This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

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Our Legal Duty

Kinetic Performance Physical Therapy (“the Practice”) is committed to protecting the privacy of your Protected Health Information (“PHI”). We are required by law to:

    •    Maintain the privacy and security of your PHI under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and Florida Statutes §456.057.

    •    Provide you with this Notice explaining our duties and privacy practices.

    •    Notify you in the event of a breach of your unsecured PHI.

    •    Abide by the terms of this Notice.

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How We May Use and Disclose Your Information

No personal information, mobile number, or messaging consent information will be shared with third parties or affiliates for marketing or promotional purposes. We may use or disclose your PHI without your written authorization for the following purposes:

Treatment

To provide, coordinate, or manage your healthcare and related services. For example, we may share information with your physician or other healthcare providers involved in your care.

Payment

To bill and collect payment from you, your insurance company, or a third-party payer for the services you receive.

Healthcare Operations

For activities that support our practice operations, such as quality assessment, staff training, compliance programs, or accreditation.

As Required by Law

We may disclose PHI when required by federal, state, or local law. Examples include:

    •    Public health reporting

    •    Health oversight activities (audits, investigations, inspections)

    •    Judicial or administrative proceedings

    •    Law enforcement purposes

    •    Workers’ compensation claims

    •    National security or protective services

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Other Uses Requiring Authorization

We will obtain your written authorization for:

    •    Most uses and disclosures of psychotherapy notes

    •    Marketing communications not otherwise permitted by law

    •    The sale of your PHI

You may revoke an authorization at any time in writing, except where we have already relied on it.

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Your Rights

You have the following rights regarding your PHI:

    •    Access: You may inspect or obtain a copy of your medical records.

    •    Amendment: You may request corrections if your records are incomplete or inaccurate.

    •    Accounting of Disclosures: You may request a list of disclosures of your PHI made by the Practice.

    •    Restrictions: You may request limitations on how we use or disclose your PHI. We are not required to agree to all requests unless required by law.

    •    Confidential Communications: You may request that we communicate with you in a certain way (e.g., by phone, mail, or email).

    •    Paper Copy: You may request a paper copy of this Notice, even if you receive it electronically.

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Terms & Conditions

INFORMED CONSENT FOR TREATMENT:

The term “informed consent” means that the potential risks, benefits and alternatives of physical therapy treatment have been explained to you. The therapist provides a wide range of services and I understand that I will receive information at the initial visit concerning the treatment and options available for my condition.

Potential risks: You may experience an increase in your current level of pain or discomfort, or an aggravation of your existing injury or condition. This discomfort is usually temporary; if it does not subside in 24 hours, I agree to contact my physical therapist.
Alternatives: All physical therapy treatment options available to your conditions will be explained to you. You may inquire about the cost of these services and discuss them with your therapist. If you do not wish to participate in the therapy program, you may discuss your medical, surgical or pharmacological alternatives with your primary care physician.

NO WARRANTY:

I understand that the physical therapist cannot make any promises or guarantees regarding a cure for or improvement in my condition. I understand that my physical therapist will share with me opinions and available statistics and studies regarding results of physical therapy treatment for my condition and will discuss treatment options with me before I consent to treatment.

FINANCIAL RESPONSIBILITIES:

I agree to pay for my treatments at time of service, by cash, check, or credit card unless other mutually agreed upon arrangements have been made. I understand the cash-based physical therapy services provided by the physical therapist that both parties have determined will help them reach treatment goals most efficiently.

SMS DISCLOSURE:

By providing your mobile number and checking the box below, you agree to receive text messages from Kinetic Performance Physical Therapy related to appointment reminders, account updates, or promotional offers. Message frequency may vary. Message and data rates may apply depending on your mobile carrier.

You can opt in by replying START and opt out at any time by replying STOP to cancel future messages. For assistance, reply HELP or contact us at info@kineticperformancept.org or (305) 317-4420. Consent is not a condition of purchase.

PRIVACY PRACTICES:

I acknowledge that I have been informed of the clinic’s privacy practices. I understand that my personal health information will be kept confidential and will only be used for purposes related to my care, clinic operations, or as required by law. My information will not be shared with third parties without my written consent, except in cases where disclosure is legally required (such as emergencies or public health reporting).

CANCELLATION POLICY:

I understand that if I need to cancel or reschedule my appointment, I must provide at least 24 hours’ notice. I acknowledge that if I give less than 24 hours’ notice or I do not show up for my appointment, I may be responsible for a cancellation fee.

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Florida-Specific Protections

Florida law provides additional privacy protections. For example, records related to mental health, substance abuse, HIV/AIDS, and genetic information are subject to heightened protection and cannot be disclosed without your written consent, except as required or permitted by law.

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Breach Notification

If a breach occurs involving your unsecured PHI, we will notify you in compliance with both HIPAA and Florida law.

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Complaints

If you believe your privacy rights have been violated, you may file a complaint with any of the following:

The Practice:

Kinetic Performance Physical Therapy

753 Shotgun Road

Sunrise, FL, 33326

Phone: 732-991-2031

Email: info@kineticperformancept.org

Florida Agency for Health Care Administration (AHCA):

HIPAA Privacy Officer

2727 Mahan Drive, Mail Stop #6

Tallahassee, FL 32308

Phone: (888) 419-3456

Website: https://ahca.myflorida.com

U.S. Department of Health and Human Services, Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Phone: (800) 368-1019

TDD: (800) 537-7697

Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not face retaliation for filing a complaint.

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Contact Information

For more information about this Notice or to exercise your privacy rights, please contact:

Kinetic Performance Physical Therapy

753 Shotgun Road

Sunrise, FL, 33326

Phone: 732-991-2031

Email: info@kineticperformancept.org