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.

1. Our Commitment to Your Privacy

Pelvique, LLC is a cash-based physical therapy practice. While we do not transmit health information for electronic insurance claims, we are committed to protecting your health information (PHI) in accordance with Pennsylvania and Delaware state professional standards and data breach laws.

2. How We May Use and Disclose Your Information

We use your information primarily for Treatment, Payment, and Healthcare Operations (TPO):

• Treatment: We may share information with your physician, specialist, or other healthcare providers involved in your care to coordinate treatment.

• Payment: As a cash-based practice, we use your information to process your payments (e.g., via secure credit card processors). We do not share your medical records with insurance companies unless you specifically request a "Superbill" for your own reimbursement.

• Operations: We use your information to run our clinic, such as sending secure appointment reminders or performing internal quality reviews.

• Required by Law: We may disclose information when required by state or federal law (e.g., reporting suspected abuse/neglect, or in response to a valid subpoena).

3. Your Rights Regarding Your Health Information

• Right to Access: You have the right to inspect and receive a copy of your clinical records. In accordance with PA and DE law, we will provide these within 30 days of a written request. We may charge a reasonable, cost-based fee.

• Right to Amend: If you believe information in your record is incorrect, you may ask us to amend it. We may deny this if the record was not created by us or is already accurate.

• Right to Restrict: You can ask us not to share certain information for treatment or payment. Because you pay out-of-pocket, we will honor requests to not disclose information to a health plan for those services.

• Right to Alternative Communication: You can ask us to contact you in a specific way (e.g., "cell phone only" or "don't leave voicemails").

4. Special Protections & Authorizations

We will never sell your information or use it for marketing/social media (e.g., testimonials) without your separate, explicit written authorization. You may revoke such authorization at any time.

5. Changes to This Notice

We reserve the right to change this notice. The new notice will be available upon request, in our clinic, and on our website.

6. Contact Information & 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. You will not be penalized for filing a complaint.

Privacy Officer: Megan Siegel