HIPAA Notice of Privacy Practices

1. Our Commitment to Your Privacy

Skilled Fitness & Therapy LLC (“we,” “us,” or “our”) is committed to protecting the privacy and security of your protected health information (“PHI”).

PHI is information that identifies you and relates to your past, present, or future physical or mental health or condition and the health care services you receive.

We are required by law to:

• Maintain the privacy and security of your PHI
• Provide you with this Notice of Privacy Practices
• Follow the terms of this Notice currently in effect
• Notify you following a breach of unsecured PHI when required by law

2. How We May Use and Disclose Your PHI

We may use and disclose your PHI for the following purposes without your written authorization, as permitted or required by law.

1. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your physical therapy and related health care services.

Examples include:

• Sharing information with other health care providers involved in your care, such as your physician, surgeon, or other therapists
• Consulting with other professionals regarding your condition or plan of care

2. Payment

We may use and disclose your PHI to bill for and receive payment for services provided to you.

Examples include:

• Providing information about your care to you or a third party responsible for payment
• Maintaining records of services rendered and payment history, even though we are cash-based

3. Health Care Operations

We may use and disclose your PHI for health care operations necessary to run our practice and ensure quality care.

Examples include:

• Quality assessment and improvement activities
• Training and supervision of staff and providers
• Practice management, audits, and compliance activities

4. Business Associates

We may disclose your PHI to third-party service providers (“business associates”) who perform services on our behalf, such as billing, scheduling, documentation, telehealth platforms, electronic medical records, and IT services.

Business associates are required by contract to protect the privacy and security of your PHI and to use it only for the services they provide to us.

5. Persons Involved in Your Care

Unless you object, we may share certain PHI with a family member, close friend, or other person you identify who is involved in your care or payment for your care, to the extent relevant to that person’s involvement.

In an emergency or when you are incapacitated, we may share information if we believe it is in your best interest and consistent with your prior preferences, to the extent allowed by law.

6. As Required or Permitted by Law

We may use or disclose your PHI without your authorization when required or permitted by law, including:

• Public health activities, such as reporting certain diseases or injuries
• Reporting suspected abuse, neglect, or domestic violence
• Health oversight activities, such as audits, inspections, or licensure matters
• Judicial and administrative proceedings, such as court orders or subpoenas
• Law enforcement purposes, as permitted by law
• To avert a serious threat to health or safety
• Research under strict conditions and approvals
• Workers’ compensation and similar programs, as applicable
• Specialized government functions, such as military or national security requirements, when required

3. Uses and Disclosures Requiring Your Written Authorization

For purposes not described in this Notice, we will use or disclose your PHI only with your written authorization.

This includes most uses and disclosures:

• For marketing communications that are not face-to-face or promotional gifts of nominal value
• That involve the sale of your PHI
• Of certain types of particularly sensitive information where additional protections may apply under state or federal law

You may revoke your authorization at any time, in writing, except to the extent we have already relied on it.

4. Your Rights Regarding Your PHI

You have the following rights regarding your PHI. To exercise any of these rights, please contact us using the information at the end of this Notice.

1. Right to Access and Obtain Copies

You have the right to inspect and obtain a copy of your health and billing records that we maintain, with limited exceptions, such as psychotherapy notes or information compiled for certain legal proceedings.

• Requests must be made in writing
• We may charge a reasonable, cost-based fee as permitted by law for copies
• We will respond within the time frames required by law

If we deny your request, you may have the right to request a review of that decision in certain situations.

2. Right to Request Amendments

If you believe that information in your record is incorrect or incomplete, you may request that we amend it.

• Requests must be in writing and explain why the information should be amended
• We may deny the request if, for example, we did not create the information, the information is accurate and complete, or the information is not part of the record we maintain
• If we deny your request, you may submit a written statement of disagreement, which will be included in your record

3. Right to an Accounting of Disclosures

You have the right to request a list (“accounting”) of certain disclosures of your PHI made by us in the six years prior to your request, excluding disclosures for treatment, payment, health care operations, and certain other disclosures such as those you authorized.

• Requests must be made in writing
• The first accounting in a 12-month period is free; we may charge a reasonable fee for additional requests

4. Right to Request Restrictions

You may request restrictions on how we use or disclose your PHI for treatment, payment, or health care operations, or to persons involved in your care.

We are not required to agree to such requests, except:

• If you request that we not disclose PHI to a health plan for payment or health care operations purposes and the PHI relates only to a service for which you have paid us in full out of pocket, we must agree to that restriction unless disclosure is otherwise required by law

Any agreed restrictions will be documented and followed, except in emergencies or as otherwise permitted by law.

5. Right to Request Confidential Communications

You may request that we communicate with you about your PHI in a certain way or at a certain location, such as at a different mailing address or via a specific phone number.

We will accommodate reasonable requests. Requests must specify how or where you wish to be contacted.

6. Right to a Paper or Electronic Copy of This Notice

You have the right to receive a paper copy of this Notice, even if you agreed to receive it electronically. You may also access a copy on our website if available.

7. Right to Notification of a Breach

You have the right to be notified if there is a breach of your unsecured PHI, as defined by applicable law, that may have compromised the privacy or security of your information.

We will notify you without unreasonable delay and in accordance with legal requirements.

5. Our Duties

• We are required by law to maintain the privacy and security of your PHI
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
• We must follow the duties and privacy practices described in this Notice
• We will not use or share your PHI other than as described here unless you tell us we can in writing

If you give us permission, you may change your mind at any time by notifying us in writing.

We reserve the right to change the terms of this Notice and our privacy practices at any time, as permitted by law. Any new Notice will apply to all PHI we maintain and will be made available in our office and on our website, if applicable.

The “Effective Date” at the top of this Notice will indicate when it was last revised.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us and/or with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights.

To file a complaint with us:

Skilled Fitness & Therapy LLC
Attn: Privacy Officer
170 Willow Dr.
Annandale, MN 55302
Email: info@skilledfitnesstherapy.com
Phone: +1 (320) 433-8361

To file a complaint with HHS:

Office for Civil Rights
U.S. Department of Health and Human Services
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019 (TDD: 1-800-537-7697)

You will not be retaliated against for filing a complaint.