Kid At Heart Therapy, LLC
Notice of Privacy Practices
Effective: July 5, 2009
THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE INFORMATION ABOUT YOU WILL BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Kid At Heart Therapy, LLC (Kid At Heart Therapy) understands that your information is highly personal and we are committed to safeguarding your protected health information. Please read this Notice of Privacy Practices thoroughly. Kid At Heart Therapy is required by law to maintain the privacy of individually identifiable patient health information. This information is “protected health information” and is referred to in this Notice as “PHI” to provide you with an explanation of how we handle your information. We will only use or disclose your PHI as permitted or required by applicable state or federal law. Kid At Heart Therapy can help you understand our privacy practices and your rights.
HEALTH INFORMATION USES AND DISCLOSURES
Treatment
Kid At Heart Therapy will use and disclose your PHI to those who have a legitimate need for such
information in the provision and coordination of your health care which may include physicians, nurses, technicians, students or other health care providers.
This information is provided to carry out treatment functions at Kid At Heart Therapy, which includes consultations or referrals with other providers or
agencies. PHI may be used or disclosed to obtain X-rays, laboratory work, surgical information or other ancillary services related to your treatment.
Payment
Kid At Heart Therapy will use and disclose your PHI to obtain payment for services rendered to you.
Health Care Operations
Kid At Heart Therapy will use and disclose your PHI during routine health care operations
including assessments, evaluations, and improvement activities; utilization review; activities to coordinate your care; legal, regulatory, accreditation
and licensure activities; reviewing the performance or qualifications of therapy providers for credentialing and evaluation purposes; conducting training
and education programs; and medical review.
Appointment Reminders
Kid At Heart Therapy may use and disclose PHI to contact you as a reminder that you have an
appointment with Kid At Heart Therapy.
Family and Care Providers
Unless you object, Kid At Heart Therapy may disclose PHI about you to a friend, a relative,
or other party, such as daycare provider, teacher, or other persons, who are involved in your daily care, medical care or to someone who helps you pay for
your care. We will disclose such information as deemed medically necessary. Kid At Heart Therapy may disclose your PHI for notification purposes, for
example if your condition changes during your care period. You can request a limitation or restriction on the disclosure of your PHI for some or all of
your friends, relatives, or other party involved in your care.
Required by Law
Kid At Heart Therapy will disclose PHI about you when required to do so by federal, state or local law.
Abuse and Neglect
Kid at Heart Therapy will notify the appropriate authorities if we have reason to believe
that the patient has been a victim of abuse, neglect, or domestic violence. We may disclose your PHI to the degree necessary to prevent or avert any
serious threats to the patient’s health or safety or the health or safety of others.
Marketing/Advertisement
Kid At Heart Therapy does not share your PHI with companies that sell health care
products or services. Kid At Heart Therapy does use your name or family members to contact for marketing and/or advertisement purposes. Your consent
will be requested in these insistences to ensure you PHI is properly protected and confidentiality is maintained by Kid At Heart Therapy.
Your Authorization
In addition to the above uses of your PHI, you have the right to give us written authorization
to use or disclose your PHI to anyone for any reason. We will not release your PHI without your written authorization. You are allowed to revoke the
authorization at any time; however, this revocation will not affect any prior uses or disclosures of this information that may have been released while
this authorization was in effect.
PATIENT HEALTH INFORMATION RIGHTS
Although all records concerning your treatment obtained at Kid At Heart Therapy are property of Kid At Heart Therapy, you have the following rights concerning your PHI:
Right to Confidential Communications
You have the right to receive confidential communications of your PHI by alternative
means or at alternative locations. For example, you may request that Kid At Heart Therapy only contact you at work or by mail.
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your PHI.
Kid At Heart Therapy will consider your request, but is not required to agree to your requested restrictions.
Right to Access
With some exceptions you have the right to inspect and copy information about your PHI as long as we
maintain the information. In certain limited circumstances, Kid At Heart Therapy may be required to deny your request. Copying requires that you pay a $1.00
per page copying charge.
Right to Amend
With some exceptions you have the right to request an amendment of your PHI for as long as Kid At
Heart Therapy maintains the information.
Right to Disclosure Accounting
With some exceptions you have a right to receive an accounting of certain disclosures
of your PHI that Kid At Heart Therapy has made.
Right to Receive a Copy of this Notice
You have the right to receive a paper copy of this Notice of Privacy Practices.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Kid At Heart Therapy. All complaints must be submitted in writing directly to Kid At Heart Therapy at 520 Butternut Dr. Suite 8, PMB #224, Holland, MI 49424. Kid At Heart Therapy assures you that there will be no retaliation for filing a complaint.
FURTHER INFORMATION
To obtain additional information, please contact Brianna Chesser at (616) 510-1267.
CHANGES TO THIS NOTICE
Kid At Heart Therapy will abide by the terms of the notice currently in effect for PHI in our possession including medical records generated by us. Kid At Heart Therapy reserves the right to change the terms of its notice and to make the new notice provisions effective for all PHI that it maintains. You will receive the most current Notice at your next scheduled visit.