Notice of Privacy Practices

Effective Date: September 10, 2025

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 Commitment to Your Privacy

At JPT Physical Therapy, I am committed to protecting your private health information. This Notice of Privacy Practices (NPP) explains my legal duties and your rights concerning your Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). PHI is information that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.

How I May Use and Disclose Your Health Information

The following categories describe the different ways that I may use and disclose your PHI without your specific written authorization.

1. For Treatment: I will use and disclose your PHI to provide, coordinate, and manage your physical therapy treatment. For example, I will use your medical history to develop a plan of care. I may also share information with another healthcare provider (such as your primary care physician) to ensure you receive the best possible coordinated care.

2. For Payment: Since this is a private pay practice, I will not be using your PHI for payment purposes with insurance companies. However, this category would apply if, for example, you requested documentation to submit for out-of-network reimbursement or if collection activities were necessary.

3. For Health Care Operations: I may use and disclose your PHI for the day-to-day operations of this practice. These uses are necessary to run my practice efficiently and to make sure that all of my clients receive quality care. For example, I may use your PHI for quality assessment activities, training, and legal or administrative compliance.

Other Permitted and Required Uses and Disclosures

I may also use or disclose your PHI without your authorization in the following situations:

• As Required By Law: I will disclose PHI about you when required to do so by federal, state, or local law.

• To Avert a Serious Threat to Health or Safety: I may use and disclose PHI to prevent a serious threat to your health and safety or the health and safety of the public or another person.

• Public Health Activities: I may disclose your PHI for public health activities, such as to a public health authority to prevent or control disease, injury, or disability.

• Health Oversight Activities: I may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, I may disclose PHI in response to a court order, subpoena, or other lawful process.

• Law Enforcement: I may release PHI if asked to do so by a law enforcement official in response to a court order or other legal mandates.

• Workers’ Compensation: I may release PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs.

Your Rights Regarding Your Health Information

You have the following rights regarding the PHI I maintain about you:

• Right to Inspect and Copy: You have the right to inspect and obtain a copy of your health information. I may charge a reasonable, cost-based fee for this service.

• Right to Amend: If you feel that health information I have about you is incorrect or incomplete, you may ask me to amend the information. You must provide a reason that supports your request.

• Right to an Accounting of Disclosures: You have the right to request a list of the disclosures I have made of your PHI for purposes other than treatment, payment, and health care operations.

• Right to Request Restrictions: You have the right to request a restriction on the PHI I use or disclose for treatment, payment, or health care operations. I am not required to agree to your request, but I will consider it.

• Right to Request Confidential Communications: You have the right to request that I communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that I only contact you at work or by mail.

• Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time.

My Responsibilities

I am required by law to:

• Maintain the privacy and security of your protected health information.

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

• Abide by the terms of the notice currently in effect.

• Notify you if a breach occurs that may have compromised the privacy or security of your information.

Changes to This Notice

I reserve the right to change this notice and to make the revised or changed notice effective for health information I already have about you as well as any information I receive in the future. I will post a copy of the current notice on my website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with me or with the Secretary of the Department of Health and Human Services. To file a complaint with me, please contact me at the information below. You will not be penalized for filing a complaint.

Contact Information

If you have any questions about this notice or would like to exercise any of your rights, please contact:

Privacy Officer: Jansen Nicholas Practice Name: JPT Physical Therapy Email: owner@jansendpt.com Phone: (929)322-4205