PRIVACY PRACTICES

Effective Date: January 1st, 2021

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

Please review the full Notice of Privacy Practices (NPP) which is attached. If you have any questions about this notice, please contact, Linda Velazco, Compliance Officer, at linda@performanceoptimalhealth.com.

Who will follow this notice:

Performance Optimal Health of Connecticut, LLC
Performance Optimal Health of New Canaan, PLLC
Performance Optimal Health of Hamden, LLC
Performance Optimal Health of New York, PLLC
Performance Optimal Health of Stamford LLC
Performance Optimal Health of Westport, LLC

All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites, and locations may share health information with each other for treatment, payment, or healthcare operations purposes described in this notice.

Our pledge regarding health information:

We understand that health information about you and your healthcare is personal. We are committed to protecting health information about you. 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 healthcare practice, whether made by your personal physical therapist or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

- Make sure that health information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to health information about you; and
- Follow the terms of the notice that are currently in effect.

How we may use and disclose health information about you.

The following categories describe different ways that we use and disclose health information. By coming for care, you give us the right to use your information for treatment, to get reimbursed for your care, and to operate our organization. There are also various other ways in which we may use or disclose your information:

- Appointment Reminders
- Health-Related Services and Treatment Alternatives
- To Allow Oversight of the Quality of the Healthcare We Provide
- To Allow Workers' Compensation Claims
- As Required by Subpoena in Lawsuits and Disputes
- Various Uses as Required by Law or to Avert a Serious Threat to Health or Safety The full details for all these uses are contained in the full NPP.

Your rights regarding health information about you.

You have the following rights regarding health information we maintain about you:

- Right to Inspect and Copy
- Right to Amend
- Right to an Accounting of Disclosures
- Right to Request Restrictions
- Right to Request Confidential Communications
- Right to a Paper Copy of This Notice

Information on how to exercise these rights can be seen in the NPP or can be obtained from Linda Velazco, Compliance Officer, at linda@performanceoptimalhealth.com.

Changes to this notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register for treatment or healthcare services, we will offer you a copy of the current notice in effect.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact Linda Velazco, Compliance Officer at linda@performanceoptimalhealth.com. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Other uses of health information

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

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