Notice of Privacy Practices

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

Next Level Physical Therapy and Sports Performance LLC (“we”, “us”, or “our”) is committed to protecting your privacy and maintaining security of your personal information. “You” and “your” refers to each patient who is entitled to receive a copy of this Notice of Privacy Practices. In this Notice, we will provide information about how we use your Protected Health Information (“PHI”), how we may disclose your PHI to others, your privacy rights and how to use them, our privacy duties, and who to contact for information or file a complaint.

How We Use and Disclose Your Protected Health Information (PHI)

We may use your PHI within our organization or disclose it outside of our organization to treat you, to obtain payment for your care and related services, and for certain activities we call “health care operations”. We will also use or disclose your PHI as required or permitted by law.

Treatment

We use and disclose your PHI as part of your treatment. For example, after your evaluation, re-evaluation, or when creating a plan of care, we may send a copy or summary of our report to your referring or attending physician. We also keep records of the care and services you receive at our facility to ensure your care is accurate, consistent, and meets legal requirements. Our workforce members may use or disclose these records to provide proper and optimal care.

Payment Involving a Third-Party Payer

After your treatment, we typically bill a third party (such as your insurance provider) for the services you received. This involves collecting your treatment information, entering it into our computer system, and submitting a claim either on paper or electronically. The claim includes details about your health problem, the treatments you received, and identifying information such as your social security number and insurance policy number. The third-party payer may request to review your records to ensure the services were medically necessary. Using and disclosing your information in this way helps us receive payment for your care.

Payment Exclusive of a Third-Party Payer (Fully Self-Pay)

If you choose to pay for your services in full without involving a third party (such as an insurer or employer), you may request that we do not disclose any information regarding your services for payment purposes. In this case, we will provide you with a Good Faith Estimate (GFE) for all self-paid visits or treatments, regardless of the reason. However, you will not receive a GFE if you are enrolled in Medicare Part A, B, or C, Medicaid, TRICARE, Veterans Affairs, or Indian Health Services.

Health Care Operations

We may use and disclose your PHI for health care operations. For example, our therapists may review clinical records to monitor the quality of care provided at our facility. Your records and PHI may be used in these quality assessments. We may also use PHI for student internship programs, business planning, compliance monitoring, or to investigate and resolve complaints.

Special Uses

We may use or disclose your PHI for purposes related to your relationship with us as a patient. For example, we may update your workers compensation case worker or employer (note: if you are a workers compensation patient, you may not opt out of this disclosure if your state does not require your authorization).

You may opt out of the following uses verbally or in writing:

  • Reminding you of appointments

  • Following up on home programs you have been taught

  • Advising you of new or updated services or home supplies

  • Releasing equipment or supplies to your designee

  • Conducting follow-ups on your home programs or discharge planning

  • Advising you on new or updated services or home supplies via telecommunication or newsletter

  • Conducting research that does not directly identify you

  • Communicating via electronic means at your request or with your authorization (using secure transmission to protect your information)

  • Conducting marketing functions, including providing nominal promotional gifts

  • Contacting you regarding fundraising projects we are engaged in

If we receive financial remuneration from a third party for marketing a product, item, or for any fundraising activity, we will notify you in advance and provide you the opportunity to opt out of receiving these materials. We will obtain your written authorization before using PHI for marketing purposes when required by law.

Uses and Disclosures Required or Permitted by Law

Various laws and regulations may require or permit us to use or disclose your PHI. The federal health information privacy regulations specify several required or permitted uses and disclosures:

Permitted without Authorization:

  • If you do not verbally object, we may share some of your PHI with a family member or friend involved in your care

  • In an emergency if you are unable to communicate

  • If we receive certain assurances that protect your privacy, we may use or disclose your PHI for research purposes. We will always obtain an authorization from you even it is “permitted” without it

  • If you are a workers’ compensation patient, we may update your workers’ compensation case worker or employer, unless state law requires your authorization

Required without Authorization:

  • When required by law (e.g., court orders)

  • For public health activities (e.g., reporting communicable diseases or adverse reactions)

  • To report neglect, abuse, or domestic violence

  • To government regulators or agents to determine compliance with rules and regulations

  • In judicial or administrative proceedings (e.g., valid subpoenas)

  • When requested by law enforcement officials or other legal requirements (e.g., reporting gunshot wounds)

  • To avert a health hazard or respond to a public safety threat (e.g., imminent crimes)

  • As deemed necessary by military command authorities if you are in the Armed Forces

  • In connection with certain organ donor programs

Required Use and Disclosure Exception:

Some disclosures require your authorization, such as when substance use disorder records are involved. According to 42 CFR Part 2, you must authorize the release of any substance use disorder history or treatment records unless required by federal law. Part 2 allows disclosure without your authorization only in limited circumstances, including:

  • Medical emergencies

  • Scientific research under strict safeguards

  • Audits or program evaluations

  • Court orders that meet specific legal requirements

  • Reporting suspected child abuse or neglect as required by law

  • Crimes committed on program premises or against program staff

Your Authorization May Be Required

In the situations described above, we have the right to use and disclose your PHI. If you change your mind later, you may revoke your authorization or opt out of the disclosure, as permitted by law.

Your Privacy Rights and How to Exercise Them

We will provide patients with a written notice regarding the risks of transmitting PHI via unsecured email or messaging platforms. We will obtain your authorization before initiating or responding to such electronic communication.

You have specific rights under the federally required privacy program, summarized as follows:

  • Your Right to Request Limited Use or Disclosure: You may request that we do not use or disclose your PHI in a particular way. While we are not always required to honor your request, if we agree, we must abide by it. We may require your request in writing.

  • Your Right to Confidential Communication: You may request that we communicate with you at a specific location or phone number. We may require your request in writing and confirmation that it will not interfere with your payment method.

  • Your Right to Inspect and Copy Your PHI: You may inspect and copy your PHI in the format in which it is maintained (paper or electronic). If we deny your request, we will provide a resource person to assist you. We must respond within 30 days, may charge reasonable fees, and may require an appointment. We may require your request in writing.

  • Your Right to Revoke Your Authorization: You may revoke your authorization to use or disclose your PHI at any time in writing. Uses and disclosures made prior to revocation are not affected.

  • Your Right to Amend Your PHI: You may request an amendment to your record. We may require your request in writing and may deny the request if the record is accurate or was not created by us. If we accept the amendment, we will notify you and others who have the original record.

  • Your Right to Know Who Else Sees Your PHI: You may request an accounting of certain disclosures made within the past six years (with some exceptions). We may require your request in writing and may charge for more than one request per year.

  • Your Right to Be Informed of a Breach: We are required to notify you by first class mail or email of any breaches of unsecured PHI as soon as possible, but no later than 60 days after discovery. The notice will include a description of the breach, including the date and its discovery, if known.

  • Your Right to Complain: You may file a complaint if you believe your privacy rights have been violated. Complaints can be made to our HIPAA officer or to the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling 1-877-696-6775. We will not retaliate if you file a complaint, and your complaint should include enough detail for us to investigate.

  • Your Right to Receive a Copy of the Privacy Notice: We are obligated to provide you with a copy of this Notice and to post it in a place accessible to patients and on our website. We may update the Notice as policies or laws change and are required to maintain each version for at least six years.

  • Your Right to Expect Protection of Substance Use Disorder or Treatment Records (42 CFR Part 2): We are required by federal law to protect the privacy of your substance use disorder (SUD) treatment records, which receive additional protections beyond HIPAA. We may not use or disclose your SUD treatment records without your written consent unless permitted by law, including for medical emergencies, scientific research under safeguards, audits, court orders, reporting child abuse or neglect, or crimes on program premises or against staff. You may authorize us to disclose your SUD treatment information to others for treatment, payment, or healthcare operations. Your authorization must meet the requirements of 42 CFR Part 2. You may revoke your authorization at any time unless we have already acted on it. Any recipient of your SUD treatment information is prohibited from redisclosing it unless you give written permission or the disclosure is otherwise permitted by Part 2. Federal law does not protect information if you voluntarily disclose it to others who are not bound by Part 2. You have the right to:

    • Request restrictions on how your SUD information is used or disclosed.

    • Request an accounting of disclosures of your Part 2–protected information.

    • Receive a copy of this Notice and any updates.

    • File a complaint if you believe your privacy rights have been violated, and we are prohibited from retaliation against you for filing a complaint.

Our Privacy Obligations

We are required by law to maintain the privacy and security of your protected health information. We will notify you 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 provide you with a copy. We will not use or share your information other than as described here unless you give us written permission. You may revoke permission at any time in writing. If we make changes to our Notice of Privacy Practices, we will provide the revised Notice to you the next time you seek treatment.

Contact Information

If you have any questions about this Notice of Privacy Practices or if you have a complaint or concern, please contact our Privacy Officer:
Next Level Physical Therapy and Sports Performance LLC
1 Clarendon Ln, Bluffton, SC 29909
Phone: 814-937-3188

Effective Date: This revised notice takes effect on 04/11/2026