Notice of Privacy Practices
Anchor Pelvic Therapy
Ventura, California
Effective date: October 24, 2o26
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 Anchor Pelvic Therapy, protecting your privacy and maintaining the confidentiality of your health information are important parts of providing respectful, individualized physical therapy care.
This Notice of Privacy Practices (“Notice”) explains how your protected health information may be used and disclosed, your rights regarding that information, and our legal responsibilities for protecting it.
This Notice applies if Anchor Pelvic Therapy is subject to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). We are required to follow the privacy practices described in our current Notice when HIPAA applies.
1. How We May Use and Disclose Your Health Information
We may use and disclose your protected health information for the following purposes, as permitted or required by law.
Treatment
We may use your health information to evaluate your condition, develop your physical therapy plan of care, provide treatment, and coordinate care with other healthcare professionals involved in your treatment.
For example, we may communicate with your physician, midwife, or another treating provider when necessary to coordinate your care, subject to applicable law.
Payment
We may use or disclose health information as necessary to obtain payment for services.
For example, we may provide information needed to prepare billing documentation, issue a superbill, process a payment, or respond to an authorized payment-related inquiry.
Because Anchor Pelvic Therapy offers self-pay services, we generally collect payment directly from patients. If you choose to submit a superbill to an insurer, you are responsible for submitting it unless we separately agree to assist you.
Healthcare Operations
We may use or disclose health information for healthcare operations, such as maintaining records, reviewing the quality of care, managing our practice, and meeting applicable professional and legal obligations.
We may also use qualified service providers to help with administrative, scheduling, recordkeeping, or other business functions. When HIPAA requires it, we will obtain appropriate written assurances from those service providers.
Appointment Reminders and Communications
We may contact you about appointments, scheduling changes, billing matters, or information related to your care using the contact information you provide.
You may request reasonable confidential communications, such as asking us to contact you at a particular phone number or email address. We will accommodate reasonable requests as required by applicable law.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose health information without your written authorization when HIPAA or other applicable law permits or requires it. Depending on the circumstances, this may include disclosures:
Required by law.
For public health activities.
Related to health oversight activities.
In response to certain judicial or administrative proceedings.
To comply with certain law enforcement requirements.
To avert a serious threat to health or safety.
For workers' compensation or other legally authorized purposes.
We will limit disclosures to what is permitted or required by applicable law.
Uses and Disclosures Requiring Your Written Authorization
Uses and disclosures not described in this Notice will generally require your written authorization when required by law.
For example, certain disclosures of your health information for marketing purposes or the sale of protected health information require authorization.
You may revoke an authorization in writing, except to the extent we have already acted in reliance on it or another legal exception applies.
2. Your Rights Regarding Your Health Information
If HIPAA applies, you have the following rights regarding your protected health information, subject to certain legal exceptions.
Right to Inspect and Obtain a Copy
You may request to inspect or obtain a copy of health information maintained in your designated record set, including certain clinical and billing records.
You may request an electronic or paper copy, as applicable. We may charge a reasonable, cost-based fee when permitted by law.
We will respond within the time required by applicable law. In certain limited circumstances, a request may be denied, and you may have the right to request a review of that denial.
Right to Request an Amendment
If you believe information in your records is incorrect or incomplete, you may request an amendment in writing and explain why the information should be changed.
We may deny a request in certain circumstances permitted by law. If we deny your request, we will provide an explanation and information about your rights.
Right to Request Restrictions
You may ask us to restrict how we use or disclose your health information for treatment, payment, or healthcare operations, or how we share information with certain people involved in your care.
We are not generally required to agree to every requested restriction. However, when you pay for a service in full out of pocket, you have the right to request that information about that service not be disclosed to a health plan for payment or healthcare operations, unless disclosure is otherwise required by law.
Right to Request Confidential Communications
You may request that we communicate with you about health matters in a particular way or at a particular location.
For example, you may ask us to use a specific phone number, email address, or mailing address. We will accommodate reasonable requests as required by law.
Right to an Accounting of Certain Disclosures
You may request a list of certain disclosures of your health information made during the period allowed by law.
This accounting does not include every disclosure. For example, disclosures for treatment, payment, and healthcare operations are generally excluded, as are other disclosures excluded by law.
Right to a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Right to Choose Someone to Act for You
If someone has legal authority to act on your behalf, such as a legally authorized personal representative, that person may exercise certain privacy rights on your behalf, subject to applicable law.
Right to Receive Notice of a Breach
We will notify you of a breach of your unsecured protected health information when notification is required by applicable law.
3. Our Responsibilities
When HIPAA applies, we are required to:
Maintain the privacy of your protected health information.
Provide you with this Notice describing our legal duties and privacy practices.
Follow the terms of the Notice currently in effect.
Notify you when a breach of your unsecured protected health information requires notification.
Provide you with information about how to exercise your privacy rights and submit a complaint.
We reserve the right to change our privacy practices and the terms of this Notice when permitted by law.
Any revised Notice will apply to the health information we maintain, as permitted by applicable law. We will make the revised Notice available as required.
4. Complaints and Questions
If you believe your privacy rights have been violated, you may submit a complaint to Anchor Pelvic Therapy using the contact information below.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
U.S. Department of Health and Human Services, Office for Civil Rights
Website: https://www.hhs.gov/ocr/complaints/index.html
Phone: 1-800-368-1019
We will not retaliate against you for filing a complaint.
5. Contact Information
For questions about this Notice, to exercise your privacy rights, or to request a copy of your health information, contact:
Anchor Pelvic Therapy
Ventura, California
Email: anchorpelvictherapy@gmail.com
Thank you for trusting Anchor Pelvic Therapy with your care. We take our responsibility to protect your privacy seriously.