HIPAA Notice of Privacy Practices

Effective January 1, 2026
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.

Our commitment to your privacy

Forge Physical Therapy ("Forge") is committed to protecting the privacy and security of your protected health information ("PHI"). This Notice describes how we may use and disclose your PHI, and your rights regarding that information, under the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA").

Our legal duties

We are required by law to:

  • Maintain the privacy of your PHI
  • Provide you with this Notice of our legal duties and privacy practices
  • Notify you in the event of a breach of your unsecured PHI
  • Abide by the terms of the Notice currently in effect

How we may use and disclose your PHI without your authorization

We may use and disclose your PHI, without your written authorization, for the following purposes:

Treatment

We use your PHI to provide you with physical therapy care. We may share your PHI with other providers involved in your care — for example, a referring physician, a surgeon, or a specialist — so that everyone treating you has the information needed to coordinate your care.

Payment

We may use and disclose your PHI to obtain payment for the services we provide. This includes submitting claims to your health insurance, verifying coverage and benefits, and working with billing services.

Health care operations

We may use and disclose your PHI for internal operations such as quality review, care coordination, credentialing, training, audits, and business planning.

Appointment reminders and health-related communications

We may contact you to remind you of an appointment or follow up on your care. We may also tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.

As required or permitted by law

We may use or disclose your PHI when required or permitted by federal, state, or local law — for example, for public health activities, reporting suspected abuse or neglect, judicial or administrative proceedings, law enforcement purposes, organ donation, workers' compensation, health oversight activities, research under strict safeguards, coroners and medical examiners, national security, and to avert a serious threat to health or safety.

Uses and disclosures that require your written authorization

Other uses and disclosures not described in this Notice will be made only with your written authorization. This includes:

  • Most uses and disclosures of psychotherapy notes (if any)
  • Uses and disclosures for marketing purposes
  • Disclosures that constitute a sale of PHI

If you give us authorization, you may revoke it in writing at any time, except to the extent we have already acted in reliance on it.

Your rights

Right to inspect and copy

You have the right to inspect and obtain a copy of your PHI in our designated record set. Submit requests in writing to our Privacy Officer. We may charge a reasonable, cost-based fee. In limited circumstances, we may deny your request and will provide a written explanation if we do.

Right to request an amendment

If you believe information in your record is incorrect or incomplete, you may ask us to amend it. Submit requests in writing, with a reason supporting the request, to our Privacy Officer. We may deny your request under certain conditions, and will explain our reasons in writing.

Right to an accounting of disclosures

You have the right to request a list of certain disclosures we have made of your PHI. This does not include disclosures for treatment, payment, or health care operations, or certain other disclosures. Submit requests in writing to our Privacy Officer. The first accounting in any 12-month period is free; we may charge a reasonable fee for additional requests.

Right to request restrictions

You have the right to request a restriction on how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to most requests, but if we agree we will abide by it except in an emergency.

We are required to agree to your request if you ask us not to disclose PHI to a health plan for purposes of payment or health care operations, and the PHI pertains solely to a service for which you have paid us out of pocket in full.

Right to request confidential communications

You have the right to ask us to contact you about medical matters in a specific way or at a specific location — for example, to call you only at work or to mail communications only to a specified address. We will accommodate reasonable requests.

Right to a paper copy of this Notice

You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Ask at the front desk or contact our Privacy Officer.

Right to be notified of a breach

You have the right to be notified in the event of a breach of your unsecured PHI.

How to exercise your rights

To exercise any of the rights described above, contact our Privacy Officer:

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer (contact information above) or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

To file a complaint with HHS: hhs.gov/hipaa/filing-a-complaint.

Changes to this Notice

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any information we receive in the future. We will post the current Notice in our clinic and on our website and will include the effective date at the top. You may request a copy of the current Notice at any time.