Notice of Privacy Practices (HIPAA)

Effective Date: 04FEB26

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.

This Notice applies to Restore & Reform, LLC (doing business as Restore & Reform) ("Restore & Reform," "we," "our," or "us"). We are required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice.

Our Legal Duties

We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI)

  • Provide you with this Notice of our legal duties and privacy practices

  • Follow the terms of this Notice currently in effect

  • Notify you if a breach occurs that may have compromised the privacy or security of your PHI

Uses and Disclosures of PHI

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

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This may include communication with other healthcare providers involved in your care.

Payment

We may use and disclose your PHI to obtain payment for services provided. As a cash-based practice, this is generally limited to billing you directly for services rendered.

Healthcare Operations

We may use and disclose your PHI for healthcare operations, including quality assessment, administrative activities, practice management, and compliance purposes.

Other Permitted Uses and Disclosures

We may use or disclose your PHI:

  • As required by law

  • For public health activities

  • For health oversight activities

  • In response to court orders or lawful requests

  • To prevent or lessen a serious threat to health or safety

Uses and Disclosures Requiring Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, including most marketing activities. You may revoke an authorization at any time in writing, except to the extent we have already relied on it.

Your Rights Regarding Your PHI

You have the right to:

Get a Copy of Your Health Records

You may request access to or a copy of your PHI. We will provide the information within the time required by law and may charge a reasonable, cost-based fee.

Request Corrections

You may request correction of your PHI if you believe it is incorrect or incomplete.

Request Confidential Communications

You may request that we contact you in a specific way or at a specific location (for example, only at work or by mail).

Ask Us to Limit What We Use or Share

You may request restrictions on certain uses or disclosures of your PHI. We are not required to agree to all requests, but will comply when required by law.

Get a List of Disclosures

You may request an accounting of certain disclosures of your PHI.

Get a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

File a Complaint

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

Our Use of Electronic Systems

We utilize Zanda Health as our electronic medical record (EMR) and patient portal system. Zanda Health is a secure, HIPAA-compliant platform based in New Zealand that meets or exceeds applicable United States healthcare privacy and security standards.

Changes to This Notice

We reserve the right to change this Notice at any time. Changes will apply to all PHI we maintain. The updated Notice will be available on our website and upon request.

Contact Information

If you have questions about this Notice, wish to exercise your rights, or file a complaint, please contact:

Restore & Reform, LLC
North Carolina
Phone: 984.286.2933
Email: info@restore-reform-pt.com

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201