Data & Consent

This Privacy Policy describes the health information privacy practices of Phy Health, Inc. (referred to as “Phy Health,” “we,” “our,” or “us,” herein). Phy Health offers coaching and other forms of guidance or therapy using the Phy Solution to individual participants in Phy Health coaching or professional health care services (“Participants”).

Phy Health shall make every reasonable effort to comply with the Privacy and Security Rules under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) the Health Information Technology for Economic and Clinical Health (“HITECH”) Act of 2009, and the regulations promulgated thereto. Phy Health complies with these federal laws, applicable state laws, including but not limited to, when applicable, the California Privacy Rights and Enforcement Act of 2020 (the “CPRA”) and the California Consumer Privacy Act of 2018 (the “CCPA”) as well as, when applicable, the European Union General Data Protection Regulation (“GDPR”) regarding the privacy and security of protected health information. Under the GDPR, if applicable, you have the right to be forgotten and may request deletion of your data from Phy Health computer systems at any time, by sending an email to Privacy@Phy.health. Any questions or concerns regarding the privacy or security of protected health information hosted or transmitted by Phy Health, shall be reported to the Phy Health Privacy Officer at privacy@phy.health.

Under applicable state and federal laws (Collectively, the “Laws”), Phy Health maintains the privacy of each Participant’s health information (“Protected Health Information” or “PHI”) and provides each Participant with this Notice of Privacy Practices regarding Protected Health Information. When Phy Health uses or discloses Protected Health Information, it is required to abide by the terms of its privacy policy as reflected in this Notice as it may be amended or updated from time to time.

The Laws divide uses and disclosures of PHI into those which can be done without Participant authorization and those which require Participant authorization. Section IV describes uses and disclosures that can be done without Participant authorization. Section V describes uses and disclosures that can be made only with written Participant authorization.

• Uses and Disclosures For Treatment, Payment and Health Care Operations. Phy Health may use and disclose PHI under federal law in order to provide treatment, receive payment or engage in healthcare operations as described below:

  Treatment. Phy Health may use and disclose PHI to provide diagnosis and treatment to a Participant. Consistent with that use and disclosure, Phy Health may contact provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest and to disclose PHI to other providers involved in a Participant’s treatment.

  Payment. Phy Health may use and disclose PHI to obtain payment for services that Phy Health provides, for example to your health plan. HITECH provides, however, that you may pay for the services and request that your PHI not be disclosed to the health plan for that service.

  Health Care Operations. Phy Health may use and disclose your PHI for health care operations, which include administration, management and activities that improve the quality and cost effectiveness of Phy Health Services. Phy Health may also disclose PHI to health care providers or health care facilities when such PHI is required for them to engage in treatment, payment or health care operations.

  Research. We may also use your de-identified PHI to run (or authorize third parties to run) statistical or other research on individual or aggregate health or medical trends. Such research would only use your PHI in an anonymous manner that cannot be tied directly back to you.

• Disclosure to Relatives, Close Friends and Other Caregivers. Phy Health may use or disclose PHI to a Participant’s family member, other relative, a close personal friend or any other person identified by a Participant if Phy Health (1) obtains and documents the Participant’s authorization; (2) provides the Participant with a confidential opportunity to object to the disclosure and the Participant does not object; or (3) reasonably infers from the circumstances and in the Phy Health provider’s professional judgment, that the Participant’s condition is dependent upon such a disclosure and/or that the Participant would not object given the circumstances.

  If a Participant is not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of incapacity or an emergency circumstance, Phy Health personnel may exercise professional judgment to determine whether a disclosure is in the best interest of the Participant. If Phy Health discloses information to a family member, other relative or a close personal friend without an authorization, Phy Health would disclose only information that Phy Health believe is directly relevant to the person’s involvement with the health care or payment related to the Participant’s health care. Phy Health may also disclose PHI in order to notify (or assist in notifying) such persons of a Participant’s location, general condition or death.

• Public Health Activities. Phy Health may disclose PHI in order to comply with public health requirements, including but not limited to: (1) to report certain diseases, conditions or other findings to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report suspected abuse or neglect to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse or neglect; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; or (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition (under specifically limited circumstances).
• Health Oversight Activities. Phy Health may disclose PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid and civil rights laws.
• Judicial and Administrative Proceedings. Phy Health may disclose PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
• Law Enforcement Officials. Phy Health may disclose PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
• Uses or Disclosures Required By Law. Phy Health may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.

This Section V describes the circumstances pursuant to which Phy Health must obtain Participant’s written authorization to use or disclose PHI.

Phy Health only may use or disclose PHI when it receives a written authorization for such use or disclosure for any purpose other than the ones described above, and as described below.

• HIV/AIDS Related Information. Phy Health shall only disclose PHI related to HIV or AIDs with the express authorization of the Individual, and for those reasons listed above.
• Behavioral Health Information. Consistent with State and Federal laws, Phy Health will only disclose Behavioral Health Information pursuant to a valid written authorization. The confidentiality of alcohol and drug abuse Participant records maintained by Phy Health is protected by federal and state law and regulations. Phy Health may not disclose drug and alcohol medical records without a Participant’s written authorization.

• For Further Information; Complaints. Further information, concerns or complaints about Phy Health’s privacy practices, or about any violations of Participant privacy rights or disagreements with a decision that Phy Health made regarding access to PHI, should be addressed to the Phy Health Privacy Office, at the following address:

  Privacy Officer, PHY HEALTH
  Privacy@Phy.Health

  A Participant may also file written complaints with the Office of Civil Rights of the U.S. Department of Health and Human Services, at the following address:

  Office for Civil Rights
  https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html

  Or

  Centralized Case Management Operations
  U.S. Department of Health and Human Services
  200 Independence Avenue, S.W.
  Room 509F HHH Bldg.
  Washington, D.C. 20201

  Or, Email to OCRComplaint@hhs.gov

  Phy Health will not retaliate against any person who reports a privacy issue or files a complaint with the Director of OCR/HHS or with the Privacy Officer.

• Right to Request Restrictions. A Participant may request restrictions on Phy Health’s use and disclosure of PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by the Participant) involved with care or with payment related to care or to prevent or limit the notification of such individuals regarding a Participant’s location and general condition. While Phy Health will consider all requests for restrictions carefully, Phy Health is not required to agree to a requested restriction.
• Right to Receive Confidential Communications. A Participant may request, and Phy Health will accommodate, any reasonable written request to receive his or her PHI by alternative means of communication or at alternative locations. Requests should be made to the Privacy Office in writing.
• Right to Revoke Your Authorization. A Participant may revoke his or her Authorization, except to the extent that Phy Health have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified above.
• Right to Inspect and Copy Health Information. A Participant may request access to medical record files and billing records maintained by Phy Health, if any, in order to inspect and request copies of the records. Under limited circumstances, Phy Health may deny access to a portion of such records. Record requests must be made in writing to the Privacy Office. Phy Health will charge $1.00 per page, for the first 100 pages, and $0.25 per page after that, up to a maximum of $200.00 per record, plus postage costs if mailing is requested.
• Right to Amend Records. Each Participant has the right to request that Phy Health amend Protected Health Information maintained in Phy Health’s medical record file or billing records, by making such a request in writing to the Privacy Office. Phy Health will comply with such requests unless Phy Health believes that the amendment is inaccurate or would result in an inaccurate or incomplete record.
• Right to Receive An Accounting of Disclosures. Upon written request to the Privacy Office, Phy Health will provide a Participant with an accounting of certain disclosures of PHI made by Phy Health during any period of time prior to the date of said request to the Effective Date, provided such period does not exceed six years.
• Right to Receive Paper Copy of this Notice. Upon request, Phy Health will provide a paper copy of this Notice.

Phy Health offers exercise therapy services to assess, measure, analyze and remediate human posture, movement and performance. Phy Health coaches and professionals (hereinafter “Professionals”) may provide options for exercise programs to optimize human movement and performance provided in response to a wide range of human structure, movement and posture needs of individuals of all ages regardless of gender, color, ethnicity, creed, or disability.

I consent and authorize Phy Health, Inc. to provide:

• Services using remote telehealth technologies;
• Assessments and diagnoses using scans, analyses and other information derived using the Phy Solution;
• Guidance for remedial training exercises using the Phy Solution;
• Administration and performance of all relevant biometric testing using the Phy Solution;

I consent to, understand and agree that:

• I have the right to discuss the risks and benefits of all diagnoses and courses of therapy proposed by my Phy Health Professional, together with any available alternatives.
• Each Phy Health Professional is an independent contractor; Phy Health will not influence or interfere with the professional decision making and services offered by such Phy Health Professional.
• Each Phy Health Professional offers services and makes decisions regarding diagnosis and therapy in his or her sole discretion but makes no assurances or guarantees as to the results of Services.

By accessing Services through Phy Health, I agree to receive telehealth services. Telehealth involves the delivery of Phy Services, including assessment, therapy, diagnosis, and education, using interactive audio, video, and data communications. During my visit, my Phy Health Professional and I will be able to see and speak with each other from remote locations.

By consenting to telehealth encounters, I understand and agree that:

• I will not be in the same location or room as my Phy Health Professional accessed using telehealth modalities;
• My Phy Health Professional either will not be subject to professional licensure or will be licensed in the state in which I have indicated that I am currently located. I agree that I am solely responsible for accurately indicating my location accurately during registration.
• Potential benefits of telehealth (which are not guaranteed or assured) include: (i) access to Services without traveling to a Phy Health Professional’s office; (ii) more timely evaluation and management; and (iii) reduced exposure to other individuals, coaches, providers and other individuals at a physical location.
• Potential risks of telehealth include: (i) limited or no availability of diagnostic laboratory, x-ray, EKG, and other testing, to assist my Phy Health Professional in diagnosis and guidance and/or therapy; (ii) my Phy Health Professional’s inability to conduct a hands-on physical examination of me and my condition; and (iii) potential delays in evaluation and therapy due to technical difficulties or interruptions, distortion of diagnostic images or specimens resulting from electronic transmission issues, unauthorized access to my information, or loss of information due to technical failures. I will not hold Phy Health responsible for lost or inaccessible information due to technological failures.
• I further understand that my Phy Health Professional’s advice, recommendations, and/or decisions may be based on factors not within their control, including incomplete or inaccurate data provided by me. I understand that Phy Health Professional’s advice, recommendations, and/or decisions will be based on information provided by me before and during our telehealth encounter and that I must provide information about my medical history, condition(s), and current or previous medical care that is complete and accurate to the best of my ability.
• I may discuss these risks and benefits with my Phy Health Professional and will be given an opportunity to ask questions about telehealth services. I have the right to withdraw this consent to telehealth services or end the telehealth session at any time without affecting my right to future therapy through Phy Health.
• I understand that the level of care provided by my Phy Health Professional is to be the same level of care that is available to me through an in-person encounter to the extent possible. However, if my Phy Health Professional believes I would be better served by face-to-face services or another form of care, I will be referred to appropriate health care services.

In case of an emergency, I will dial 911 or go directly to the nearest hospital emergency room.

I hereby acknowledge and understand the inherent risks in all physical conditioning disciplines and activities such as suggested exercises, conditioning and use of technology (including but not limited to the Phy Solution) or exercise equipment utilized or recommended by Phy Health Professional (“Exercises”). I, and I alone, am responsible for reducing or stopping any exercise which causes me pain or which I cannot perform as instructed due to incapacity or for any other reason.

I accept any and all risks that may be caused by my performance of or poor execution of exercises, bad decision-making, inattention, misuse or failure of equipment and freakish accidents that cannot be foreseen.

• I accept all responsibilities and assume all risks with full knowledge and appreciation of the potential danger and risk involved. I recognize, agree and accept that there may be dangers and risks in performing the exercises, including the risk of serious personal injuries, paralysis, and death.
• I have no physical or mental condition that would compromise my safe execution of exercises suggested by Phy Health Professionals.
• I have consulted with a healthcare professional or accept the responsibility for not so consulting, and accept responsibility for being in adequate physical condition to engage in the Phy Health exercises.
• I am at least 18 years of age, or my parent or guardian shall co-sign this document.

I, for myself, my spouse, children, parents, siblings and any other family, heirs or assigns, knowingly and intentionally release, indemnify and hold harmless my Phy Health Professional, Phy Health, its officers, directors, employees, contractors and agents for any damage (including physical, mental, vocational, financial and otherwise), injury, bodily harm, death or any other loss of any kind whatsoever, including any and all actions, suits, claims, damages, and liability (including attorney fees and costs). which may result directly or indirectly from my receiving Phy Health Services or engaging in activities suggested by my Phy Health Professional.

I fully understand that this is given in advance of any specific diagnosis or therapy or of any Services. I intend this consent to be continuing in nature even after a specific diagnosis has been made and therapy recommended.

I understand that my Phy Health Professional and Phy Health, Inc. may rely upon this Participant Consent, Liability Waiver, and Authorization Form.

I, the undersigned, authorize Phy Health, Inc. to use, receive and disclose my information for the purposes of therapy, payment, and healthcare operations as described in the Phy Health Notice of Privacy Practices. I acknowledge that I have been given the opportunity to access and review the Phy Health, Inc. Notice of Privacy Practices. I understand that if I have questions or complaints that I should contact the Phy Health Privacy Officer.

Specifically, by executing this Consent and Authorization Form I knowingly authorize and intend to permit Phy Health, Inc. to:

• exchange information regarding my diagnosis and therapy, as well as images, analyses and recommendations with Phyxd, Inc. d/b/a Phy;
• use and release protected health information to other healthcare providers and to my health plan as necessary (unless I am paying for the services independently of the health plan), and to permit other healthcare providers and my health plan to release the necessary protected health information to Phy Health, Inc. and to my coach or health professional, as necessary for Treatment, Payment and Healthcare Operations.
• host or transmit my de-identified PHI to run (or authorize third parties to run) statistical or other research on individual or aggregate health or medical trends.

If I wish to deny access to my information to individuals or entities, I will send a written request via email to privacy@phy.health stating the names of those individuals or entities.

This authorization is valid 12 months from the date of acceptance. Confirmation of form opt-in on ActiveCampaign shall be considered as valid as an original signed waiver.

I certify that I have read and fully understand the above statements, consent and authorization fully and voluntarily to its contents.

• Effective Date. This Notice is effective on January 7th, 2022.
• Right to Change Terms of this Notice. Phy Health may change the terms of this Notice at any time. If Phy Health change this Notice, Phy Health may make the new notice terms effective for all Protected Health Information that Phy Health maintain, including any information created or received prior to issuing the new notice. Copies of any amended notice will be available from the Privacy Office.