitted through the secure patient portal, by telephone, or through another written method accepted by the Practice.

We may verify your identity before releasing records. Under California law, patients generally may inspect records within five working days after a written request, and copies generally must be provided within 15 days after a written request.

You may request all records or specific portions of your record. Fees permitted by law may apply for copying or preparing records.

Access may be denied in limited circumstances permitted by law. When access is denied, we will explain the reason and any applicable review rights.

Ask Us to Correct Your Medical Record

You may request an amendment to health information that you believe is incorrect or incomplete.

We may deny a request in circumstances permitted by law, including when information was not created by the Practice, is not part of records we maintain, is not available for inspection, or is determined to be accurate and complete.

If a request is denied, we will explain the reason in writing, generally within 60 days, and describe any additional rights available to you.

Request Confidential Communications

You may ask us to communicate with you in a particular manner or at a specific location.

For example, you may request communication through a particular telephone number, a different mailing address, or the secure patient portal. You may also ask us to avoid detailed voicemail messages or certain communication methods.

We will accommodate reasonable requests. You do not need to explain why you are requesting confidential communications.

Ask Us to Limit What We Use or Share

You may ask us to restrict certain uses or disclosures of your health information for treatment, payment, or health care operations.

We are not always required to agree to a requested restriction. If we agree, we will follow it except when another permitted or required disclosure applies.

If you pay for a service entirely out of pocket, you may request that information about that service not be disclosed to a health plan for payment or health care operations. We will honor such a request unless disclosure is required by law.

Receive a List of Certain Disclosures

You may request an accounting of certain disclosures of your health information made during the six years before your request.

Certain disclosures are excluded, including many made for treatment, payment, health care operations, directly to you, with your written authorization, or for other purposes excluded by law.

One accounting during a 12-month period will be provided without charge. Additional accountings during the same period may be subject to a reasonable fee, disclosed before processing.

Receive a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Choose Someone to Act for You

A legally authorized personal representative may exercise applicable privacy rights on your behalf.

Examples include a person with a valid health care power of attorney, a legally authorized parent or guardian, or a court-appointed representative. We may request documentation confirming that authority.

Additional rules may apply when a minor is legally permitted to consent to certain health services independently.

File a Privacy Complaint

You may file a complaint if you believe your privacy rights have been violated or your information has not been appropriately protected.

To submit a complaint to the Practice, contact the Privacy Officer using the information provided at the end of this Notice. Current patients may also use the secure patient portal.

Please do not send sensitive medical information or privacy complaints through ordinary website contact forms, social-media messages, or unencrypted email.

You may also file a complaint with:

U.S. Department of Health and Human Services Office for Civil Rights

200 Independence Avenue, S.W., Washington, D.C. 20201

Telephone: 1-877-696-6775

Information about privacy complaints is available through the HHS Office for Civil Rights .

We will not retaliate against you, refuse treatment, or otherwise penalize you for filing a complaint.

Your Choices

In certain circumstances, you may express preferences about how your health information is shared.

People Involved in Your Care

You may tell us whether information relevant to your care or payment should be shared with family members, a spouse or partner, a caregiver, a close friend, or another person involved in your care.

If you cannot communicate your preference, we may share relevant information when permitted by law and when we reasonably believe the disclosure is in your best interest.

Disclosures may also be permitted when necessary to prevent or reduce a serious and imminent threat to health or safety.

Disaster-Relief Situations

When permitted by law, limited information may be disclosed to organizations assisting with disaster relief so others responsible for your care may be informed about your location, condition, or safety.

Marketing

We will obtain written authorization before using or disclosing your health information for marketing when authorization is required by law.

Certain communications involving treatment, appointment reminders, care coordination, available services, or treatment alternatives may be permitted without a marketing authorization.

Sale of Health Information

We do not sell your health information. We will not receive payment in exchange for protected health information except where written authorization or a specific legal exception permits it.

Psychotherapy Notes

Most uses and disclosures of psychotherapy notes require written authorization.

The Practice does not ordinarily create psychotherapy notes as defined under HIPAA. Additional protections may apply to such notes received or maintained from another provider.

Fundraising

The Practice does not currently use patient health information for fundraising communications.

If this changes, we will comply with applicable notice, authorization, and opt-out requirements.

Hospital Directories

The Practice is an independent, in-home physical therapy practice and does not maintain a hospital or facility patient directory.

How We May Use and Share Your Health Information

We may use or disclose health information for treatment, payment, and health care operations without a separate written authorization when permitted by law.

Other uses or disclosures may be permitted or required under federal or California law.

Treatment

We may use and share health information to evaluate, treat, coordinate, and manage your care.

This may include reviewing your medical history, developing a treatment plan, communicating with other health professionals, coordinating referrals, providing home exercises, and reviewing records from other providers.

Health Care Operations

We may use and disclose health information to operate the Practice, manage appointments and records, evaluate treatment quality, respond to patient concerns, conduct administrative reviews, maintain technology systems, and meet legal or professional requirements.

We may use outside service providers, known as business associates, for activities involving protected health information.

These may include electronic health record providers, scheduling platforms, patient portals, payment processors, secure storage, technology support, and professional advisors. Required privacy agreements will be used where applicable.

Payment and Billing

The Practice primarily operates on a private-pay, out-of-network basis and does not routinely submit insurance claims on behalf of patients.

Health information may be used for processing payments, maintaining billing records, collecting amounts owed, responding to payment disputes, providing receipts, or preparing reimbursement documents.

At your request, we may prepare a superbill containing information such as diagnoses, dates of service, procedures, provider details, and payment information. You may choose whether to submit that document to your health plan.

If direct communication with an insurer is requested, written authorization may be required where applicable.

Appointment and Treatment Communications

We may communicate with you regarding consultation requests, appointments, reminders, intake forms, treatment instructions, home programs, referrals, billing, and other matters related to your care.

Communication methods may include telephone calls, voicemail, text messages, secure portal messages, postal mail, and email when appropriate and authorized.

Ordinary email, text messages, and voicemail may present privacy or security risks. You may request a different communication method.

Sensitive documents should generally be exchanged through the secure patient portal or another approved secure method.

Public Health and Safety

When permitted or required by law, health information may be disclosed for public health and safety purposes, including disease prevention, reporting certain health conditions, product safety, abuse or neglect reporting, and preventing serious threats to health or safety.

Health Oversight Activities

Information may be shared with authorized oversight agencies for legally permitted audits, investigations, inspections, licensing, disciplinary actions, professional-board reviews, and regulatory compliance.

Workers' Compensation

We may disclose information as authorized or required for workers' compensation claims or similar programs involving work-related injuries or illnesses.

Research

Health information may be used or disclosed for research only when permitted by law and with any required authorization, waiver, review, or other privacy protection.

The Practice does not ordinarily conduct clinical research involving patient records.

Compliance With the Law

We will disclose health information when required by applicable law. Information may also be disclosed to the U.S. Department of Health and Human Services when necessary to demonstrate compliance with federal privacy requirements.

Organ, Eye, and Tissue Donation

When applicable and legally permitted, information may be shared with organizations involved in organ, eye, or tissue donation, procurement, or transplantation.

Coroners, Medical Examiners, and Funeral Directors

Information may be disclosed to coroners, medical examiners, or funeral directors when permitted or required by law.

Law Enforcement and Government Requests

We may disclose information for certain authorized law-enforcement, correctional, governmental, national-security, or protective-service purposes when permitted or required by law.

Applicable federal and California privacy requirements will be considered before information is released.

Lawsuits, Subpoenas, and Legal Proceedings

Health information may be disclosed in response to valid court or administrative orders.

Responses to subpoenas, discovery requests, and other legal processes are subject to applicable law. A subpoena alone does not necessarily authorize the release of every requested record.

Depending on the circumstances, additional documentation may be required, such as written authorization, appropriate notice, a qualified protective order, or a court order.

Uses and Disclosures Requiring Written Authorization

When a use or disclosure is not otherwise permitted or required by law, we will obtain written authorization as required.

Written authorization is generally required for:

• Most uses or disclosures of psychotherapy notes, when applicable.
• Marketing activities requiring authorization.
• The sale of protected health information.
• Other activities requiring authorization under applicable federal or California law.

You may revoke an authorization in writing at any time. Revocation does not affect actions already taken in reliance on the authorization and may be subject to other limitations permitted by law.

Substance Use Disorder Patient Records

To the extent that the Practice receives, creates, or maintains substance use disorder patient records protected by 42 CFR Part 2, those records receive additional federal confidentiality protections.

Such records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without:

1. Your written consent; or
2. A court order and subpoena, or another similar legal mandate satisfying applicable legal requirements.

These protections may apply even where other health information could otherwise be disclosed under HIPAA.

If fundraising communications would use records protected by Part 2, the Practice will provide required notice and an opportunity to choose whether to receive those communications.

Additional Protections Under California and Other Laws

California and other applicable laws may provide greater privacy protection for certain health information or restrict its disclosure.

Additional protections may apply to information concerning:

• Mental or behavioral health treatment
• Substance use disorder diagnosis or treatment
• HIV status
• Communicable diseases
• Sexually transmitted infections
• Genetic testing or genetic information
• Reproductive or sexual health
• Sexual assault
• Domestic violence
• Services to which a minor may legally consent
• Other specially protected medical information

Where applicable California or other laws provide stronger privacy protections than HIPAA, the Practice will follow the more protective requirements.

Our Responsibilities

The Practice is responsible for maintaining the privacy and security of protected health information as required by law.

Our responsibilities include:

• Providing notice of legal duties and privacy practices.
• Following the Notice currently in effect.
• Using or disclosing health information only as permitted or required by law.
• Applying reasonable administrative, technical, and physical safeguards.
• Following applicable minimum-necessary requirements.
• Providing required notifications if a breach compromises protected information.
• Complying with applicable federal and California privacy requirements.

We will not use or disclose your health information outside the circumstances described in this Notice unless you provide written permission or another legal basis permits or requires the disclosure.

Changes to This Notice

We may revise this Notice and make the revised terms effective for health information maintained by the Practice, including information created or received before the revised Notice took effect.

When material revisions are made, we will:

• Display an updated effective date.
• Post the current Notice on our website.
• Make the Notice available through the patient portal when applicable.
• Provide a paper or electronic copy upon request.
• Take any additional steps required by law.

Questions, Requests, and Complaints

For questions about this Notice, medical-record requests, confidential communications, requests to amend or restrict health information, accountings of disclosures, or privacy complaints, please contact the Practice's Privacy Officer.