Notice of Privacy Practices

Our Commitment to Your Privacy

Spine IQ, LLC, d/b/a Adjusted Health + Performance (“AHP,” “we,” “us,” or “our”) is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. We are required to abide by the terms of the Notice currently in effect.

“Protected health information” means information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition, the health care services you receive from us (including chiropractic care, spinal and soft tissue treatment, sports injury evaluation, functional rehabilitation and performance training, diagnostic imaging, and related wellness and supplement services), and payment for those services.

How We May Use and Share Your Health Information Without Your Written Authorization

Federal law permits us to 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 chiropractic and rehabilitative care and any related services. Examples include sharing exam findings and treatment plans among our providers and clinical staff, coordinating your care with a referring physician or specialist, and communicating with you about appointments, home exercise programs, or recommended supplement protocols.

Payment

We may use and disclose your PHI to bill and collect payment for the treatment and services you receive from us, including submitting claims to your health insurer, verifying eligibility and benefits, and communicating with billing services regarding your account.

Health Care Operations

We may use and disclose your PHI to support the day-to-day operation of the practice, including quality assessment and improvement, staff training, compliance and audit activities, licensing, and business planning — for example, administering membership and prepaid bundle programs such as our Recovery Club, or reviewing outcomes across similar cases to improve care.

Business Associates

We contract with outside companies that need access to PHI to perform services on our behalf — for example, our electronic health record and practice management platform, supplement dispensing and fulfillment platform, and billing or IT support vendors. These companies (“Business Associates”) are contractually required to protect your PHI and to use it only as permitted by their agreement with us and by law.

Other Uses and Disclosures Permitted or Required by Law

We may also use or disclose PHI, without your authorization, in the following circumstances:

• ›As Required by Law — when disclosure is mandated by federal, state, or local law.
• ›Public Health Activities — to public health authorities for purposes such as disease reporting, or to the FDA regarding products or devices used in your care.
• ›Health Oversight Activities — to government agencies for audits, investigations, inspections, or licensure actions.
• ›Judicial and Administrative Proceedings — in response to a court order, subpoena, or other lawful process.
• ›Law Enforcement — for purposes such as identifying a suspect, fugitive, witness, or in response to a valid legal request.
• ›To Avert a Serious Threat to Health or Safety — to prevent or lessen a serious and imminent threat to the health or safety of you or others.
• ›Workers' Compensation — as authorized by and to the extent necessary to comply with workers' compensation laws.
• ›Coroners, Medical Examiners, and Funeral Directors — as necessary for them to carry out their duties.
• ›Military, National Security, and Government Functions — as required by applicable law for specialized government functions.
• ›Research — in limited circumstances, subject to a privacy board or ethics committee review, or in a form that does not identify you.

Uses and Disclosures That Require Your Written Authorization

Other than as described above, we will not use or disclose your PHI without your written authorization. If you provide us with an authorization, you may revoke it in writing at any time, except to the extent we have already relied on it. Authorization is required for:

• ›Marketing communications that fall outside routine treatment communications or general health education — for example, if we were to share your PHI with an outside company for that company's own marketing purposes.
• ›Sale of your PHI. We do not sell PHI, and we will never do so without your specific written authorization.
• ›Psychotherapy notes, if any such notes are ever created (AHP does not currently provide behavioral health services).
• ›Any other use or disclosure not identified in this Notice or otherwise permitted or required by law.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You may request to inspect and receive a copy of PHI we maintain about you, including records used to make decisions about your care and billing. Requests must be made in writing to our Privacy Officer. In limited circumstances, we may deny your request, and if we do, we will explain the denial and, where applicable, your right to have the denial reviewed.

Right to Request Amendment

If you believe information in your record is incorrect or incomplete, you may ask us to amend it for as long as we maintain the information. We may deny your request if, for example, the information was not created by us or is already accurate and complete. We will provide a written explanation of any denial.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your PHI, other than disclosures for treatment, payment, health care operations, disclosures made to you, or disclosures made pursuant to your authorization.

Right to Request Restrictions

You may ask us to restrict how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree, except that we must honor a request to restrict disclosure to a health plan for services you paid for entirely out of pocket, provided the disclosure is not otherwise required by law.

Right to Request Confidential Communications

You may ask us to communicate with you about your health information in a specific way or at a specific location (for example, by contacting you only at a particular phone number or email 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. You may request a copy at the front desk or by contacting our Privacy Officer.

Right to Be Notified of a Breach

You have the right to be notified if we discover a breach of your unsecured PHI, as required by law.

Right to Choose Someone to Act on Your Behalf

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions about your health information on your behalf. We will verify the identity and authority of that person before taking any action.

Our Responsibilities

• ›We are required by law to maintain the privacy and security of your PHI.
• ›We will notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI.
• ›We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• ›We will not use or share your PHI other than as described here unless you provide written authorization, which you may revoke at any time by notifying us in writing.

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 on our website and in our office, and the effective date will appear at the top of the current version.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, by mail to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-800-368-1019, or through www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Contact Us

Questions about this Notice, or requests to exercise any of the rights described above, should be directed to:

Privacy Officer: Spine IQ, LLC, Adjusted Health + Performance
9501 171st Street, Suite I, Tinley Park, IL 60487
(708) 813-9606 — admin@adjustedhp.com