HIPPA Notice of Privacy Practices

Effective Date: 2/15/26

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Fulcrum All-Terrain Therapeutic Services, LLC (“Fulcrum”) is required by law to protect the privacy of your Protected Health Information (PHI) and to provide you with this Notice describing our legal duties and privacy practices.

Protected Health Information (PHI) includes information that identifies you and relates to your past, present, or future physical or mental health condition, the provision of health care services, or payment for those services.

Our Legal Duties

We are required by law to:

Maintain the privacy of your PHI
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Notify you if a breach of your unsecured PHI occurs

We reserve the right to revise this Notice. Any changes will apply to all PHI maintained by Fulcrum. Updated versions will be posted on our website.

How We May Use and Disclose Your PHI:

1. For Treatment - We may use and disclose your PHI to provide, coordinate, or manage your care.
Example: Consulting with another healthcare provider involved in your treatment.

2. For Payment - We may use and disclose PHI to obtain payment for services.
Example: Processing payment through Square or providing documentation if you request reimbursement through an HSA.

3. For Health Care Operations - We may use PHI for practice management, quality review, legal consultation, or compliance purposes.

Uses and Disclosures That Do Not Require Authorization

We may disclose PHI without your written authorization when required or permitted by law, including:

Suspected child abuse or neglect (Wisconsin mandated reporting)
Suspected abuse of vulnerable adults
Serious threat of harm to yourself or others
Court orders or lawful subpoenas
Public health reporting requirements
Health oversight activities
Law enforcement as required by law

Uses That Require Your Authorization

Any other use or disclosure not described above requires your written authorization. You may revoke authorization in writing at any time, except where action has already been taken.

Your Rights Regarding Your PHI

You have the right to:

Access Your Records - Request access to or copies of your PHI. Requests must be made in writing. We may charge a reasonable fee as permitted by law.
Request Amendments - Request corrections to your PHI if you believe information is inaccurate or incomplete.
Request Restrictions - Request limitations on how your PHI is used or disclosed. We will consider your request but are not required to agree.
Request Confidential Communications - Request that we contact you at a specific address or by specific means (e.g., email instead of phone).
Receive an Accounting of Disclosures - Request a list of certain disclosures made in the past six (6) years, excluding disclosures for treatment, payment, and healthcare operations.
Receive a Copy of This Notice - You may request a paper or electronic copy at any time.

Telehealth and Electronic Communications

Fulcrum provides services via Zoom. While we take reasonable steps to ensure secure communication, electronic transmission carries inherent risks. By engaging in telehealth services, you acknowledge these risks.

How to File a Complaint

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

Fulcrum All-Terrain Therapeutic Services, LLC
D’Angelo Capriglione

madcityfulcrum@gmail.com

(608) 618-6552

You may also file a complaint with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
www.hhs.gov/ocr

You will not be retaliated against for filing a complaint.

Have more questions?

You can always message us using the "Contact Us" button at the bottom of your screen.