NOTICE OF PRIVACY PRACTICES
Updated: 11/05/2024
SMS Privacy Policy
This Privacy Policy explains how Speak for Yourself, LLC collects, uses and discloses personal information of its clients, prospective clients, and visitors to its website at www.speak-yourself.com.
COLLECTION OF PERSONAL INFORMATION
Information collected directly from you: We may collect personal information directly from you, for example [through an electronic form, during an online, in-person, or over-the-phone registration, or while making an appointment.] Personal information we collect directly from you may include first and last name, date of birth, address, email address, phone number, health insurance information, and medical history.
Information collected from referral sources: We may collect personal information about you through referrals from your Primary Care Physician or other specialty health care providers. Personal information we collect from referral sources may include your first and last name, date of birth, address, email address, phone number, health insurance information, and medical history.
USE OF PERSONAL INFORMATION
We use information collected directly from you and referral sources to provide you with our services and other relevant information.
DISCLOSURE OF PERSONAL INFORMATION
We may use third-party service providers to assist us with providing services to you and we may share your information with such third parties for these limited purposes.
- – We use Klara for our HIPAA-compliant text message communications. For more information about how we may use your information with Klara, visit https://www.klara.com/privacy.
- – We use Fusion Web Clinic as our EMR and payment processor. Fusion Web Clinic maintains your medical records and processes your payment information in accordance with its privacy policy available at https://fusionwebclinic.com/privacy/.
EMAIL AND TEXT MESSAGE COMMUNICATIONS
If you wish to unsubscribe from our email appointment reminders, please click on the Unsubscribe link at the bottom of any email sent from Fusion Web Clinic.
If you wish to stop receiving text messages from us, reply STOP to any text message sent from us directly or via Klara.
YOUR PRIVACY RIGHTS
You may have the right to request access to the personal information we hold about you, to transfer to another provider, or to request that your personal information be corrected. To exercise any of these rights, please contact us at [email protected].
CHANGES TO THIS PRIVACY POLICY
We may update this Privacy Policy at any time. Please review it frequently.
CONTACT INFORMATION
If you have any questions about this policy or our privacy practices, please contact us at [email protected].
HIPAA Privacy Policy
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how I may use or disclose your/your child’s protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and or refuse the release of specific information outside of this system except when the release is required to be authorized by law or regulation.
Acknowledgement of Receipt of this Notice
You will be asked to provide a signed acknowledgement of receipt of this notice. The intent is to make you aware of the possible uses and disclosures of your/your child’s protected health information and your privacy rights. The delivery of your/your child’s health care services will in no way be conditioned upon your signed acknowledgement.
Who Will Follow this Notice
This notice applies to all therapy services provided by Speak for Yourself, LLC. It also applies to office personnel and billing personnel.
Our Responsibility Regarding Protected Health Information
Your/your child’s protected health information is individually identifiable health information. This includes demographics such as age, address, email address, and relates to your/your child’s past, present, or future physical or mental health or condition and related health care services. We are required by law to do the following:
- – Make sure that your/your child’s protected information is kept private
- – Give you this notice of our legal duties and privacy practices related to the use and disclosures of your/your child’s protected health information
- – Follow the terms of the notice currently in effect
- – Communicate any changes in the notice to you
We reserve the right to change this notice. Its effective date is at the top of the first page and at the bottom of the last page. We reserve the right to make the revised or changed notice effective for health information we already have about your/your child as well as any information received in the future. You may obtain a Notice of Privacy Practices by calling the phone number at the top of this notice.
Our System
Speak for Yourself, LLC works with several agencies and referral sources. Your/your child’s health information will be shared in the following manner:
- – Treatment: I will use and disclose your/your child’s protected health information to provide, coordinate, or manage your/your child’s health care and any related services. This includes disclosure to your physician or other health care providers who become involved in your/your child’s care.
- – Within my office for administrative activities, quality assessment, oversight, and peer review.
- – With my billing personnel and as necessary to obtain payment for your health care services.
- – With your insurance company or other payers as required for payment.
- – With the referring agency and case manager, if applicable.
- – With any other provider, school, or agency with your written request. You may request written or verbal information sharing in writing. Your request should include a specified period of time for information sharing.
Required by Law
I may use or disclose your/your child’s protected health information if law or regulation requires the use of disclosure. I will notify the appropriate government authority if I believe a patient has been a victim of abuse, neglect, or domestic violence.
Health Oversight
I may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
Legal Proceedings
I may disclose your/your child’s protected information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process.
Parental Access
I may disclose your/your child’s protected information to parents, guardians, and persons acting in similar legal status.
Uses and Disclosures of Protected Health Information Requiring Your Permission
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your/your child’s protected health information. Since this service is provided in your home or other natural environments, those present during the session, including friends, family, or daycare providers, may hear health information regarding your child. Please notify your therapist if you do not want your/your child’s protected health information to be discussed.
Your Rights Regarding Your/Your Child’s Health Information
You may exercise the following rights by submitting a written request to Speak for Yourself.
- 1. You may inspect and obtain a copy of your/your child’s protected health information that is kept as a part of medical and billing records.
- 2. You may ask me not to use or disclose any part of your/your child’s health information for treatment, payment, or healthcare operations. Your request must be made in writing. This request will be honored if we mutually agree that the restriction will not harm your child.
- 3. You may request that I communicate with you using alternative means or at an alternative location. I will not ask you the reason for your request. I will accommodate reasonable requests, when possible.
- 4. If you believe that the information I have about your child is incorrect or incomplete, you may request an amendment to your/your child’s protected health information as long as I am responsible for and maintain this information. While I will accept requests for amendment, I am not required to agree to the amendment.
- 5. You may request that I provide you with an accounting of disclosures I have made of your/your child’s protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. This disclosure must have been made after April 21, 2010, and no more than six years from the date of request. This right excludes disclosures made to you or authorized by you, to family members or friends involved in your/your child’s care, or for notification. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice.
Federal Privacy Laws
This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply, including the Freedom of Information Act and the Privacy Act. These laws have been taken into consideration in developing policies and this notice of how I will use and disclose your/your child’s protected information.
Complaints
If you believe these privacy rights have been violated, you may file a written complaint with the Department of Health and Human Services. No retaliation will occur against you for filing a complaint.
This notice is effective in its entirety as of 05/01/2013.