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Privacy Practices

Plandome Speech-Language Therapy

HIPAA Notice of Privacy Practices


Your Information. Your Rights. Our Responsibilities.

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.


“Protected health information“ (PHI) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care.

Your Rights Regarding Your PHI You have the right to:

● Get a copy of your paper or electronic medical record ● Correct your paper or electronic medical record
● Request confidential communication
● Ask us to limit the information we share

● Get a list of those with whom we’ve shared your information
● Get a copy of this privacy notice
● Choose someone to act for you
● File a complaint if you believe your privacy rights have been violated


Our Uses and Disclosures
We may use and share your information as we:

● Treat you
● Run our organization
● Bill for your services
● Help with public health and safety issues
● Do research
● Comply with laws that may be in place now or in the future


Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.


Request confidential communications
● You can ask us to contact you in a specific way (for example, home or office phone) or to send

mail to a different address.
● We will say “yes” to all reasonable requests.


Ask us to limit what we use or share
● You can ask us not to use or share certain health information for treatment, payment, or our

operations. We are not required to agree to your request, and we may say “no” if it would

affect your care.
● If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that

information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.


Get a list of those with whom we’ve shared information
● You can ask for a list (accounting) of the times we’ve shared your health information for six

years prior to the date you ask, who we shared it with, and why.
● We will include all disclosures except for those about treatment, payment, and health care

operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.


Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.


Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.In these cases, you have both the right and choice to tell us to:

● Share information with your family, close friends, or others involved in your care. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.


Our Uses and Disclosures
IF you give us permission, how would we typically use or share your health information? We

typically use or share your health information in the following ways.


Treat you
● We can use your health information and share it with other professionals who are treating you.

Example: Your physician and I may need to coordinate your care. Run our organization

● We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.


Bill for your services
● We can use and share your health information to bill and get payment from health plans or

other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.


How else can we use or share your health information?

Help with public health and safety issues
We can share health information about you for certain situations such as:

● Reporting suspected abuse, neglect, or domestic violence
● Preventing or reducing a serious threat to anyone’s health or safety


Do research
● We can use or share your information for health research.

Comply with the law
● We will share information about you if state or federal laws require it, including with the

Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.


We can use or share health information about you:

● For workers’ compensation claims

● For law enforcement purposes or with a law enforcement official
● With health oversight agencies for activities authorized by law
● For special government functions such as military, national security, and presidential protective


Respond to lawsuits and legal actions

● We can share health information about you in response to a court or administrative order


Our Responsibilities
● We are required by law to maintain the privacy and security of your protected health

● We will not use or share your information other than as described here unless you tell us we

can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information, see:


Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website,


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