NOTICE OF PRIVACY PRACTICES

Summerland Physical Therapy & Wellness
A trade name of SB Mindful Momentum Physical Therapy, A Professional Corporation

Effective Date: January 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.

Summerland Physical Therapy & Wellness (“Company,” “we,” “our,” or “us”) is required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices.

Contact Information

Privacy Officer:
Dr. Shannon Barrett, PT, DPT, RYT
Summerland Physical Therapy & Wellness
2270 Lillie Ave Summerland California, 93067
Inside Beach Club Athletics
Email: Admin@summerlandphysicaltherapy.com
Phone: 805-222-0271

SUMMARY OF OUR DUTIES AND YOUR RIGHTS

Each time you visit us, we create a record of your visit. This record may include your symptoms, examination findings, test results, diagnosis, treatment plan, interventions provided, and future care recommendations.

We are legally and ethically obligated to protect the privacy of your health information and will only use or disclose your PHI as described in this Notice or as permitted by law.

Although the physical record belongs to our practice, the information contained within it belongs to you.

HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

1. Treatment

We may use and disclose your PHI to provide, coordinate, and manage your care. This may include consultation with other healthcare providers or referral to specialists involved in your treatment.

2. Payment

We may use and disclose your PHI to bill and collect payment for services rendered. This may include contacting your health insurer to verify eligibility or submitting information necessary for reimbursement.

If you pay out-of-pocket in full for a specific service and request that we not disclose related information to your health plan, we are required to honor that request.

If payment arrangements are not fulfilled, we may disclose limited information to a collection agency or court of competent jurisdiction as permitted by law.

3. Healthcare Operations

We may use your PHI to operate our practice, including quality improvement activities, business planning, case review, and compliance activities.

4. Students and Interns

Students or interns may participate in or observe your care for educational purposes. You have the right to refuse observation or participation by a student or intern.

5. Business Associates

We may disclose PHI to third-party business associates (such as billing services, legal counsel, consultants, or electronic health record providers) who perform services on our behalf. All business associates are contractually required to safeguard your information.

6. Appointment Reminders

We may contact you via phone, voicemail, text, or email regarding appointment reminders. You may request specific communication preferences.

7. Treatment Options and Health-Related Services

We may inform you about alternative treatments or health-related services that may benefit you.

8. Release to Family or Friends

Using professional judgment, we may disclose relevant information to individuals involved in your care or payment unless you object.

9. Public Health Activities

We may disclose PHI for public health purposes, including reporting abuse, neglect, domestic violence, communicable diseases, births, deaths, or other activities required by law.

10. Law Enforcement and Legal Proceedings

We may disclose PHI in response to court orders, subpoenas, warrants, or other lawful processes.

11. Workers’ Compensation

We may disclose PHI as required to comply with workers’ compensation laws.

12. Research

We may disclose de-identified information for research purposes or identifiable information with proper authorization or institutional review board approval.

13. Disaster Relief

We may disclose PHI to disaster relief organizations to coordinate care or notify family members.

14. Marketing

We will obtain your written authorization before using your PHI for marketing purposes, except for face-to-face communications or promotional gifts of nominal value. We will not sell your health information.

15. Fundraising

We may use limited demographic information to contact you regarding fundraising efforts. You may opt out at any time.

16. De-Identified Information

We may remove identifying details from your PHI and use or disclose that de-identified information.

17. Personal Representatives

If you have a legal personal representative, we will treat that person as you with respect to disclosures.

18. Limited Data Sets

We may use or disclose limited data sets for research or operations pursuant to a data use agreement.

19. Other Uses

Other uses or disclosures not described in this Notice will be made only with your written authorization. You may revoke authorization at any time in writing.

ELECTRONIC COMMUNICATIONS

We may communicate with you via email, text message, telehealth platforms, or other electronic means. While we implement reasonable safeguards, electronic communications may not be completely secure. By providing your contact information, you acknowledge and accept these risks.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

A. Right to a Paper Copy

You have the right to receive a paper copy of this Notice at any time.

B. Right to Inspect and Copy

You have the right to inspect and obtain a copy of your medical and billing records. Requests must be submitted in writing. Reasonable cost-based fees may apply.

C. Right to Amend

You may request an amendment to your medical record if you believe it is incorrect or incomplete. Requests must be submitted in writing and include a reason.

D. Right to an Accounting of Disclosures

You may request an accounting of disclosures made within the past six years, excluding certain disclosures (such as treatment, payment, or healthcare operations).

E. Right to Request Restrictions

You may request restrictions on certain uses or disclosures of your PHI. We are required to honor restrictions for services paid in full out-of-pocket.

F. Right to Request Confidential Communications

You may request that we communicate with you in a specific manner or location.

G. Right to Receive Notice of a Breach

You will be notified without unreasonable delay, and no later than 60 days after discovery, of any breach of unsecured PHI affecting you.

OUR DUTIES

We are required to:

• Maintain the privacy of your health information
• Provide this Notice of our legal duties and privacy practices
• Abide by the terms of this Notice
• Notify you of any breach of unsecured PHI
• Accommodate reasonable requests for confidential communications

We reserve the right to change this Notice. Revised versions will be available upon request and posted as required by law.

COMPLAINTS

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.

To file a complaint with us, contact:

Dr. Shannon Barrett
Admin@summerlandphysicaltherapy.com
805-222-0271

You will not be penalized for filing a complaint.

For more information, visit:
https://www.hhs.gov/ocr/hipaa/