Privacy Policy

January, 2025

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.

MY PLEDGE REGARDING HEALTH INFORMATION:

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your are generated by this practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.

FULL CIRCLE SPEECH & VOICE THERAPY is required by law to keep your protected health information (“PHI”) safe. This information may include notes from your doctor, teacher, or other health care provider; medical history; test results; speech therapy treatment notes; or insurance information.

The Health Insurance Portability and Accountability Act (HIPAA) also requires that you get a copy of this privacy notice. I will ask you to sign a paper saying that you have been given this notice. Read this at any time to see how your health information can be used and who can see it.

HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

When Your Permission Is Not Needed

We may use or share your health information without your permission for the following reasons:

• Treatment. We may share information with doctors and other health care providers who care for you. For example, if your doctor orders speech therapy, we will share the results of our treatment with that doctor.
• Payment. We may use and share information about the treatment you receive with your insurance company or other payer to receive payment for services. This may include sharing important medical information. We may share information to get the insurancecompany’s permission to start treatment, or get permission for more treatment, and/or get paid for the treatment you receive.
• Health Care Operations. We may use and share your health information to run the practice and make sure all patients receive good care. For example, we may use your health information to see how well our services are working, see how well our staff is doing, see how we compare to other Speech Therapy practices, improve our services, and help others study healthcare services.
• 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 in the mail, by email, or by 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. If you are a veteran, your information may be shared with the U.S. Department of Veterans Affairs.
• Information About a Person Who Has Died. We may share information with the coroner, the medical examiner, or a funeral director, as needed.
• 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.
• 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.

When Your Permission Is Needed

You must give us permission to use or share your health information for any situation that is not listed in this notice. You will be asked to sign a form—called an authorization—to allow us to use or share your information. You are allowed to take back this authorization—called revoking authorization—at any time. We will not be able to get the information back that we shared with your permission.

YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

You have the right to do all of the following:

• Ask us not to share your information. You can ask us not to use or share your information for treatment, payment, or health care operations. You can also ask us not to share information with people involved in your care, like family members or friends. You must ask for limits in writing. We must share information when required by law. We do not have to agree to what you ask.
• Ask us to contact you privately. 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. You must ask us in writing. We will make every effort to comply with your request.
• Look at and copy your health information. You have the right to see your health information and get a copy of that information. You have a right to see treatment, medical, and billing information. You may not be able to see or copy information put together for a court case, certain lab results, and copyrighted materials, such as test protocols.
• Ask for changes to your health information. You can ask us to change information that you think is wrong. You can also ask that we add information that is missing. You must ask us in writing and give us a reason for the change. We do not have to make the change.
• Get a report of how and when your information was used or shared. You can ask us to tell you when your information was shared and who we shared it with. There are some rules about this: You must ask us in writing. You must tell us the dates you are asking about and if you want a paper or electronic copy. You may get information going back 6 years, but it cannot befor/earlier than Apri l14, 2003. This is the date when the government privacy rules took effect.
• Get a paper copy of this privacy notice. You can get a paper copy of this notice at any time. You can get a copy even if you have already signed the form saying you have seen this notice.

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 FULL CIRCLE SPEECH & VOICE THERAPY
• anyone who is allowed to add health information to your file
• any volunteers who may help you while you are receiving treatment in this practice

CHANGES TO THE INFORMATION IN THIS NOTICE

We may change this notice at any time. Changes may apply to information that we already have in your file and to any new information. The new Notice will be available upon request, in my office, and on my website. The notice will have a date on the front page to tell you when it went into effect.

CONTACTS

If you have any questions about this notice or your privacy rights, please ask your speech- language pathologist.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By signing this document, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.

(Effective date: January 1, 2025.)