Privacy & Legal Information

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Our pledge regarding health information

We understand that health information about you and your health care is personal, and we are committed to protecting it. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice. It explains the ways we may use and disclose health information about you, your rights regarding the health information we keep about you, and certain obligations we have regarding its use and disclosure. We are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your information.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on this website.

II. How we may use and disclose health information about you

The following categories describe different ways we use and disclose health information. Not every use or disclosure in a category is listed, but all of the ways we are permitted to use and disclose information fall within one of these categories.

For treatment, payment or health care operations: Federal privacy rules allow health care providers who have a direct treatment relationship with a patient to use or disclose the patient’s personal health information, without the patient’s written authorization, to carry out the provider’s own treatment, payment or health care operations. We may also disclose your PHI for the treatment activities of another health care provider. For example, if a health care provider were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, to help that provider diagnose and treat your condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard, because other health care providers need access to the full record and/or full and complete information to provide quality care. “Treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.

Lawsuits and disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. Certain uses and disclosures require your authorization

1. Session notes. We keep session notes, and any use or disclosure of these notes requires your authorization unless the use or disclosure is:
   1. For our use in treating you.
   2. For our use in training or supervising associates to help them improve their clinical skills.
   3. For our use in defending ourselves in legal proceedings brought by you.
   4. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
   5. Required by law, and the use or disclosure is limited to the requirements of that law.
   6. Required by law for certain health oversight activities pertaining to the originator of the session notes.
   7. Required by a coroner who is performing duties authorized by law.
   8. Required to help avert a serious threat to the health and safety of others.
2. Marketing purposes. We will not use or disclose your PHI for marketing purposes.
3. Sale of PHI. We will not sell your PHI in the regular course of our business.

Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

IV. Certain uses and disclosures do not require your authorization

Subject to certain limitations in the law, we can use and disclose your PHI without your authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of that law.
2. For public health activities, including reporting suspected child, elder or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on our premises.
6. To coroners or medical examiners, when they are performing duties authorized by law.
7. For research purposes, including studying and comparing the patients who received one form of care with those who received another form of care for the same condition.
8. For specialized government functions, including ensuring the proper execution of military missions, protecting the President of the United States, conducting intelligence or counterintelligence operations, or helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although our preference is to obtain an authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
10. For appointment reminders and health-related benefits or services. We may use and disclose your PHI to contact you to remind you of an appointment. We may also use and disclose your PHI to tell you about treatment alternatives or other health care services or benefits that we offer.

V. Certain uses and disclosures require you to have the opportunity to object

Disclosures to family, friends or others. We may provide your PHI to a family member, friend or other person you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. Your rights regarding your PHI

1. The right to request limits on uses and disclosures of your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The right to request restrictions for out-of-pocket expenses paid in full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or service that you have paid for out of pocket in full.
3. The right to choose how we send PHI to you. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The right to see and get copies of your PHI. Other than session notes, you have the right to get an electronic or paper copy of your medical record and other information we have about you. We will provide you with a copy of your record, or a summary of it if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.
5. The right to get a list of the disclosures we have made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving it. The list will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable, cost-based fee for each additional request.
6. The right to correct or update your PHI. If you believe there is a mistake in your PHI, or that a piece of important information is missing from it, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The right to get a paper or electronic copy of this notice. You have the right to get a paper copy of this notice, and you have the right to get a copy of this notice by email. Even if you have agreed to receive this notice by email, you also have the right to request a paper copy of it.

VII. Questions and complaints

If you have questions about this notice, or want to make a request under it, contact our privacy contact, Corey Klein, PT, at (678) 543-0699 or hello@empathypt.com, or write to the address at the bottom of this page.

If you believe your privacy rights have been violated, you can file a complaint with us using the contact details above, or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/complaints or 1-877-696-6775. We will not retaliate against you for filing a complaint.

Effective date of this notice

This notice went into effect on March 16, 2025.