Notice of Privacy Practices
April 1, 2003
Center for Children's
Speech-Language Disorders, Inc.
NOTICE OF PRIVACY PRACTICES
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) requires
all health care records and other individually identifiable health information
(protected health information) used or disclosed to us in any form, whether
electronically, on paper, or orally, be kept confidential. This federal law
gives you, the patient, significant new rights to understand and control how
your health information is used. HIPAA provides penalties for covered entities
that misuse personal health information. 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.
Without specific written authorization, we are permitted to use and disclose
your health care records for the purposes of treatment, payment and health
care operations.
- Treatment means providing, coordinating, or managing health care and related
services by one or more health care providers. Examples of treatment would
include assessment results and treatment notes.
- Payment means such activities
as obtaining reimbursement for services, confirming coverage, billing or
collection activities, and utilization review. An example of this would be
billing your insurance plan for your therapy/assessment/consultation services.
- Health Care Operations include the business aspects of running our practice,
such as conducting quality assessment and improvement activities,
auditing functions, cost-management analysis, and customer service.
An example would include a periodic assessment of our documentation protocols, etc.
In addition, your confidential information may be used to remind you of an
appointment (by phone or mail) or provide you with information about treatment
options or other health-related services including release of information to
friends and family members that are directly involved in your care or who
assist in taking care of you. We will use and disclose your protected when
we are required to do so by federal, state or local law. We may disclose
your PROTECTED HEALTH INFORMATION to public health authorities that are
authorized by law to collect information, to a health oversight agency for
activities authorized by law included but not limited to: response to a court
or administrative order, if you are involved in a lawsuit or similar proceeding,
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 party has requested. We will release your PROTECTED HEALTH INFORMATION if
requested by a law enforcement official for any circumstance required by law.
We may release your PROTECTED HEALTH INFORMATION to a medical examiner or
coroner to identify a deceased individual or to identify the cause of death.
If necessary, we also may release information in order for funeral directors
to perform their jobs. We may release PROTECTED HEALTH INFORMATION to
organizations that handle organ, eye or tissue procurement or
transplantation, including organ donation banks, as necessary to
facilitate organ or tissue donation and transplantation if you are an
organ donor. We may use and disclose your PROTECTED HEALTH INFORMATION
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. We may disclose your
PROTECTED HEALTH INFORMATION if you are a member of U.S.
or foreign military forces (including veterans) and if required by the
appropriate authorities. We may disclose your
PROTECTED HEALTH INFORMATION to federal officials for intelligence
and national security activities authorized by law.
We may disclose PROTECTED HEALTH INFORMATION to federal officials
in order to protect the President, other officials or foreign heads of state,
or to conduct investigations.
We may disclose your PROTECTED HEALTH INFORMATION to correctional institutions
or law enforcement officials if you are an inmate or under the custody of a
law enforcement official. Disclosure for these purposes would be necessary:
(a) for the institution to provide health care services to you,
(b) for the safety and security of the institution, and/or
(c) to protect your health and safety or the health and safety of other
individuals or the public.
We may release your PROTECTED HEALTH INFORMATION
for workers' compensation and similar programs.
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.
You have certain rights in regards to your PROTECTED HEALTH INFORMATION,
which you can exercise by presenting a written request to our
Privacy Officer at the practice address listed below:
- The right to request restrictions on certain uses and disclosures of
PROTECTED HEALTH INFORMATION, including those related to disclosures to
family members, other relatives, close personal friends, or any other person
identified by you. 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 request to receive confidential communications of
PROTECTED HEALTH INFORMATION from us by alternative means or at alternative locations.
- The right to access, inspect and copy your PROTECTED HEALTH INFORMATION.
- The right to request an amendment to your PROTECTED HEALTH INFORMATION.
- The right to receive an accounting of disclosures of PROTECTED HEALTH
INFORMATION outside of treatment, payment and health care operations.
- The right to obtain a paper copy of this notice from us upon request.
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.
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.
Revisions to our Notice of Privacy Practices will be posted on the
effective date and you may request a written copy of the Revised
Notice from this office.
You have the right to file a formal, written complaint with us at the
address below, or with the Department of Health & Human Services,
Office of Civil Rights, in the event you feel your privacy rights
have been violated. We will not retaliate against you for filing a complaint.
For more information about our Privacy Practices, please contact:
Cheryl Bland, M.S., CCC-SLP
Director/Privacy Official
Center for Children's Speech-Language Disorders, Inc.
5125 S. Kipling St., #205, Littleton, Co 80127
303-971-0411
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)