NOTICE OF PRIVACY PRACTICES
NeuroFit Physical Therapy and Wellness LLC
Your Information. Your Rights. Our Responsibilities.
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.
Effective Date: 10/1/2026
Your Rights
You have the right to:
● Get a copy of your paper or electronic medical record
● Correct your paper or electronic medical record
● Request confidential communication
● Ask us to limit the information we share
● Get a list of those with whom we've shared your information
● Get a copy of this privacy notice
● Choose someone to act for you
● File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
● Tell family and friends about your condition
● Provide disaster relief
● Market our services
Our Uses and Disclosures
We may use and share your information as we:
● Treat you
● Collaborate with your other healthcare providers
● Run our organization
● Bill for your services
● Help with public health and safety issues
● Do research
● Comply with the law
● Address workers' compensation, law enforcement, and other government requests
● Respond to lawsuits and legal actions
To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
Your Rights, In Detail
Get an electronic or paper copy of your medical record
● You can ask to see or get an electronic copy of your medical record and other health information we have about you. Ask us how to do this.
● We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
● You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
● We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
● You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
● We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
● You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say “no” if it could affect your care. If we agree, we may still share this information if you need emergency treatment.
● If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer. We will say “yes” unless a law requires us to share it.
Get a list of those with whom we've shared information
● You can ask for a list (accounting) of the times we've shared your health information for six years prior to your request, who we shared it with, and why.
● We may charge a reasonable, cost-based fee for requests.
Get a copy of this privacy notice
● You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly.
Choose someone to act for you
● If someone has medical power of attorney or is your legal guardian, they can exercise your rights and make choices about your health information. We will verify this authority before acting.
File a complaint if you feel your rights are violated
● You can complain by contacting us using the information on page 1.
● You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696-6775, or hhs.gov/hipaa/filing-a-complaint/index.html.
● We will not retaliate against you for filing a complaint.
Your Choices, In Detail
For certain health information, you can tell us your choices about what we share. In these cases, you have both the right and choice to tell us to:
● Share information with your family, close friends, or others involved in your care or payment for your care
● Share information in a disaster relief situation
● If you are not able to tell us your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
● Marketing purposes
Our Uses and Disclosures, In Detail
How do we typically use or share your health information?
Treat you
We can use your health information and share it with other professionals who are treating you. Example: coordinating with a referring physician about your overall condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities, or to provide a superbill for your own submission to insurance.
How else can we use or share your health information?
We are allowed or required to share your information in other ways, usually contributing to the public good, such as public health and research. We must meet many legal conditions before sharing for these purposes. In all cases, if we have substance use disorder patient records about you subject to 42 CFR part 2, we cannot use or share that information in civil, criminal, administrative, or legislative proceedings against you without your consent or a court order and subpoena.
● Help with public health and safety issues (preventing disease, reporting adverse reactions, reporting suspected abuse or neglect, preventing serious threats to safety)
● Do research
● Comply with the law, including with HHS if it wants to see that we're complying with federal privacy law
● Address workers' compensation, law enforcement, and other government requests
● Respond to lawsuits and legal actions
Our Responsibilities
● We are required by law to maintain the privacy and security of your protected health information.
● 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 and give you a copy of it.
● We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.
For more information, see: hhs.gov/hipaa/for-professionals/privacy/index.html
Changes to the Terms of This Notice
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, in our office, and on our website.
Contact / Privacy Official
NeuroFit Physical Therapy and Wellness LLC
Christina Miranda, PT, DPT, NCS, Owner