THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

ACCESS THIS INFORMATION PURSUANT TO FEDERAL REGULATIONS. PLEASE REVIEW IT CAREFULLY.

At Spirit Winds Physical Therapy, we understand that medical information about you and your health is personal. We are committed

to protecting medical information about you. We create a record of the care and services you receive directly from one of our

physicians. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice of

Privacy Practices (“Notice”) applies to all the records of your care generated by Practice.

This Notice will tell you about the ways in which Practice may use and disclose your protected health information (“PHI”). This

Notice also describes your rights and certain obligations Practice has regarding the use and disclosure of PHI.

REGULATORY REQUIREMENTS.

Practice is required by law to maintain the privacy of your PHI, to provide individuals with notice of Practice’s legal duties and

privacy practices with respect to PHI, and to abide by the terms described in the Notice currently in effect.

RIGHTS.

You have the following rights regarding your PHI:

Restrictions.

You may request that Practice restrict the use and disclosure of your PHI. To request restrictions, you must make your request in

writing to our Privacy Officer using the applicable Practice form. In your request, you must tell us (1) what information you want to

limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the restrictions to apply, for example,

disclosures to your spouse.

Alternative Communications.

You have the right to request that communications of PHI to you from Practice be made by particular means or at particular

locations. For instance, you might request that communications be made at your work address, instead of your home address. Your

requests must be made in writing using Practice’s form and sent to the Privacy Officer. Practice will accommodate your reasonable

requests.

Inspect and Copy.

Generally, you have the right to inspect and copy your PHI that Practice maintains, provided you make your request in writing to

Practice’s Privacy Officer. If you request copies of your PHI, we may impose a reasonable fee to cover copying and postage. If we

deny access to your PHI, we will explain the basis for denial and your opportunity to have your request and the denial reviewed by

a licensed health care professional (who was not involved in the initial denial decision) designated as a reviewing official. If

Practice does not maintain the PHI you request and if we know where that PHI is located, we will tell you how to redirect your

request.

Amendment.

If you believe that your PHI maintained by Practice is incorrect or incomplete, you may ask us to correct your PHI. Your request

must be made in writing, and it must explain why you are requesting an amendment to your PHI. We can deny your request if your

request relates to PHI: (i) not created by Practice; (ii) not part of the records Practice maintains; (iii) not subject to being

inspected by you; or (iv) that is accurate and complete. If your request is denied, we will provide you a written denial that explains

the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) if you do not file a statement of

disagreement, submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Practice’s

denial attached; and (iii) complain about the denial.

Disclaimer: While the information and guidance provided in this document is believed to be current and accurate at the time of posting, it is not intended to be and should not be construed to be or

relied upon as legal, financial, or consulting advice. Before use, each document should be tailored to the unique nature of your practice, including applicable state law. Consult with an attorney and

other advisors. References and links to third parties do not constitute an endorsement or sponsorship by the AMA, and the AMA hereby disclaims all express and implied warranties of any kind in the

information provided.

© 2023 American Medical Association. All rights reserved.Accounting of Disclosures.

You generally have the right to request and receive a list of the disclosures of your PHI we have made at any time during the six (6)

years prior to the date of your request (provided that such a list would not include disclosures made prior to April 14, 2003). The

list will not include disclosures made at your request, with your authorization, and does not include certain uses and disclosures to

which this Notice already applies, such as those: (i) for treatment, payment and health care operations; (ii) made to you; (iii) for

Practice’s patient list; (iv) for national security or intelligence purposes; or (v) to law enforcement officials. You should submit any

such request to Practice’s Privacy Officer. Practice will provide the list to you at no charge, but if you make more than one request

in a year you will be charged a fee of the costs of providing the list.

Right to Copy of Notice.

You have the right to receive a paper copy of this notice upon request. To obtain a paper copy of this notice, please contact the

Privacy Officer at the address and contact information stated at the end of this notice.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

Practice may use or disclose your PHI for the purposes described below without obtaining written authorization from you. In

addition, Practice and the members of its medical and allied health professional staff who participate in the organized health care

arrangement described below may share your PHI with each other as necessary to carry out their treatment, payment and health

care operations related to the organized health care arrangement.

For Treatment.

Practice may use and disclose PHI while providing, coordinating or managing your medical treatment, including the disclosure of PHI

for treatment activities of another health care provider.

For Payment.

Practice may use and disclose PHI to bill and collect payment for the health care services provided to you. For example, Practice

may need to give PHI to your health plan to be reimbursed for the services provided to you. Practice may also disclose PHI to its

business associates, such as billing companies, claims processing companies and others that assist in processing health claims.

Practice may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health

plans.

For Health Care Operations.

Practice may use and disclose PHI as part of its operations, including for quality assessment and improvements, such as evaluating

the treatment and services you receive and the performance of staff and physicians in caring for you, patient surveys, provider

training, underwriting activities, compliance and risk management activities, planning and development, credentialing and peer

review activities, and health care fraud and abuse detection or compliance, and management and administration. Practice may

disclose PHI to doctors, nurses, technicians, students, attorneys, consultants, accountants and others for review and learning

purposes, to help make sure Practice is complying with all applicable laws, and to help Practice continue to provide quality health

care to its patients.

As Required by Law and Law Enforcement.

Practice may use or disclose PHI when required to do so by applicable laws and when ordered to do so in a judicial or administrative

proceeding. Practice may also use or disclose PHI upon a properly documented and limited request from law enforcement agencies.

For Public Health Activities and Public Health Risks.

Practice may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and

controlling disease, or notifying a person who may have been exposed to a communicable disease or may be at risk of contracting or

spreading a disease or condition.

For Health Oversight Activities.

Practice may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections,

licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system,

government programs and compliance with civil rights laws.

Coroners, Medical Examiners and Funeral Directors.

Practice may disclose PHI to coroners, medical examiners and funeral directors for the purpose of identifying a decedent,

determining a cause of death or otherwise as necessary to enable these parties to carry out their duties consistent with applicable

law.

Disclaimer: While the information and guidance provided in this document is believed to be current and accurate at the time of posting, it is not intended to be and should not be construed to be or

relied upon as legal, financial, or consulting advice. Before use, each document should be tailored to the unique nature of your practice, including applicable state law. Consult with an attorney and

other advisors. References and links to third parties do not constitute an endorsement or sponsorship by the AMA, and the AMA hereby disclaims all express and implied warranties of any kind in the

information provided.

© 2023 American Medical Association. All rights reserved.Research.

Under certain circumstances, Practice may use and disclose PHI for medical research purposes. For example, a research project may

involve comparing the health and recovery of all patients who received one medication with those who received another, for the

same condition.

To Avoid a Serious Threat to Health or Safety.

Practice may use and disclose PHI to law enforcement personnel or other appropriate persons to prevent or lessen a serious threat

to the health or safety of a person or the public.

Specialized Government Functions.

Practice may use and disclose PHI of military personnel and veterans under certain circumstances. Practice may also disclose PHI to

authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of

protective services to the president or other authorized persons or foreign heads of state or to conduct special investigations.

Disclosures to You or for HIPAA Compliance Investigations.

Practice may disclose your PHI to you or to your personal representative and is required to do so in certain circumstances described

below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI. Practice must

disclose your PHI to the secretary of the United States Department of Health and Human Services (the "Secretary") when requested

by the Secretary in order to investigate Practice’s compliance with privacy regulations issued under the federal Health Insurance

Portability and Accountability Act of 1996.

Patient List; Marketing.

Unless you object, Practice may use some of your PHI to maintain a list of patients it has served. This information may include your

name, treatment facility, and the services Practice provided to you. This patient list and the information on it may be used for

marketing purposes.

Disclosures to Individuals Involved in Your Health Care or Payment for Your Health Care.

Unless you object, Practice may disclose your PHI to a family member, other relative, friend, or other person you identify as

involved in your health care or payment for your health care.

OTHER USES AND DISCLOSURES.

Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which with

some limitations; you have the right to revoke your authorization in writing. If you revoke your authorization, Practice will no

longer use or disclose PHI about you for the reasons covered in your written authorization. Please understand that Practice is

unable to recover any disclosures already made with your authorization, and that Practice is required to retain records of the care

provided to you.

RIGHT TO FILE A COMPLAINT.

At Practice, we value the relationships we develop with our patients, our patients’ privacy, and the trust our patients’ have in us.

As such, we make every effort to remedy any issues or concerns you may have. You may submit any complaint regarding your

privacy rights to:

You also have the right to file a complaint with the secretary of the Department of Health and Human Services, Office for Civil

Rights. You will not be penalized for filing a complaint. You may contact the Office for Civil Rights at:

Office for Civil Rights

U.S. Department of Health and Human Services

Information for regional offices

PLEASE CONTACT THE PRIVACY OFFICER IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE OF PRIVACY PRACTICES OR

YOUR PRIVACY RIGHTS.

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