Effective September 01, 2005
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how I may use or disclose your child’s protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and or refuse the release of specific information outside of my system except when the release is required or authorized by law or regulation.
Acknowledgement of Receipt of this Notice
You will be asked to provide a signed acknowledgment of receipt of this notice. The intent is to make you aware of the possible uses and disclosures of your child’s protected health information and your privacy rights. The delivery of your child’s health care services will in no way be conditioned upon your signed acknowledgment.
My Responsibility Regarding Protected Health Information
Your child’s ‘protected health information’ is individually identifiable health information. This includes demographics such as age, address, email address, and relates to your child’s past, present, or future physical or mental health or condition and related health care services. We are required by law to do the following:
I reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. I reserve the right to make the revised or changed notice effective for health information I already have about your child as well as any information we receive in the future. You may obtain a Notice of Privacy Practices.
Your child’s health information will be shared in the following manner:
Required by Law
I may use or disclose your child’s protected health information if law or regulation requires the use or disclosure.
I will notify the appropriate government authority if I believe a patient has been the victim of abuse, neglect, or domestic violence.
I may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.
I may disclose your child’s protected information to parents, guardians and persons acting in similar legal status.
Uses and Disclosures of Protected Health Information Requiring Your Permission
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your child’s protected health information.
Since my therapies are provided in your home or other natural environments, those present during the session, including friends, family, or day care providers may hear health information regarding your child. Please notify me if you do not want your child’s protected health information to be discussed.
Your Rights Regarding Your Child’s Health Information
You may exercise the following rights by submitting a written request.
Federal Privacy Laws
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act and the Privacy Act. These laws have been taken into consideration in developing my policies and this notice of how I will use and disclose your child’s protected information.
If you believe these privacy rights have been violated, you may file a written complaint with the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.
This notice is effective in its entirety as of September 01, 2005.