NOTICE OF PRIVACY PRACTICES/TERMS AND CONDITIONS
HOLISTIC PHYSICAL THERAPY & WELLNESS
Notice of Privacy Practices and Privacy Policy

YOUR PRIVACY MATTERS
This Notice of Privacy Practices describes how Holistic Physical Therapy & Wellness may use and disclose your protected health information, your rights regarding that information, and our legal responsibilities to protect your privacy.
This policy also explains how we handle personal information collected through our website and text messaging program.
Please review this notice carefully.
Holistic Physical Therapy & Wellness is committed to protecting the privacy and confidentiality of your personal and health information in accordance with applicable federal and Washington State law, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), where applicable.
1. INFORMATION WE COLLECT AND PROTECT
Protected Health Information (PHI)
Protected health information includes individually identifiable information relating to your past, present, or future physical or mental health, the healthcare services you receive, or payment for those services.
This may include:

• Medical history, symptoms, diagnoses, examinations, test results, and treatment plans.

• Physical therapy and other treatment records.

• Referrals and communications with other healthcare providers.

• Insurance, billing, and payment information.

• Appointment records and related communications.

• Other information created, received, or maintained in connection with your care.

PHI may exist in written, electronic, photographic, or verbal form.
Other Personal Information
We may also collect personal information you provide when contacting us, scheduling appointments, completing forms, or interacting with our website or text messaging program. This may include your name, contact information, appointment preferences, and communications with our office.
We use this information to respond to inquiries, coordinate services, communicate with you, and operate our practice.
We maintain appropriate administrative, technical, and physical safeguards designed to protect the confidentiality, integrity, and availability of information in our possession.
We are required by law to maintain the privacy of protected health information, provide this notice, follow the terms of our current notice, and notify affected individuals of breaches of unsecured PHI when required by law.
2. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
HIPAA permits healthcare providers to use and disclose PHI for certain purposes without obtaining a separate written authorization. Washington State law may impose additional requirements on particular disclosures. We follow applicable federal and state law.
A. Treatment
We may use and disclose your health information to provide, coordinate, and manage your healthcare.
For example, we may:

• Review your medical history when developing your treatment plan.

• Communicate with your referring provider or other healthcare professionals involved in your care.

• Request relevant medical information from other providers.

• Share treatment progress and recommendations when appropriate for coordinating your care.

These activities help us provide appropriate and coordinated healthcare.
B. Payment
We may use and disclose information as permitted by law to obtain payment for services we provide.
For example, we may submit claims to your health insurance company, verify benefits, determine coverage, or request prior authorization when required.
C. Healthcare Operations
We may use and disclose PHI as permitted by law to operate our practice and support the quality and effectiveness of our services.
These activities may include:

• Evaluating and improving the quality of care.

• Reviewing staff performance and clinical processes.

• Managing scheduling, billing, and administrative functions.

• Conducting internal quality assessments and compliance activities.

• Working with authorized service providers who support our operations.

Where required, we obtain appropriate agreements and implement safeguards to protect your information.
D. Appointment Reminders and Health-Related Communications
We may contact you regarding appointments, scheduling changes, treatment-related matters, and other health-related services that may be relevant to your care.
Communications may occur by telephone, voicemail, mail, email, or text message, depending on the contact information you provide and any communication preferences or restrictions you request.
We will use appropriate safeguards when communicating sensitive information.
E. Personal Representatives
If you have a legally authorized personal representative, such as a guardian or another person authorized to make healthcare decisions on your behalf, we may disclose information to that person as permitted or required by law.
We will verify the person's authority when appropriate and follow applicable legal requirements.
F. Family Members and Others Involved in Your Care
We may disclose relevant health information to a family member, friend, caregiver, or another person involved in your care or payment for care when permitted by law.
Depending on the circumstances, we may obtain your agreement, provide an opportunity for you to object, or use professional judgment to determine whether a limited disclosure is appropriate.
If you are unable to agree or object because of incapacity or an emergency, we may disclose information when permitted by law and when our professional judgment supports the disclosure as being in your best interest.
We limit these disclosures to information relevant to the person's involvement in your care or payment.
G. Other Permitted or Required Disclosures
We may use or disclose PHI without your written authorization when permitted or required by applicable law. Depending on the circumstances, these disclosures may include:

• Legal requirements: To comply with applicable federal, state, or local laws.

• Public health and safety: To report certain public health matters, prevent or control disease, or address a serious threat to health or safety.

• Abuse, neglect, or domestic violence: To report certain circumstances when reporting is required or otherwise permitted by law.

• Health oversight: To authorized agencies conducting audits, investigations, inspections, licensing, or other oversight activities.

• Workers' compensation: To comply with applicable workers' compensation laws.

• Judicial and administrative proceedings: In response to qualifying court orders, subpoenas, or other lawful processes, subject to applicable legal requirements.

• Law enforcement: When disclosure is authorized or required under applicable law.

• Coroners and medical examiners: When necessary for legally authorized duties.

• Military, national security, and government functions: In limited circumstances authorized or required by law.

• Research: When applicable legal requirements and any required approvals or authorizations have been satisfied.

• De-identified information: For permitted purposes when information has been de-identified in accordance with applicable law.

These categories are subject to applicable legal limitations. We do not assume that every request from a government agency, law enforcement officer, or other third party automatically authorizes disclosure.
H. Specially Protected Health Information
Certain types of health information may be subject to additional confidentiality protections under federal or Washington State law.
For example, records concerning substance use disorder treatment may be subject to special federal confidentiality requirements when protected under 42 CFR Part 2. Other categories of information may also receive special legal protections.
When such requirements apply, we will handle and disclose the information in accordance with the applicable law.
I. Uses and Disclosures Requiring Your Authorization
Uses and disclosures not otherwise permitted or required by law will generally require your written authorization.
Depending on the circumstances, authorization may be required for:

• Certain uses or disclosures of psychotherapy notes, where applicable.

• Marketing activities requiring authorization.

• The sale of PHI.

• Other uses or disclosures not otherwise permitted by law.

If you provide written authorization, you may revoke it in writing at any time, except to the extent we have already acted in reliance on it.
We do not sell your PHI or use it for marketing purposes requiring authorization without the authorization required by law.
3. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights concerning PHI maintained by our practice. Certain rights are subject to specific legal requirements, exceptions, and procedures.
A. Right to Inspect and Obtain Copies
You may request access to and copies of health and billing records that we maintain and use to make decisions about your care, subject to applicable law.
To make a request, contact our Front Office and ask for the Patient Records Access Request Form.
We will respond within the time required by law. We may charge a reasonable, cost-based fee for permitted copying, mailing, or other authorized expenses.
In limited circumstances, we may deny access as permitted by law. If we deny your request, we will provide an explanation and information about any applicable right to request a review of the denial.
B. Right to Request an Amendment
If you believe information in your records is incorrect or incomplete, you may request an amendment for as long as we maintain the information.
Contact our Front Office for a Request to Amend Records form.
Your request should be in writing and explain why an amendment is appropriate.
We may deny a request in certain circumstances permitted by law, including when the information is accurate and complete, was not created by us and the originator remains available to act, is not part of the records we maintain, or is not available for inspection under applicable law.
If we deny your request, we will explain the decision and describe your options for submitting a statement of disagreement or pursuing other remedies, as applicable.
C. Right to an Accounting of Disclosures
You may request an accounting of certain disclosures of your health information made during the six years preceding your request, or a shorter period if you specify one.
The accounting does not include every disclosure. For example, certain disclosures for treatment, payment, healthcare operations, disclosures made pursuant to your authorization, and other legally excluded categories are generally omitted.
To make a request, contact our Front Office for a Request for Accounting of Disclosures form.
The first accounting you request within a 12-month period is generally free. We may charge a reasonable, cost-based fee for additional accountings, as permitted by law. If a fee applies, we will notify you before proceeding so you may withdraw or modify your request.
D. Right to Request Restrictions
You may request restrictions on certain uses and disclosures of your PHI for treatment, payment, or healthcare operations. You may also request limits on disclosures to individuals involved in your care or payment.
We are not generally required to agree to every requested restriction.
However, if you or another person on your behalf pays for a healthcare item or service in full out of pocket, you may request that we not disclose information about that item or service to your health plan for payment or healthcare operations purposes. We must honor a qualifying request unless disclosure is otherwise required by law.
To request a restriction, contact our Front Office for a Request to Restrict Disclosure form.
E. Right to 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 contact you only at a specific telephone number, by mail, or through another reasonable communication method.
We will accommodate reasonable requests as required by law. You do not need to explain the reason for your request.
To make a request, contact our Front Office for a Request for Alternative Communications form.
F. Right to Receive a Paper Copy
You may request a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically.
Contact our Front Office to obtain a copy.
G. Right to Receive Notice of a Breach
If a breach of your unsecured PHI occurs and notification is required by law, we will notify you and any applicable authorities in accordance with the applicable requirements.
H. Right to File a Complaint
You have the right to complain if you believe your privacy rights have been violated.
You may submit a complaint to our practice or to the U.S. Department of Health and Human Services, Office for Civil Rights.
We will not retaliate against you for filing a complaint.
4. WEBSITE PRIVACY AND PERSONAL INFORMATION
When you contact us through our website, submit an inquiry, or otherwise communicate with our office, we may collect the information you voluntarily provide.
We use that information to respond to your inquiries, coordinate services, schedule appointments, and operate our practice.
We do not sell your personal information for third-party marketing purposes.
We may share personal information with service providers that perform necessary functions on our behalf, such as website hosting, scheduling, communications, or information technology support. These providers may access information only as appropriate to perform their services and must comply with applicable confidentiality and security requirements.
Where information qualifies as PHI, its use and disclosure are governed by applicable healthcare privacy laws and our Notice of Privacy Practices.
Information you submit through ordinary website forms or email may not be transmitted securely. Please do not send sensitive medical information through a website form or email unless you have confirmed that the communication method is appropriate for that information.
Our website may use technical tools necessary to operate and maintain the site. The information collected and the use of cookies, analytics, or other tracking technologies depend on the tools actually implemented on the website and are subject to applicable law.
5. SMS AND MOBILE INFORMATION PRIVACY
We respect your privacy when you communicate with Holistic Physical Therapy & Wellness by text message.
A. Collection and Use of Mobile Information
If you provide your mobile phone number and opt in to receive text messages, we may collect and use your phone number and related consent information to administer our text messaging program and send the messages you have agreed to receive.
These messages may include appointment confirmations, scheduling changes, responses to inquiries, customer support, and other service-related communications.
B. Sharing of Mobile Information
Your information will not be shared be third parties. We do not sell, rent, or share mobile phone numbers, SMS opt-in information, or consent records with third parties or affiliates for their own marketing or promotional purposes.
We may share mobile phone numbers and related information with service providers that send and manage text messages on our behalf, solely to operate and support our messaging program. These providers may use the information only to perform services for us and must protect it in accordance with applicable confidentiality and security requirements.
We do not use mobile information for unrelated purposes without appropriate consent, except as permitted or required by law.
C. Consent to Receive Text Messages
By providing your mobile phone number and affirmatively opting in to receive text messages, you consent to receive the categories of messages described in our SMS terms.
Your consent to receive text messages is not a condition of purchasing goods or services from our practice.
Consent to receive text messages does not replace any separate authorization or permission required by law for the use or disclosure of protected health information.
D. Opting Out
You may opt out of text messages at any time by replying STOP to a message from us.
After you opt out, you may receive a final message confirming that your request has been processed. We will not send additional text messages covered by that opt-out unless you subsequently opt in again or the law otherwise permits the communication.
For assistance, reply HELP or contact us at 360-550-9640.
E. Text Message Terms
By opting in to receive text messages from Holistic Physical Therapy & Wellness, you agree to receive service-related SMS messages consistent with your consent.

• Message frequency: Message frequency may vary, but subscribers will receive no more than eight messages per month under our current program.

• Message and data rates: Standard message and data rates may apply, depending on your mobile carrier and plan.

• Opt-out: Reply STOP to opt out at any time.

• Help: Reply HELP or call 360-550-9640 for assistance.

• Consent: Consent to receive text messages is not a condition of purchasing goods or services.

We do not sell or share your SMS consent with third parties or affiliates for their own marketing or promotional purposes.
We use messaging service providers only as necessary to operate our text messaging program, subject to applicable confidentiality and security requirements.
Text messages may be visible to anyone with access to your mobile device or message notifications. Although we take reasonable precautions, ordinary SMS text messaging is not a fully secure method for transmitting sensitive medical information. Please contact our office if you prefer another communication method.
6. OUR RESPONSIBILITIES
Holistic Physical Therapy & Wellness is required by law to:

• Maintain the privacy of PHI as required by applicable law.

• 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 unsecured PHI requires notification under applicable law.

• Comply with applicable federal and Washington State privacy requirements.

We reserve the right to revise this notice when our practices or legal obligations change.
If we make a material change to our privacy practices, we will revise the notice as required by law. The revised notice will apply to information we already maintain as well as information we receive in the future, to the extent permitted by law.
The current notice will be available on our website and in our office. You may request a copy at any time.
7. CONTACT INFORMATION
If you have questions about this notice, wish to exercise your privacy rights, or would like to file a complaint with our practice, please contact our office.
Holistic Physical Therapy & Wellness
1233 Lawrence Street
Port Townsend, WA 98368
Phone/Text: 360-550-9640
Fax: 866-816-1311
Email: cvc.holisticpt@gmail.com
Please do not include sensitive medical or other confidential personal information in an ordinary email unless you have confirmed that the communication method is appropriate.
Filing a Complaint with the U.S. Department of Health and Human Services
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your privacy rights have been violated.
You may submit a complaint without fear of retaliation.
Our practice will not retaliate against you for filing a privacy complaint.
Thank you for trusting Holistic Physical Therapy & Wellness with your care. We are committed to treating your health information with respect and protecting your privacy.