Ariel Stern Pelvic Health Physical Therapy
Effective Date: July 13, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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

Ariel Stern Pelvic Health Physical Therapy is committed to protecting the privacy and security of your health information. This Notice explains how your health information may be used and disclosed, your rights regarding that information, and the responsibilities of the practice.

Your Rights

You have certain rights regarding your health information. These include the right to:

• Access or obtain a copy of your medical record.

• Ask for corrections to your medical record.

• Request confidential communications.

• Ask us to limit certain uses or disclosures of your information.

• Request an accounting of certain disclosures.

• Receive a paper copy of this Notice.

• Choose someone who is legally authorized to act for you.

• File a complaint if you believe your privacy rights have been violated.

These rights are explained in more detail below.

How We May Use and Share Your Health Information

Treatment

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

For example, when appropriate and permitted by law, we may communicate with a physician or other health care professional involved in your care about your condition, treatment, or progress.

Practice Operations

We may use and share your health information as necessary to operate and manage the practice. This may include maintaining clinical and administrative records, coordinating your care, improving the quality of services, conducting necessary business activities, and contacting you when necessary.

We may also work with service providers that assist with functions such as electronic health records, scheduling, payment processing, communications, technology, data storage, accounting, legal services, or other practice operations. When required by law, appropriate privacy and security protections will apply.

Payment and Billing

Ariel Stern Pelvic Health Physical Therapy is a private-pay practice and does not routinely submit insurance claims on behalf of patients.

We may use your health information to process payments, collect amounts owed, maintain billing records, and prepare receipts or superbills.

At your request, we may provide you with a superbill or other documentation that may contain diagnosis, treatment, or billing information. You may choose whether to submit that information to an insurance plan or other payer.

When applicable, we may use or disclose health information for payment-related purposes as permitted by law.

Appointment and Care Communications

We may use the contact information you provide to communicate with you regarding:

• Appointments and scheduling

• Intake forms and other documents

• Your treatment or plan of care

• Billing and payment matters

• Other matters related to your care

We use reasonable safeguards to protect your privacy. However, ordinary email, text messaging, and other electronic communications may have privacy or security risks. When available, you are encouraged to use the secure patient portal for sensitive health information.

Your Choices

For certain health information, you may tell us your preferences about how your information is shared.

Family Members, Caregivers, and Others Involved in Your Care

You may tell us whether we may share relevant information with a family member, caregiver, close friend, or another person involved in your care or payment for your care.

If you are unable to communicate your preference, we may share relevant information when permitted by law and when we reasonably believe doing so is in your best interest.

We may also share information when permitted by law to lessen a serious and imminent threat to health or safety.

Disaster Relief

When permitted by law, we may share relevant information with an organization assisting with disaster relief so that your family or others responsible for your care can be notified about your condition or location.

Marketing and Sale of Health Information

We will obtain your written authorization for uses or disclosures of your health information for marketing when authorization is required by law.

We do not sell your health information.

Psychotherapy Notes

Most uses or disclosures of psychotherapy notes require written authorization. Ariel Stern Pelvic Health Physical Therapy does not ordinarily create psychotherapy notes, but additional legal protections may apply if such records are received or maintained.

Fundraising

Ariel Stern Pelvic Health Physical Therapy does not currently use your health information for fundraising communications.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose health information without your written authorization when permitted or required by applicable law and when the applicable legal requirements are met.

These situations may include the following.

Public Health and Safety

We may use or disclose health information for certain public health or safety activities, such as:

• Preventing or controlling disease.

• Reporting certain injuries, diseases, or conditions as required by law.

• Reporting suspected abuse, neglect, or domestic violence when required or permitted by law.

• Reporting certain adverse events or product concerns.

• Preventing or reducing a serious threat to health or safety.

Health Oversight Activities

We may disclose health information to authorized health oversight agencies for activities permitted by law, such as audits, investigations, inspections, licensing activities, or other oversight functions.

Workers’ Compensation

We may use or disclose health information as authorized or required for workers’ compensation or similar programs.

Legal Proceedings

We may disclose health information in response to certain court or administrative orders, subpoenas, discovery requests, or other lawful processes, subject to applicable federal and California privacy requirements.

Law Enforcement and Government Requests

We may disclose health information for certain law-enforcement or government purposes when permitted or required by law and when the applicable legal requirements are satisfied.

Coroners, Medical Examiners, and Funeral Directors

We may disclose health information to a coroner, medical examiner, or funeral director when permitted or required by law.

Organ and Tissue Donation

We may disclose health information to organizations involved in organ, eye, or tissue donation or transplantation when applicable and permitted by law.

Research

We may use or disclose health information for research only when permitted by applicable law and when any required privacy protections or authorizations are in place.

Compliance With the Law

We will disclose health information when required to do so by applicable federal or state law.

We may also disclose information to the U.S. Department of Health and Human Services when necessary to demonstrate compliance with applicable federal health-information privacy requirements.

Uses and Disclosures Requiring Your Written Authorization

For uses or disclosures not otherwise permitted or required by law or described in this Notice, we will obtain your written authorization when required.

You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it or as otherwise provided by law.

Your authorization may be required for matters including:

• Certain marketing activities.

• The sale of health information.

• Most uses or disclosures of psychotherapy notes, if applicable.

• Other uses or disclosures for which authorization is required by federal or California law.

Substance Use Disorder Records

To the extent that Ariel Stern Pelvic Health Physical Therapy receives or maintains substance use disorder patient records that are protected by 42 CFR Part 2, those records receive additional federal protections.

Such information generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena that meet applicable legal requirements.

Additional requirements may apply to the use, disclosure, or redisclosure of records protected by 42 CFR Part 2.

Additional Protections Under California and Other Laws

California and other applicable laws may provide greater privacy protection for certain medical information or may place additional limitations on its use or disclosure.

Certain categories of information may receive additional protection under applicable law, including certain mental health, substance use disorder, reproductive health, genetic, and communicable-disease information.

When another applicable law provides greater privacy protection than federal law, we will follow the more protective requirement.

Your Rights in More Detail

Access Your Health Information

You may ask to inspect or obtain an electronic or paper copy of your medical record and other health information that we maintain about you.

We will respond within the time required by applicable law. Under California law, physical therapists generally must provide requested copies of patient records within 15 days after receiving a written request, subject to applicable legal requirements.

A reasonable fee may be charged where permitted by law.

Request a Correction

You may ask us to correct health information that you believe is incorrect or incomplete.

We may deny a request in certain circumstances, but we will explain the reason as required by law and inform you of any additional rights that may apply.

Request Confidential Communications

You may ask us to contact you in a particular way or at a particular location.

For example, you may ask that we contact you only at a particular phone number or email address. We will accommodate reasonable requests as required by law.

Request Restrictions

You may ask us to limit certain ways in which we use or share your health information.

We are not always required to agree to a requested restriction. If we agree to a restriction, we will follow it except as otherwise permitted or required by law, including when information may be needed for emergency treatment.

If you pay for a health care service in full out of pocket, you may ask us not to disclose information about that service to your health plan for payment or health care operations. We will honor the request when required by law.

Receive an Accounting of Certain Disclosures

You may request a list, or accounting, of certain disclosures of your health information made during the period permitted by law.

The accounting generally does not include certain disclosures, such as disclosures for treatment, payment, or health care operations, or disclosures that you specifically authorized or requested.

We will provide an accounting in accordance with applicable law. A reasonable fee may apply to additional requests made within the same 12-month period when permitted by law.

Receive a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you previously received or accessed it electronically.

Choose Someone to Act for You

If another person is legally authorized to act as your personal representative, that person may exercise applicable privacy rights on your behalf.

We may require appropriate documentation showing that the person has authority to act for you before taking action on a request.

Our Responsibilities

Ariel Stern Pelvic Health Physical Therapy is responsible for:

• Maintaining the privacy and security of protected health information as required by applicable law.

• Following the duties and privacy practices described in this Notice.

• Providing you with access to this Notice.

• Using or disclosing health information only as permitted or required by law.

• Notifying you as required by law if a breach occurs that may have compromised the privacy or security of your health information.

• Following applicable federal and California privacy laws.

We will not use or disclose your health information other than as described in this Notice unless you give us written permission or the use or disclosure is otherwise permitted or required by law.

If you give us written authorization, you may revoke that authorization in writing at any time, except to the extent that we have already acted in reliance on it or as otherwise provided by law.

Changes to This Notice

We may change the terms of this Notice and make the revised Notice effective for all health information we maintain, including information created or received before the change.

When this Notice is materially revised, the current version will be made available on our website and upon request.

The effective date of the current Notice appears at the top of this page.