Notice of Privacy Practices
Information. Your Rights. Our Responsibilities.
This Notice explains how your medical information may be used and disclosed, and how you can access this information. Please read it carefully.
For more details or to file a privacy-related complaint, please contact our Compliance Officer at info@experience-pt.com or the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. Contact details are provided at the end of this Notice.

How We Use and Share Your Health Information
Protected Health Information (PHI) includes details created or received by a healthcare provider about your past, present, or future health, treatments, or healthcare payments. We may use or share your PHI without your consent or authorization for:

1. Treatment – Sharing information to provide or coordinate your healthcare.

o Example: A doctor treating your injury consults another doctor about your medical history.

2. Payment – Using your information for billing and receiving payments from health plans or other entities.

o Example: We provide your insurance company with details to process payment for your treatment.

3. Healthcare Operations – Using your information to manage our practice, improve care, and communicate with you.

o Example: Conducting quality assessment audits.

When contracting services with Business Associates, we may share PHI for them to perform their job, requiring them to protect your information appropriately.
Feedback and Reviews: We may contact you via email for satisfaction surveys or reviews. Independent vendors may assist in collecting this data. If you submit an online review, remember not to include sensitive or personal information unless you wish for it to be public.

Our Obligations

• We are required by law to protect your PHI’s privacy and security.
• You will be notified promptly if a breach compromises your information.
• We adhere to the privacy practices described in this Notice unless you provide written consent otherwise.
• You may revoke written authorization at any time by submitting a written request.

For more details, visit HHS HIPAA Overview.

Your Choices
You can choose how we share certain health information. If you have preferences, please inform us.
You may decide to:

• Share information with family, friends, or others involved in your care.
• Share information in disaster relief situations.
• Receive or decline fundraising communications.

If you cannot communicate (e.g., unconscious), we may share information if it aligns with your best interests or reduces a serious threat to safety.
We require written permission to:

• Use your information for marketing purposes.
• Sell your information.

Other Ways We May Use Your Information
We may share PHI to promote public health or comply with legal obligations, under strict conditions:

• Public Health and Safety: Preventing disease, reporting product recalls, or suspected abuse.
• Research: >upporting health research projects.
• Legal Compliance: Sharing data as required by state or federal law.
• Organ and Tissue Donation: Coordinating with organ procurement organizations.
• Law Enforcement and Government Requests: Assisting with workers’ compensation claims, law enforcement, or national security functions.
• Lawsuits and Legal Actions: Responding to court orders or subpoenas.

Your Rights
Access Your Records:
You may request to inspect or obtain copies of your medical records. We will respond within 30 days and may charge a reasonable fee.
Request Restrictions:
You may ask us to limit how we use or share your information. If you pay for services in full, you can restrict sharing payment-related details with your insurer.
Confidential Communication:
You can request alternative communication methods or locations, which we will honor if reasonable.
Amend Your Records:
If you find errors in your information, you may request corrections. If we deny your request, we will provide a written explanation within 60 days.
Request a Disclosure Log:
You can request a record of disclosures made in the past six years, excluding those for treatment, payment, or healthcare operations.
Get a Copy of This Notice:
You may request a paper copy of this Notice at any time.
Choose a Representative:
Your designated legal representative or guardian may exercise your rights on your behalf.
File a Complaint:
If you feel your rights have been violated, you can file a complaint with our Compliance Officer or the HHS Office for Civil Rights at HHS Complaint Filing.
There will be no retaliation for filing a complaint.

Contact Information
For questions, complaints, or more details, please contact:
Experience Physical Therapy Compliance Officer
info@experience-pt.com
HHS Office for Civil Rights
Toll-Free: 1-800-368-1019
TTY: 1-800-537-7697
Effective Date: January 2025