Notice of Privacy Practices

Apple Medical Clinic, PLLC

d/b/a Apple Wellness Chiropractic Center and Winchester Spine & Injury

3038 Valley Avenue, Winchester, VA 22601 | (540) 545-7891

Effective Date: November 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.

Our Duties

Apple Medical Clinic, PLLC ("we," "us," or "our") is required by law to maintain the privacy of your protected health information ("health information"), to give you this Notice of our legal duties and privacy practices, and to notify you if a breach of your unsecured health information occurs. We must follow the terms of the Notice currently in effect. Health information is information that identifies you and relates to your past, present, or future physical or mental health, the care we provide to you, or payment for that care.

How We May Use and Disclose Your Health Information

The following categories describe ways we may use and disclose your health information without your written authorization. Not every use or disclosure in a category is listed.

Treatment. We may use and disclose your health information to provide, coordinate, or manage your care, including with physicians, physical therapists, imaging centers, and other providers involved in your care.

Payment. We may use and disclose your health information to bill and collect payment for our services from you, your health insurer, an automobile or personal injury insurer, a workers’ compensation carrier, or another responsible party. For example, we may send treatment records to an insurer to obtain payment for care following an auto injury.

Health Care Operations. We may use and disclose your health information for our business operations, such as quality assessment, staff training, licensing and accreditation, audits, legal services, and business planning.

Appointment Reminders and Health-Related Services. We may contact you by telephone, voicemail, text message, email, or mail to remind you of appointments or to tell you about treatment alternatives or health-related services we offer.

Business Associates. We may share your health information with vendors that perform services for us, such as billing, technology, and scheduling providers. We require each business associate, by written agreement, to protect your information.

Individuals Involved in Your Care. We may share health information with a family member, friend, or other person you identify who is involved in your care or payment for your care, unless you object. If you are unable to agree or object, we may share information we believe is in your best interest, using our professional judgment.

As Required by Law. We will disclose your health information when federal, state, or local law requires it.

Public Health and Safety. We may disclose health information to prevent or control disease, injury, or disability; to report suspected abuse, neglect, or domestic violence as permitted or required by law; to report adverse events involving products; and to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Health Oversight. We may disclose health information to agencies that oversee the health care system, such as for audits, investigations, inspections, and licensure.

Lawsuits and Legal Proceedings. We may disclose health information in response to a court or administrative order, or in response to a subpoena or other lawful process when the requirements of law are met.

Law Enforcement. We may disclose health information to law enforcement officials for certain purposes permitted by law, such as identifying a suspect, fugitive, material witness, or missing person, or reporting a crime on our premises.

Coroners, Medical Examiners, and Funeral Directors. We may disclose health information to these individuals as needed for them to carry out their duties.

Organ and Tissue Donation. We may disclose health information to organizations that handle organ, eye, or tissue donation.

Research. We may use or disclose health information for research when the use or disclosure is approved under the privacy protections required by law.

Military, National Security, and Correctional Institutions. We may disclose health information of armed forces personnel to military authorities as required, to authorized federal officials for national security and intelligence activities, and to a correctional institution or law enforcement official having lawful custody of an inmate.

Workers’ Compensation. We may disclose health information as authorized by workers’ compensation laws and similar programs.

Uses and Disclosures That Require Your Written Authorization

We will obtain your written authorization before we use or disclose your health information for marketing purposes (except face-to-face communications and promotional gifts of nominal value), before we sell your health information, and for most uses and disclosures of psychotherapy notes, if any exist. Any other use or disclosure not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time by writing to us, except to the extent we have already acted in reliance on it.

If we receive substance use disorder treatment records protected by 42 C.F.R. Part 2, we will not use or disclose those records, or testimony about their content, in any civil, criminal, administrative, or legislative proceeding against you unless you give written consent or a court issues an order that meets the requirements of Part 2 and is accompanied by a subpoena or similar legal requirement.

Where Virginia law provides greater protection for your health information than federal law, we will follow Virginia law.

Your Rights Regarding Your Health Information

Right to Access and Copies. You may ask to inspect or obtain a paper or electronic copy of your health information, with limited exceptions. Requests must be made in writing. We will respond within 30 days and may charge a reasonable, cost-based fee as permitted by federal and Virginia law. You may also direct us to send a copy to another person you designate.

Right to Request Amendment. If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it. We may deny your request in certain circumstances, and we will explain the reason in writing within 60 days.

Right to an Accounting of Disclosures. You may request a list of certain disclosures we made of your health information during the six years before your request, other than disclosures for treatment, payment, and health care operations and certain other disclosures. We will provide one accounting a year free of charge and may charge a reasonable, cost-based fee for additional requests within 12 months.

Right to Request Restrictions. You may ask us to limit how we use or disclose your health information for treatment, payment, or health care operations. We are not required to agree, except that we must agree to a request not to disclose information to your health plan about services you paid for in full out of pocket, unless the law requires the disclosure.

Right to Request Confidential Communications. You may ask us to contact you in a specific way (for example, only by cell phone) or at a specific address. We will accommodate all reasonable requests and will not ask you why.

Right to a Paper Copy of This Notice. You may ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Right to Choose Someone to Act for You. If you have given someone medical power of attorney, or someone is your legal guardian, that person may exercise your rights and make choices about your health information.

To exercise any of these rights, please contact our office using the information at the end of this Notice.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for all health information we already have and any information we receive in the future. The current Notice will be posted in our office and on our website at www.winchestergethealthy.com, and copies will be available at our office upon request.

Questions and Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

For questions about this Notice or to file a complaint with us, contact our Privacy Officer:

Privacy Officer: Michael A. Pasternack, D.C.
Apple Medical Clinic, PLLC
3038 Valley Avenue
Winchester, VA 22601
Telephone: (540) 545-7891
Fax: (540) 545-7893
Email: applewellness3038@aol.com

Acknowledgment of Receipt

I acknowledge that I received a copy of the Apple Medical Clinic, PLLC Notice of Privacy Practices.

Patient Name: ________________________________________

Signature (Patient or Personal Representative): ____________________________ Date: ______________

If signed by a personal representative, relationship to patient: ____________________________

For office use: If acknowledgment could not be obtained, describe good-faith efforts made and the reason: ______________________________________________________________