Privacy Policy & Notice of Privacy Practices

Effective Date: 08/07/2025

Website: www.formtheoryrehab.com

Form Theory Rehab, LLC ("Form Theory," "we," "our," or "us") is committed to protecting the privacy of your personal and health information. This Privacy Policy explains how we collect, use, and safeguard your information online, in person, and through all communications. It also serves as our Notice of Privacy Practices under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable Tennessee law.

1. Definitions

Protected Health Information (PHI): Information that identifies you and relates to your health, treatment, or payment for healthcare services.

Personally Identifiable Information (PII): Non-public information that can identify you, such as your name, contact details, or payment information.

Non-Personal Information (NPI): Data that does not identify you, collected automatically when you interact with our website.

2. Your Rights Under HIPAA and Tennessee Law

You have the right to:

Access your medical and billing records
Request corrections to your records
Receive an accounting of disclosures of your PHI
Request restrictions on certain uses or disclosures (we may not be able to agree to all requests)
Request confidential communications (e.g., phone, email, mailing address preferences)
Opt out of marketing communications and fundraising solicitations
Receive a paper copy of this policy at any time
File a complaint without fear of retaliation if you believe your privacy rights have been violated (see Section 12)

3. Information We Collect

We may collect information:

Directly from you when you complete forms, schedule an appointment, or communicate with us
Automatically via our website (e.g., IP address, browser type, pages visited, cookies)
From third parties involved in your care (e.g., other healthcare providers, insurance companies—with your authorization)

Examples include:

Name, address, phone number, email
Date of birth
Health history and clinical notes
Payment and billing information

4. How We Use and Disclose Your Information

We may use and disclose your PHI for:

Treatment: Coordination and sharing with providers involved in your care.

Payment: Billing insurers or you directly.

Healthcare Operations: Quality assessment, staff training, compliance audits.

We may also use your PHI:

When required by law (e.g., public health reporting, court orders)
To prevent a serious threat to health or safety
For workers' compensation claims
For appointment reminders and treatment alternatives

We will not use or disclose your PHI for marketing, sale of information, or non-treatment purposes without your written authorization.

5. Special Tennessee Provisions

Under Tennessee law:

You must opt in before we use or share sensitive health data for marketing purposes
You may opt out of marketing at any time (see Section 10)
HIPAA-covered healthcare providers, like Form Theory Rehab, are generally exempt from the Tennessee Information Protection Act (TIPA) for PHI, but we voluntarily extend certain rights to you (access, correction, deletion, portability)

6. Cookies and Online Tracking

Our website uses cookies and analytics tools (e.g., Google Analytics) to improve performance. You may disable cookies in your browser, but some features may not function properly. We do not honor browser "Do Not Track" signals.

7. Third-Party Services

We use secure third-party vendors for:

Appointment scheduling
Payment processing
Email and SMS communications

Vendors are contractually required to safeguard your information and comply with HIPAA where applicable.

8. Data Security

We protect your information using:

Encryption for transmitted data
Secure servers and firewalls
Access controls for staff

Despite safeguards, no system is 100% secure. If a breach occurs that compromises your PHI, we will notify you within HIPAA and Tennessee breach-notification timelines (no later than 60 days after discovery).

9. Minors

We do not knowingly collect information from individuals under 13 without parental consent.

10. Marketing and Communications

By providing your email or phone number, you consent to receive:

Appointment reminders (SMS, phone, email)
Necessary service notifications

You may opt out of promotional emails or texts at any time by:

Clicking "unsubscribe" in emails
Replying "STOP" to SMS messages
Contacting us directly (see Section 12)

Transactional and legally required messages cannot be opted out of.

11. Retention of Records

We retain medical and billing records for the period required by Tennessee law (minimum of 10 years for adults; longer for minors), after which they are securely destroyed.

12. Complaints & Contact

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

Form Theory Rehab – Privacy Officer

📧frontdesk@formtheoryrehab.com

📞615-722-0698

or with the:

U.S. Department of Health & Human Services – Office for Civil Rights

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

We will not retaliate for filing a complaint.

13. Changes to This Policy

We may update this policy at any time. Updates will be posted on our website with the revised Effective Date.