KIDSPEECH, INC. NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE INFORMAITON.
PLEASE REVIEW THIS NOTICE CAREFULLY. A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment/services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:
How we may use and disclose your IIHI
Your privacy rights in your IIHI
Our obligations concerning the use and disclosure of your IIHI
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all your records that our practice has created or maintained in the past, and for any records that we may create or maintain in the future. Our practice will post a copy of our current Notice in the office waiting area at all times, and you may request a current copy at any time.
Our privacy officer is: Kristin R. Hall
B. WE MAY USE AND DISCLOSE YOUR (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your IIHI:
1. TREATMENT. Our practice may use your IIHI to treat you. For example, we may ask you to complete a medical information questionnaire and we may use the information to help us reach a diagnosis. We may use the IIHI to obtain prescriptions for therapy services, or we might disclose your IIHI to obtain a treatment plan. Many of the people who work for our practice including, but not limited to, therapists, executive officers, and owners- may disclose your IIHI in order to treat you or to assist others in treating you. For example, when we need to refer to an ENT, Oral Surgeon, or consult with a service coordinator, social worker, or other healthcare professional. Additionally, we may disclose your IIHI to others who may assist in your care, such as parent, legal guardian, or caregiver.
2. PAYMENT. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer, Medicaid, or Babies Can’t Wait to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for our services. We also may use your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and equipment. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.
3. OPERATIONS. Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your IIHI for our operations, our practice may use it to evaluate the quality of care you received from us, or to conduct cost management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.
4. HEALTH-RELATED BENEFITS and SERVICES. Our practice may use and disclose your IIHI to inform you of health-related services that may be of interest to you.
5. DISCLOSURES REQUIRED BY LAW. Our practice will use and disclose your IIHI when we are requested to do so by federal, state, or local law or upon any audits conducted by the federal, state, or local governmental agencies.
C. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your IIHI:
1. PUBLIC HEALTH RISKS. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of reporting child abuse or neglect.
2. HEALTH OVERSIGHT ACTIVITIES. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions: civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with the civil rights laws and the health care system in general.
3. LAWSUIS AND SIMILAR PROCEDURES. Our practice may use or disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the third party has requested.
4. LAW ENFORCEMENT. We may release IIHI if asked to do so by a law enforcement official:
Regarding a crime victim in certain situations, if we are unable to obtain a person’s agreement
Regarding criminal conduct at our office
In response to a warrant, summons, court order, subpoena, or similar legal process
In an emergency, to report a crime (including the location or victim of a crime, or the description, identity, or location of the perpetrator)
5. RESEARCH. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: the use or disclosure involves no more than a minimal risk to your privacy based on the following: A) an adequate plan to protect the identifiers from improper use and disclosure; B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research ( unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study.
6. EDUCATIONAL PURPOSES. Occasionally we use our facility in training opportunities. In these instances we may use or disclose minimal necessary information to interns, students, or volunteers in limited circumstances. You may request restriction of release to these entities by a written request to our privacy officer.
7. SERIOUS THREATS TO HEALTH OR SAFTEY. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
D. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain about you:
1. CONFIDENTIAL COMMUNICATION. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the security officer.
2. REQUEST RESTRICTIONS. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment, or operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree with your request; however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in written form to the security officer listed above. Your request must describe in a clear and concise fashion;
(a) the information you wish to be restricted (b) whether you are requesting to limit our practice’s use, disclosure or both, and (c) to whom you want the limits to apply.
3. INSPECTION and COPIES. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must summit your request in written form to the company’s security officer.
4. ACCOUNTING and DISCLOSURE. All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has make of your IIHI for non-treatment, non-payment, or non-operational purposes. Use of your IIHI as a part of the routine patient care in our practice is not required to be documented. For example, the therapist sharing information with our billing personnel in order to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your written request to the company security officer.
5. RIGHT to a PAPER COPY of THIS NOTICE. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact the privacy officer or office manager.
6. RIGHT to FILE a COMPLAINT. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Kristin Hall at 678-377-2833. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
7. RIGHT to PROVIDE an AUTHORIZATION for OTHER USES and DISCLOSURES. Our practice will obtain your written authorization for uses and disclosures that are not identified in the notice or permitted by the applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reason described in the authorization. Please note we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Kristin Hall at 678-377-2833.
As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE INFORMAITON.
PLEASE REVIEW THIS NOTICE CAREFULLY. A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment/services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all your records that our practice has created or maintained in the past, and for any records that we may create or maintain in the future. Our practice will post a copy of our current Notice in the office waiting area at all times, and you may request a current copy at any time.
Our privacy officer is: Kristin R. Hall
545 Old Norcross Road
Suite 100
Lawrenceville, GA 30046
678-377-2833
B. WE MAY USE AND DISCLOSE YOUR (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your IIHI:
1. TREATMENT. Our practice may use your IIHI to treat you. For example, we may ask you to complete a medical information questionnaire and we may use the information to help us reach a diagnosis. We may use the IIHI to obtain prescriptions for therapy services, or we might disclose your IIHI to obtain a treatment plan. Many of the people who work for our practice including, but not limited to, therapists, executive officers, and owners- may disclose your IIHI in order to treat you or to assist others in treating you. For example, when we need to refer to an ENT, Oral Surgeon, or consult with a service coordinator, social worker, or other healthcare professional. Additionally, we may disclose your IIHI to others who may assist in your care, such as parent, legal guardian, or caregiver.
2. PAYMENT. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer, Medicaid, or Babies Can’t Wait to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for our services. We also may use your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and equipment. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.
3. OPERATIONS. Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your IIHI for our operations, our practice may use it to evaluate the quality of care you received from us, or to conduct cost management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.
4. HEALTH-RELATED BENEFITS and SERVICES. Our practice may use and disclose your IIHI to inform you of health-related services that may be of interest to you.
5. DISCLOSURES REQUIRED BY LAW. Our practice will use and disclose your IIHI when we are requested to do so by federal, state, or local law or upon any audits conducted by the federal, state, or local governmental agencies.
C. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your IIHI:
1. PUBLIC HEALTH RISKS. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of reporting child abuse or neglect.
2. HEALTH OVERSIGHT ACTIVITIES. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions: civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with the civil rights laws and the health care system in general.
3. LAWSUIS AND SIMILAR PROCEDURES. Our practice may use or disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the third party has requested.
4. LAW ENFORCEMENT. We may release IIHI if asked to do so by a law enforcement official:
5. RESEARCH. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following: the use or disclosure involves no more than a minimal risk to your privacy based on the following: A) an adequate plan to protect the identifiers from improper use and disclosure; B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research ( unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study.
6. EDUCATIONAL PURPOSES. Occasionally we use our facility in training opportunities. In these instances we may use or disclose minimal necessary information to interns, students, or volunteers in limited circumstances. You may request restriction of release to these entities by a written request to our privacy officer.
7. SERIOUS THREATS TO HEALTH OR SAFTEY. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
D. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain about you:
1. CONFIDENTIAL COMMUNICATION. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the security officer.
2. REQUEST RESTRICTIONS. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment, or operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree with your request; however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in written form to the security officer listed above. Your request must describe in a clear and concise fashion;
(a) the information you wish to be restricted (b) whether you are requesting to limit our practice’s use, disclosure or both, and (c) to whom you want the limits to apply.
3. INSPECTION and COPIES. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must summit your request in written form to the company’s security officer.
4. ACCOUNTING and DISCLOSURE. All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has make of your IIHI for non-treatment, non-payment, or non-operational purposes. Use of your IIHI as a part of the routine patient care in our practice is not required to be documented. For example, the therapist sharing information with our billing personnel in order to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your written request to the company security officer.
5. RIGHT to a PAPER COPY of THIS NOTICE. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact the privacy officer or office manager.
6. RIGHT to FILE a COMPLAINT. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Kristin Hall at 678-377-2833. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
7. RIGHT to PROVIDE an AUTHORIZATION for OTHER USES and DISCLOSURES. Our practice will obtain your written authorization for uses and disclosures that are not identified in the notice or permitted by the applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reason described in the authorization. Please note we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies, please contact Kristin Hall at 678-377-2833.
