Notice of Privacy Practices

Effective date: November 4, 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.

This Notice applies to Internet Physical Therapy, a service of Dr. Kareem F. Samhouri Fitness LLC (“we” or “us”), and to everyone on our team who provides or supports your physical therapy. We are required by law to protect the privacy of your health information, to give you this Notice of our legal duties and privacy practices, and to follow the Notice that is currently in effect.

Your rights

When it comes to your health information, you have certain rights. To use any of them, contact us using the details at the end of this Notice.

• Get a copy of your medical record. You can ask to see or get a copy of your medical record and other health information we have about you, on paper or electronically. We will provide it, usually within 30 days of your request, and may charge a reasonable, cost-based fee.
• Ask us to correct your record. You can ask us to correct health information that you think is incorrect or incomplete. We may say “no,” but we will tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way (for example, by mobile phone or by email) or at a different address. We will say “yes” to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say “no” if it would affect your care. If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations, and we will say “yes” unless a law requires us to share it.
• Get a list of those with whom we’ve shared information. You can ask for a list (accounting) of the times we’ve shared your health information for six years before the date you ask, who we shared it with, and why. It will include all disclosures except those about treatment, payment and health care operations, and certain others (such as any you asked us to make). We provide one list a year free and may charge a reasonable, cost-based fee for another within 12 months.
• Get a copy of this Notice. You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will check that the person has this authority before we take any action.
• File a complaint if you feel your rights are violated. You can complain to us using the contact details below, or to the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, tell us what you want us to do, and we will follow your instructions.

• In these cases, you have both the right and choice to tell us to share information with your family, close friends or others involved in your care, and to share information in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
• In these cases, we never share your information unless you give us written permission: marketing purposes and sale of your information.
• We do not raise funds, so we will not contact you for fundraising.

Our uses and disclosures

We typically use or share your health information in the following ways.

• To treat you. We use your health information and share it with other professionals who are treating you. Example: your physical therapist reviews your intake forms and visit notes to plan your exercises, or shares information with your doctor when you ask us to or when it is needed for your care.
• To run our practice. We use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use your information to schedule visits, send appointment reminders, and review the quality of our care.
• To bill for our services. We use your health information to take payment and to prepare receipts. Example: we give you an itemized receipt (superbill) when you ask for one so you can submit it yourself.

Business associates. We use service providers to help us, such as Jane (our scheduling, payment, records and video visit platform). They may receive your health information only to do work for us, and they must sign an agreement to protect it.

How else can we use or share your health information? We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

• Help with public health and safety issues, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
• Do research, under the conditions the law sets.
• Comply with the law, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director.
• Address workers’ compensation, law enforcement and other government requests: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security and presidential protective services.
• Respond to lawsuits and legal actions, such as in response to a court or administrative order, or to a subpoena.

Other uses need your written permission. We will not use or share your information in any way not described in this Notice unless you give us written permission. If you give it, you may change your mind at any time by letting us know in writing; this won’t affect anything we already did with your permission.

State law. Where the law of Arizona, Pennsylvania or another state where you receive care gives your information more protection than federal law (for example, for certain sensitive information), we follow the stricter law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• 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 information other than as described here unless you tell us we can in writing.

For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the terms of this Notice

We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available on request, on our website, and in our patient portal.

Contact our Privacy Officer

Our Privacy Officer is Dr. Kareem Samhouri, PT, DPT.

Dr. Kareem F. Samhouri Fitness LLC
Internet Physical Therapy
53 Pinon Ct, Sedona, AZ 86336
Phone: 855-375-2733
Email: support@internetphysicaltherapy.com