HIPPA Privacy Policy (NPP)

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: [October 14, 2022]

At MommasteWellness, we are committed to maintaining the privacy and confidentiality of your Protected Health Information (PHI). We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties, and notify you following a breach of your unsecured PHI.

1. For Treatment We may use and disclose your PHI to provide and coordinate your healthcare. For example, your physical therapist may share information with your referring physician or another specialist involved in your care.

2. For Payment (Superbills & Out-of-Network) Because we are a cash-based practice, we do not bill your insurance company directly. We will only disclose your PHI to a health plan if:

• You specifically request a "Superbill" or itemized receipt to submit for reimbursement.
• You provide written authorization for us to speak with your insurer regarding a claim.
• Your Right to Restrict: If you pay for a service in full out-of-pocket, you have the right to restrict us from sharing any information about that service with your health insurance plan.

3. For Healthcare Operations We may use your PHI for internal business operations, such as quality audits, staff training, or legal/financial planning.

4. Reproductive Health Care Privacy (New 2026 Requirement) We highly value the sensitive nature of pelvic floor therapy. We will not use or disclose your PHI to conduct a criminal, civil, or administrative investigation into, or to impose liability on, any person for the act of seeking, obtaining, providing, or facilitating lawful reproductive health care. We require a signed attestation for certain legal requests to ensure the information is not being used for these prohibited purposes.

5. Substance Use Disorder (SUD) Records If we receive or create records protected by 42 CFR Part 2 (federal substance use disorder laws), we will not disclose those records in legal proceedings against you without your specific written consent or a qualifying court order.

The following will only be done with your specific written authorization:

• Uses and disclosures of PHI for marketing (including testimonials).
• The sale of your PHI.
• Disclosures to your employer (unless required by Workers' Comp laws).

• Right to Inspect and Copy: You may request to see or get an electronic or paper copy of your medical record and billing information.
• Right to Amend: If you believe your record is incorrect, you may ask us to amend it.
• Right to Confidential Communications: You may ask us to contact you in a specific way (e.g., "only call my cell phone, not my home phone").
• Right to an Accounting of Disclosures: You can ask for a list of the times we’ve shared your health information for purposes other than treatment or operations.
• Right to a Paper Copy: You may request a paper copy of this notice at any time.

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information: Lee Matthews-Carter, Privacy Officer | MommmasteWellness | 937-203-8147 | 1100 Brown Street, Dayton, OH 45409 | Drleelee@Mommastewellness.com