QUALITY IN-HOME THERAPY, INC.
6000 NW 61st St, Parkland, FL 33067
Phone: (954) 593-1735
Website: www.qualityinhometherapy.com NPI: 1790442937

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.

Effective Date: February 12, 2026

I. OUR COMMITMENT TO YOUR PRIVACY

Quality In-Home Therapy, Inc. (“the Practice”), owned and operated by Dr. Vincenzo Bombara, DPT, GCS, MBA, is committed to protecting the privacy and security of your Protected Health Information (“PHI”). We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the Health Information Technology for Economic and Clinical Health Act (“HITECH”), and Florida Statutes §456.057 to:

• Maintain the privacy and security of your PHI;
• Provide you with this Notice of Privacy Practices (“Notice”) explaining our legal duties and privacy practices with respect to your PHI;
• Notify you in the event of a breach of your unsecured PHI; and
• Abide by the terms of this Notice currently in effect.

II. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

We may use and disclose your PHI without your written authorization for the following purposes:

A. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. Example: Dr. Bombara may share your treatment plan and progress notes with your referring physician, specialist, or other healthcare provider involved in your care to ensure coordinated treatment.

B. Payment

We may use and disclose your PHI to bill and collect payment for the services we provide to you. Example: We may send your insurance company or Medicare/Medicaid a claim that includes your diagnosis, treatment dates, and procedure codes so that we may be reimbursed for the in-home physical therapy services provided to you.

C. Healthcare Operations

We may use and disclose your PHI for activities that support the operation of our practice and to ensure that our patients receive quality care. Example: We may use your PHI to conduct quality assessment activities, review the competence of our staff, or conduct compliance and training programs.

D. As Required by Law

We may use or disclose your PHI when required to do so by federal, state, or local law, including but not limited to:

• Public Health Activities: Reporting disease, injury, vital events, or conducting public health surveillance as required by the Florida Department of Health (Fla. Stat. §§384.25, 392.53, 385.202);
• Health Oversight Activities: Disclosures to health oversight agencies for audits, investigations, inspections, and licensure activities, including the Florida Agency for Health Care Administration (AHCA);
• Abuse, Neglect, or Domestic Violence: Reporting suspected child abuse, abandonment, or neglect to the Department of Children and Families (DCF) Central Abuse Hotline as required under Fla. Stat. §39.201, and reporting suspected abuse, neglect, or exploitation of vulnerable adults under Fla. Stat. §415.1034;
• Judicial and Administrative Proceedings: In response to a court order, subpoena, or other lawful process, subject to the requirements of 45 CFR §164.512(e) and Florida law;
• Law Enforcement Purposes: To comply with court orders, warrants, or other lawful requests as permitted under 45 CFR §164.512(f), and in accordance with the stricter requirements of Fla. Stat. §456.057(7)(a), which generally requires written patient authorization for disclosure;
• Coroners, Medical Examiners, and Funeral Directors: To assist in identification of a deceased person or to determine cause of death as permitted under Fla. Stat. §406.12;
• Workers’ Compensation: As authorized by and necessary to comply with workers’ compensation laws;
• Serious Threats to Health or Safety: When we believe in good faith that disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public (45 CFR §164.512(j));
• Military and Veterans Activities, National Security, and Protective Services: As required by applicable law.

E. Substance Use Disorder (SUD) Records

In compliance with the updated HIPAA Privacy Rule effective February 16, 2026, if we create, receive, maintain, or transmit records protected under 42 CFR Part 2 relating to substance use disorder treatment, such records are subject to additional federal confidentiality protections. Uses and disclosures of Part 2 information may be subject to stricter limitations than other PHI. SUD records or testimony relating to them may not be used in any civil, administrative, criminal, or legislative proceeding against you without your explicit written consent or a court order. You have specific rights related to the protection of your SUD records, including the right to revoke consent previously given.

F. Individuals Involved in Your Care or Payment for Your Care

We may disclose your PHI to a family member, other relative, close personal friend, or any other person you identify who is involved in your care or payment for your care. We will provide you with an opportunity to agree or object to such disclosures. If you are incapacitated or in an emergency, we may disclose information as necessary if we determine it is in your best interest based on our professional judgment.

G. Appointment Reminders and Health-Related Communications

We may use and disclose your PHI to contact you to remind you of appointments or to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

H. Incidental Disclosures

We maintain policies and procedures to protect your PHI and limit how we use and share it. Certain limited, incidental disclosures may occur as a by-product of otherwise permitted uses and disclosures, provided we have applied reasonable safeguards.

III. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, including but not limited to:

• Marketing: Most uses and disclosures of your PHI for marketing purposes;
• Sale of PHI: Any sale or exchange of your PHI for remuneration;
• Psychotherapy Notes: Most uses and disclosures of psychotherapy notes, if applicable;
• Other Uses: Any other use or disclosure not described in this Notice.

You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance upon your authorization. To revoke an authorization, please submit your request in writing to our Privacy Officer at the address listed below.

IV. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights with respect to your PHI:

A. Right to Access

You have the right to inspect and obtain a copy of your PHI maintained in a designated record set, including in electronic form if maintained electronically, subject to applicable fees. We will respond to your request within thirty (30) days, or within sixty (60) days if an extension is necessary. Under Florida law (Fla. Stat. §456.057), you are also entitled to a copy of your medical records upon written request.

B. Right to Amend

You have the right to request an amendment to your PHI if you believe the information is incorrect or incomplete. We may deny your request under certain circumstances and will provide you with a written explanation.

C. Right to an Accounting of Disclosures

You have the right to request a list (accounting) of certain disclosures of your PHI that we have made, other than disclosures for treatment, payment, healthcare operations, and certain other exceptions. Your request may cover disclosures made up to six (6) years prior to the date of your request.

D. Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to all restrictions, but we must comply with any restriction to which we agree. We are required to agree to restrict disclosures to a health plan for payment or healthcare operations purposes if the disclosure relates to services for which you have paid out of pocket in full.

E. Right to Request Confidential Communications

You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. For example, you may request that we contact you only at your home telephone number or by mail to a specific address.

F. Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have previously received a copy or agreed to receive this Notice electronically. You may request a paper copy by contacting our Privacy Officer.

G. Right to Be Notified of a Breach

You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of your unsecured PHI, in accordance with the HIPAA Breach Notification Rule (45 CFR §§164.400-414).

V. FLORIDA-SPECIFIC PATIENT RIGHTS

Under Florida law (Fla. Stat. §456.057), you have additional rights regarding your medical records, including:

• Medical records may not be furnished to, and your medical condition may not be discussed with, any person other than you, your legal representative, or other healthcare practitioners involved in your care, except upon your written authorization (Fla. Stat. §456.057(7)(a));
• All records owners shall develop and implement policies, standards, and procedures to protect the confidentiality and security of patient medical records (Fla. Stat. §456.057(11));
• You have the right to obtain a copy of your medical records at a reasonable cost as specified by Florida law.

VI. OUR DUTIES

We are required to:

• Maintain the privacy and security of your PHI as required by HIPAA, HITECH, and applicable Florida law;
• Provide you with this Notice of our legal duties and privacy practices;
• Notify you following a breach of unsecured PHI;
• Abide by the terms of this Notice currently in effect;
• Not use or disclose your PHI in a manner that is not consistent with this Notice without your written authorization.

We reserve the right to change the terms of this Notice and to make the new provisions effective for all PHI that we maintain. If we make a material change to this Notice, a revised Notice will be made available upon request and posted on our website at www.qualityinhometherapy.com.

VII. REDISCLOSURE

Information disclosed pursuant to HIPAA may be subject to redisclosure by the recipient and may no longer be protected by federal privacy rules. However, substance use disorder records disclosed under 42 CFR Part 2 carry additional redisclosure restrictions.

VIII. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

Quality In-Home Therapy, Inc. — Privacy Officer 6000 NW 61st St Parkland, FL 33067 Phone: (954) 593-1735

U.S. Department of Health and Human Services (HHS) Office for Civil Rights Sam Nunn Atlanta Federal Center, Suite 16T70 61 Forsyth Street, S.W. Atlanta, GA 30303-8909 Phone: (800) 368-1019 Website: www.hhs.gov/ocr/privacy/hipaa/complaints

You will not be retaliated against for filing a complaint.

IX. CONTACT INFORMATION

Privacy Officer: Dr. Vincenzo Bombara, DPT, GCS, MBA Quality In-Home Therapy, Inc. 6000 NW 61st St Parkland, FL 33067 Phone: (954) 593-1735 Website: www.qualityinhometherapy.com

This Notice of Privacy Practices is provided in accordance with 45 CFR §164.520, the HIPAA Privacy Rule, the HITECH Act, 42 CFR Part 2 (as amended effective February 16, 2026), and Florida Statutes §456.057.

Patient Acknowledgment: By signing below, I acknowledge that I have received a copy of this Notice of Privacy Practices.