Notice of Privacy Practices

Effective Date: August 2024

Your Information. Your Rights. Our Responsibilities.
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights 
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You can obtain a request form for all of the following Rights by emailing us at [email protected]

Get an electronic or paper copy of your record

• You can ask to see or get an electronic or paper copy of your record and other health information we have about you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your record

• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Get a list of those with whom we’ve shared information

• You can ask for a list (“Accounting”) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one Accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We call this person a “personal representative”.
• We will make sure the personal representative has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting us using the information on page 5.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints.
• We will not retaliate against you for filing a complaint.

Your Choices

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a clinic directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Authorizations
Except for where the law permits, in these cases we never share your information unless you give us written permission (“Authorization”):

• Marketing purposes
• Sale of your information
• Research

If you give authorization but later decide you don’t want us to use or share this information, you may revoke authorization by emailing [email protected]. The revocation is considered effective upon our receipt of your complete request, and does not retroactively apply to actions we take prior to receiving the revocation. Additionally, even if you revoke authorization for research, we may continue to use or share PHI already obtained under a valid authorization, to preserve the integrity of a research study.

Our Uses and Disclosures
How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you
We can use your health information and share it with other professionals treating you.
Example: Your speech therapist asks your BCBA about the communication skills you’re working on.

Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?
We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues
We can share health information about you for certain situations such as:

• Preventing disease
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions, such as military or national security

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• We are required by law to:
• • • Maintain the privacy and security of your protected health information.
    • Provide you with a notice of our legal duties and privacy practices with respect to protected health information.
    • Notify you if a breach occurs that may have compromised the privacy or security of your information.
    • Follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to Our Privacy Practices and the Terms of this Notice
We can change our privacy practices and the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Contact Information
HIPAA Officer: [email protected]
Complaint Form: forms.office.com/r/5kbqEFnWT0
Anonymous Reporting Voicemail: 732-800-0053 ext. 555