Effective Date: August 1, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

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 rights regarding your health information.

• The choices you may make about certain uses and disclosures.

• How we may use or disclose your health information.

• Our responsibilities for protecting your information.

• How to ask questions or file a privacy complaint.

Your Rights

You have the right to:

• Inspect or receive an electronic or paper copy of your medical record.

• Ask us to correct information in your medical record.

• Request confidential communications.

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

• Receive a list of certain disclosures we have made.

• Receive a paper copy of this Notice.

• Choose someone legally authorized to act for you.

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

Obtain a Copy of Your Medical Record

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

Requests should be made through the secure patient portal, by telephone, or in another written manner accepted by the Practice. We may take reasonable steps to verify your identity before providing access.

Under California law:

• You generally may inspect your records during normal business hours within five working days after we receive your written request.

• Copies generally must be provided within 15 days after we receive your written request.

• You may request all records or only specific portions of your record.

We may charge a reasonable fee permitted by law for copying, supplies, postage, or preparation of an agreed-upon summary.

In limited circumstances permitted by law, we may deny access to some information. If we deny a request, we will explain the reason and tell you whether you have a right to request a review.

Ask Us to Correct Your Medical Record

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

We may deny your request in certain circumstances, including when:

• We did not create the information.

• The information is not part of the records we maintain.

• The information is not available for inspection.

• We determine that the information is accurate and complete.

If we deny your request, we will explain the reason in writing, generally within 60 days, and describe any additional rights you may have.

Request Confidential Communications

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

For example, you may ask us to:

• Call only a particular telephone number.

• Avoid leaving detailed voicemail messages.

• Communicate through the secure patient portal.

• Send correspondence to a different mailing address.

• Avoid a particular communication method.

We will accommodate reasonable requests. You do not need to explain why you are making the request.

Ask Us to Limit What We Use or Share

You may ask us not to use or disclose certain 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 the restriction except when the information is needed to provide emergency treatment or another use or disclosure is permitted or required by law.

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

The accounting generally will not include disclosures:

• Made for treatment, payment, or health care operations.

• Made directly to you.

• Made with your written authorization.

• Made to family members or others involved in your care as permitted by law.

• Made for certain national-security, intelligence, correctional, or law-enforcement purposes.

• Otherwise excluded from an accounting by law.

We will provide one accounting during any 12-month period without charge. We may charge a reasonable cost-based fee for an additional accounting requested during the same 12-month period. We will notify you of the fee before completing the additional request.

Receive a Paper Copy of This Notice

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

The current Notice will also be available on the Practice’s website and through the patient portal when applicable.

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 and make choices about your health information on your behalf.

Examples may include:

• A person holding a valid health care power of attorney.

• A legally authorized parent or guardian.

• A court-appointed representative.

We may request documentation confirming that the person has authority to act for you before taking action.

The rights of a parent or representative may be limited when a minor is legally permitted to consent to health care independently or when another legal exception applies.

File a Privacy Complaint

You may file a complaint if you believe we violated your privacy rights or failed to appropriately protect your health information.

To file a complaint with the Practice, contact: Ariel Stern Pelvic Health Physical Therapy

You may leave a message requesting a return call from the Privacy Officer. You do not need to leave medical details in voicemail.

You may also submit a written complaint or privacy request through the Practice’s secure patient portal.

Please do not submit medical information or privacy complaints through an ordinary website contact form, social-media message, 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

Complaints may also be submitted through the HHS Office for Civil Rights online complaint portal.

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

Your Choices

For certain health information, you may tell us your preferences about what we share.

People Involved in Your Care

You may tell us whether we may share information relevant to your care or payment for your care with:

• A spouse or partner.

• A family member.

• A caregiver.

• A close friend.

• Another person involved in your care.

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

We may also disclose information when necessary and permitted by law to prevent or reduce a serious and imminent threat to your health or safety or the health or safety of another person.

Disaster-Relief Situations

When permitted by law, we may share limited information with an organization assisting with disaster-relief efforts so that family members or others responsible for your care can be informed about your location, condition, or safety.

Marketing

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

Communications concerning your treatment, appointment reminders, care coordination, available services, or treatment alternatives may not be considered marketing under applicable law.

Sale of Health Information

We do not sell your health information.

We will not receive payment in exchange for your health information unless you provide written authorization or a specific exception permitted by law applies.

Psychotherapy Notes

Most uses and disclosures of psychotherapy notes require written authorization.

The Practice does not ordinarily create psychotherapy notes as that term is defined under HIPAA. Additional protections may apply if we receive or maintain psychotherapy notes created by another provider.

Fundraising

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

If this practice changes, we will follow 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 your health information for treatment, payment, and health care operations without obtaining a separate written authorization when permitted by law.

We may also use or disclose your information for other purposes permitted or required by federal or California law.

Treatment

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

For example, we may:

• Review your medical history and examination findings.

• Develop and update your physical therapy plan of care.

• Communicate with a physician or another health care professional involved in your care.

• Coordinate referrals.

• Provide treatment updates when appropriate.

• Create home-exercise or self-management instructions.

• Review records provided by another health care professional.

Example: We may share relevant examination findings with your physician when coordinating care for your condition.

Health Care Operations

We may use and disclose your health information to operate the Practice and improve the quality of our services.

Health care operations may include:

• Scheduling and coordinating appointments.

• Maintaining clinical and administrative records.

• Reviewing the quality and effectiveness of treatment.

• Responding to patient questions or concerns.

• Conducting compliance, accounting, legal, or risk-management activities.

• Managing technology, electronic health records, payment systems, and secure communications.

• Conducting licensing, credentialing, or professional-review activities.

• Training or evaluating personnel when applicable.

• Planning and administering Practice operations.

Example: We may review your treatment record to evaluate the quality and effectiveness of the services provided.

We may use service providers known as business associates to perform services involving protected health information on our behalf.

These service providers may include:

• Electronic health record and scheduling providers.

• Secure patient-portal providers.

• Payment processors.

• Technology-support providers.

• Secure storage or backup providers.

• Legal or accounting professionals.

• Other vendors that assist with Practice operations.

When required by law, these service providers must agree in writing to appropriately protect your information.

Payment and Billing

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

We may use your health information to:

• Process payments.

• Maintain billing and financial records.

• Collect amounts owed.

• Provide receipts.

• Respond to payment disputes.

• Prepare a superbill or other reimbursement documentation requested by you.

• Obtain payment from another responsible party when permitted or authorized.

A superbill may include your diagnosis, dates of service, procedure information, provider information, and payment information. You may decide whether to submit it to your health plan.

Example: At your request, we may prepare a superbill that you can submit to an insurance company for possible out-of-network reimbursement.

If you ask us to communicate directly with an insurer or another payer, we may require your written authorization when applicable.

Appointment and Treatment Communications

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

• Consultation requests.

• Appointment scheduling.

• Appointment reminders.

• Intake and consent forms.

• Treatment instructions.

• Home programs.

• Care coordination.

• Referrals.

• Billing and payment.

• Changes in Practice operations.

• Other matters related to your care.

Communications may occur through:

• Telephone calls.

• Voicemail.

• Text messages.

• Secure patient-portal messages.

• Postal mail.

• Email when appropriate and authorized.

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

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

Public Health and Safety Activities

We may disclose health information for certain public health and safety purposes when permitted or required by law, including:

• Preventing or controlling disease, injury, or disability.

• Reporting certain diseases, injuries, or health conditions.

• Reporting adverse reactions or product-safety concerns.

• Assisting with product recalls.

• Reporting suspected abuse, neglect, exploitation, or domestic violence.

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

Any disclosure will be limited to what is permitted or required by applicable law.

Health Oversight Activities

We may disclose health information to authorized health oversight agencies for activities permitted by law, including:

• Audits.

• Investigations.

• Inspections.

• Licensing proceedings.

• Disciplinary proceedings.

• Professional-board reviews.

• Government health-program oversight.

• Regulatory or civil-rights compliance activities.

Workers’ Compensation

We may use or disclose health information as authorized or required for workers’ compensation claims or similar programs that provide benefits for work-related injuries or illnesses.

Research

We may use or disclose health information for research only when permitted by law and when any required authorization, waiver, review, or other privacy protection is in place.

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

Compliance With the Law

We will disclose health information when federal, California, or other applicable law requires us to do so.

We may disclose information 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 permitted by law, we may disclose health information to organizations involved in organ, eye, or tissue donation, procurement, banking, or transplantation.

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.

Law Enforcement and Government Requests

We may disclose health information for certain law-enforcement or government purposes when permitted or required by law, including:

• In response to valid legal process.

• To locate or identify certain individuals when legally permitted.

• To report information concerning certain suspected crimes.

• To report certain injuries required by law.

• To authorized correctional institutions or custodial officials.

• For authorized military, national-security, intelligence, or protective-service activities.

We will review requests and apply applicable federal and California privacy requirements before disclosing information.

Lawsuits, Subpoenas, and Legal Proceedings

We may disclose health information in response to a valid court or administrative order.

We may respond to subpoenas, discovery requests, or other lawful legal processes only when applicable federal and California legal requirements have been satisfied.

A subpoena alone does not necessarily authorize the release of every requested record. We may require:

• Your written authorization.

• Evidence that appropriate notice was provided to you.

• A qualified protective order.

• A court order.

• Other documentation required by law.

Uses and Disclosures Requiring 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.

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 uses or disclosures requiring authorization under federal or California law.

You may revoke an authorization at any time by submitting a written revocation to the Practice.

A revocation will not affect actions already taken in reliance on your 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.

Part 2 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, that satisfies applicable legal requirements.

This protection applies even when we may otherwise be permitted to use or disclose other health information under HIPAA.

If fundraising communications would use information protected by Part 2, we will provide clear notice and an opportunity to choose whether to receive those communications as required by law.

Additional Protections Under California and Other Laws

California and other applicable laws may provide greater protection for certain medical information or impose additional limits on its use or 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.

When California or another applicable law provides greater privacy protection or more restrictive disclosure requirements than HIPAA, we will follow the more protective requirement.

Our Responsibilities

The Practice is responsible for:

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

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

• Following the duties and privacy practices described in the Notice currently in effect.

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

• Applying reasonable administrative, technical, and physical safeguards.

• Limiting uses, disclosures, and requests to the minimum reasonably necessary when the minimum-necessary rule applies.

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

• Following applicable federal and California privacy requirements.

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 permission, you may revoke it in writing at any time, subject to applicable legal limitations.

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 revised Notice became effective.

When we materially revise this Notice:

• The updated Notice will display a new effective date.

• The current Notice will be posted on our website.

• The current Notice will be available through the patient portal when applicable.

• A paper or electronic copy will be provided upon request.

• We will take any additional steps required by law.

Questions, Requests, and Complaints

For questions about this Notice, medical-record requests, confidential-communication requests, amendment requests, restriction requests, accounting requests, or privacy complaints, contact:

Ariel Stern Pelvic Health Physical Therapy (Privacy Officer)
Telephone: (669) 325-7493

You may leave a message asking the Privacy Officer to return your call. You do not need to include private medical details in the voicemail.

Current patients may also send a message through the secure patient portal.

No public privacy-contact email address is provided. Please do not submit medical information through ordinary email, website forms, or social-media messages.