We care about your privacy. The information that we collect about you and your child is private and is protected by the Federal Health Insurance Portability and Accountability Act (HIPAA).

We are required to give you a notice of our privacy practices. Only the people who have both the need and the legal right may see your records. Unless you give us permission in writing, we will only disclose your records for purpose of treatment, business operations, payment, or when we are required by law to do so.

If you give us permission in writing, we may use and disclose you or your child’s records. You do have the right to revoke that permission. The request must in writing and dated.

We may disclose records to coordinate therapy services. For example:

• Primary care physician for prescription for treatment.
• Case managers or other service providers working on behalf of the child’s therapy.

We may need to use and disclose information for our business operations. For example:

• Quality of care review.
• Appointment reminders and confirmations.
• Informational correspondence about business, programs, events and other special mailings.

We may use and disclose records so that the care the child receives can be properly billed and payment obtained. We inform the insurance company of the child’s diagnosis and send required reports in order to obtain payment or preauthorization of treatment.

We will release records when we are required by law to do so. For example:

• Court orders or subpoenas.
• Communicable disease reporting.
• Threat to safety or other kinds of emergencies.

Legal guardians have the following rights regarding the personal information and health records that we have about the child. There may be a fee charged for copying.

• Right to Inspect and Copy

You have the right to review or get copies of records.

• Right to Amend

If they think there is a mistake in the records, the client has the right to add a statement. We can deny your request, but we must give you a written reason for our denial.

• Right to a List of Disclosures

You have the right to ask for a list of disclosures made after April 14, 2003. This list will include those disclosures not pertaining to treatment, business operations, payment, or as required by law.

• Right to Request Restrictions on Our Use or Disclosure of Records

You have the right to ask for limits on how the records are used and disclosed. We are not required to agree with such requests.

• Right to Request Confidential Communication

You may request and provide written permission that we share information in a certain way or certain location. For example:

• Send records to work versus home.
• Private areas for discussions.

If you want to exercise your rights under this notice, wish to communicate with us about privacy issues, or if you wish to file a complaint, you may write to or contact us.

It is understood that you will not be penalized for filing a complaint.

You can report a violation by doing the following:

1. A statement regarding the specific violation can be written and provided to the Office Manager at location of service.
2. A statement regarding the specific violation may be submitted in writing and mailed to:
    
   • Privacy Officer
     Children’s Therapy Corner
     1525 Ridgewood Drive
     Midland, MI 48642
     Phone: (989) 835-6333

    

3. If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government.
    
   • Office of Civil Rights
     Dept. of Health and Human Services
     200 Independence Ave S.W.
     Washington, D.C. 20201
     Phone: (866) 627-7748
     TTY: (886) 788-4989
     Email: ocrprivacy@hhs.gov