HIPAA Notice of Privacy Practices

Starter template. Must be reviewed by healthcare counsel and personalized to MobilityWoRx PT, LLC's actual practices before public launch. The template below covers the categories required by 45 CFR §164.520; specific language should be confirmed by counsel.

About this Notice

MobilityWoRx PT, LLC ("the Practice") is a healthcare provider subject to the Health Insurance Portability and Accountability Act (HIPAA) and related federal and New Jersey privacy laws. This Notice describes how we may use and disclose your protected health information ("PHI") and the rights you have regarding that information.

What this Notice covers

This Notice applies to PHI created or received in connection with care provided by the Practice, including treatment notes, scheduling records, and billing information. It does not apply to information collected through this website (https://mobilityworxpt.com), which is intentionally designed not to collect PHI. For information about the website's data practices, see our Privacy Policy.

How we may use and disclose your PHI

For treatment

We may use your PHI to provide, coordinate, or manage your care. For example, we may share information with another healthcare provider you authorize us to coordinate with.

For payment

We may use and disclose your PHI to provide superbills you can submit to your insurer for out-of-network reimbursement, or otherwise to obtain payment for the services we provide.

For healthcare operations

We may use your PHI for activities necessary to operate the Practice, including quality assessment, credentialing, and business management.

Other uses and disclosures permitted or required by law

We may use or disclose your PHI without your authorization where permitted or required by law: for public health activities, reporting abuse or neglect, in response to court orders, to law enforcement in specific circumstances, and similar limited situations defined by HIPAA and New Jersey law.

Uses and disclosures requiring your authorization

Other uses and disclosures of your PHI (including most marketing communications, the sale of PHI, and most uses of psychotherapy notes) will be made only with your written authorization. You may revoke an authorization in writing at any time, and we will stop using and disclosing your PHI for the purposes covered by it (except where we have already taken action in reliance on the authorization).

Your rights regarding your PHI

• Access. You have the right to inspect and obtain a copy of the PHI we maintain about you, with limited exceptions.
• Amendment. You have the right to request that we amend PHI you believe is inaccurate or incomplete.
• Accounting of disclosures. You have the right to receive a list of certain disclosures of your PHI we have made.
• Restrictions. You have the right to request restrictions on certain uses or disclosures. We are required to agree to a request to restrict disclosure to a health plan if the disclosure is for payment or operations and the PHI relates to a service you paid for in full out-of-pocket.
• Confidential communications. You have the right to request that we communicate with you in a particular way or at a particular location (e.g., only at your work email).
• Paper copy. You have the right to obtain a paper copy of this Notice on request, even if you have agreed to receive it electronically.
• Notification of breach. You have the right to be notified of a breach of unsecured PHI affecting you.
• Complaints. You have the right to file a complaint with us or with the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

How to exercise your rights or file a complaint

To exercise any of these rights or to file a complaint, contact our Privacy Officer at:

MobilityWoRx PT, LLC
Attn: Privacy Officer
drmel@mobilityworxpt.com · (732) 639-1668

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
https://www.hhs.gov/ocr/

Our duties

We are required by law to maintain the privacy of PHI, to provide you this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI we maintain. The current Notice is available on this page and on request.

Effective date

This Notice is effective May 9, 2026.