HIPAA POLICY & NOTICE OF PRIVACY PRACTICES
EFFECTIVE OCTOBER 1, 2023
For the purpose of this Agreement, the terms “Client” and “Patient” mean the parent or legal guardian signing this Agreement as well as the child for whom they are signing. Pronouns “I, you, me, my, your” shall be interpreted in reference to the Client/Patient.
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. The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. HIPAA provides penalties for covered entities that misuse personal health information.
HOW YOUR HEALTH INFORMATION MAY BE USED OR SHARED
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information. We may use or share your health information both with and without your permission, depending on the circumstances.
Treatment: Treatment means providing, coordinating, or managing health care and related services, by one or more healthcare providers. For example, we may share information with other healthcare providers who care for you.
Payment: Payment means activities such as sending you an invoice, obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review.
Healthcare Operations: We may use and share your health information to run our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, business management, general administrative activities of the entity, etc.
Abuse and Neglect: We may share your health information with government agencies when there is evidence of abuse, neglect, or domestic violence.
Appointment Reminders: We may use your information to remind you of upcoming appointments. Reminders may be sent by email, text message, phone call, or voicemail message. If you do not wish to get reminders, please tell your speech-language pathologist.
As Required by Law: We will share your information when we are told to do so by federal, state, or local law. We will also share information if we are asked by the police or courts.
Government Functions: Your information may be shared for national security or military purposes.
Information About a Person Who Has Died: We may share information with the coroner, the medical examiner, or a funeral director, as needed.
Marketing: We may use your information to let you know of other services that might be of interest to you.
Public Health Risks: We may report information to public health agencies as required by law. This may be done to help prevent disease, injury, or disability. It may also be done to report medical device safety issues to the Food and Drug Administration and to report diseases and infections.
Regulatory Oversight: We may use or share your information to report to agencies overseeing health care. This may include sharing information for audits, licensure, and inspections.
Research: We may share your health information with researchers to be included in their research project. Information will be shared only for projects that have been through a special approval process. These projects have rules to protect your privacy, too.
Threats to Health and Safety: Your health information may be shared if it is believed that this information will prevent a threat to your or others’ health and safety.
Workers’ Compensation: We will share your information with the U.S. Department of Labor’s Office of Workers’ Compensation if your case is being considered as a work-related injury or illness.
We may create and distribute de-identified health information by removing all references to individually identifiable information. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
YOUR PRIVACY RIGHTS
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:
• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosure to family members, other relatives, close personal friends, or any other person identified by you. You have the right to request that we do not use or disclose certain protected health information for treatment, payment, or healthcare operations purposes. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. You can ask us to only contact you in a certain way or at a certain place. For example, you may want us to call you but not email. Or you may want us to call you at work and not at home. We will make every effort to comply with reasonable requests.
• The right to inspect and copy your protected health information. You have a right to see treatment, medical, and billing information.
• The right to get a list of the disclosures we have made. You have the right to request a list of instances in which we have disclosed your protected health information for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization.
• The right to request an amendment to your protected health information if you believe it contains incorrect or missing information. We are, however, not required to agree to the requested amendment.
• The right to obtain a paper copy of this notice from us upon request.
WHO IS COVERED BY THIS NOTICE
The people who must follow the rules in this notice are as follows:
• All Speech-Language Pathologists working at Cali Kids Speech Therapy Inc.
• Anyone who is allowed to add health information to your file, including students and other staff. Any volunteers who may help you while you are working with this practice.
This notice is effective as of October 1, 2023 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post the revisions and you may request a copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections have been violated. You have the right to file written complaints with our office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.
Please contact the following for more information:
The U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 202-619-0257
Toll Free: 1-877-696-6775
If you have any questions about this notice or your privacy rights, please ask your Speech-Language Pathologist, or contact Cali Kids Speech Therapy Inc. at info@calikidstherapy.com or (310) 461-8826.