1. HIPAA Privacy Notice
Describes how personal health information (PHI) is used, disclosed, and protected.

Uses & Disclosures of PHI

• Treatment (sharing info with providers)

• Payment (billing or communicating with insurer)

• Healthcare operations (admin tasks, quality improvement)

• All other disclosures require written authorization

Your Rights Under HIPAA

• Access and review records

• Request corrections or amendments

• Receive an accounting of disclosures

• Submit restrictions on how PHI is used or shared

• Request confidential communication (specific address or phone)

• Request no insurer disclosure for self-paid services

• Designate a personal representative

• Receive updated versions if practices change

Our Responsibilities

• Maintain privacy and security of PHI

• Notify clients if a breach occurs

• Follow stated duties and privacy practices

• Use/disclose info only as described unless authorized in writing

Privacy Officer Contact
Rue Khosa, ARNP, FNP-BC, IBCLC – HIPAA Privacy Officer
Phone: (945) 218-5688

Privacy Complaints

• Contact Rue Khosa directly

• Or file with the Office for Civil Rights, U.S. Dept. of Health & Human Services
  Phone: 1-800-368-1019 | Website: https://www.hhs.gov/ocr

• No penalties for filing a complaint

 

2. Unsecured Communication Policy

• Secure portal and telehealth are preferred.

• Clients who choose email, text, or third-party apps acknowledge the risks.

• Clients accept full responsibility and hold The Perfect Push harmless for any resulting breach.

 

3. Consent to Share Information & Documentation

• All notes stored securely in a HIPAA-compliant portal.

• Clients may opt in/out of:

  • Use of notes for personalized care

  • Documentation for personal/family reflection

  • Anonymized use of notes for education or certification

• Consent gathered at intake.

 

4. COVID-19 Liability Waiver

Health & Safety Guidelines

• TPP staff: avoid in-person visits if symptomatic, sanitize hands, wear masks on request, offer virtual options.

• Clients: notify TPP of symptoms, agree to reschedule or switch to virtual, follow safety measures.

Illness Policy

• Services may be postponed or virtual if symptoms such as fever, cough, sore throat, loss of taste/smell, GI issues, or congestion are present.

Assumption of Risk & Release of Liability

• Clients acknowledge the inherent risk of in-person care and release TPP, its employees, and contractors from liability.

Indemnification

• Clients agree to hold TPP harmless for any claims related to in-person care or staff presence in the home.

Governing Law

• This waiver is governed by the laws of Texas.

Voluntary Agreement

• Clients confirm participation is voluntary and may decline services with a refund if uncomfortable.

• Failure to follow health protocols may result in forfeiture of services and fees.

Interpretation & Severability

• If any provision is invalid, the rest remains enforceable.

 

5. Consent & Acknowledgment
By signing the service agreement and intake forms, clients:

• Confirm they have read and understood the notice

• Agree to its terms and conditions

• Accept responsibility for communication methods and participation in care

 

6. Severability

If any provision of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

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I HAVE READ AND UNDERSTOOD THIS AGREEMENT. I ACKNOWLEDGE THAT BY SIGNING BELOW, I VOLUNTARILY WAIVE CERTAIN LEGAL RIGHTS.