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HIPAA NOTICE OF PRIVACY PRACTICES
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.
As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of
1996 (HIPAA). This Notice of Privacy Practices describes how we may use and disclose your protected health information
(PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required
by law. It also describes your rights to access and control your protected health information. “Protected health information”
is information about you, including demographic information, that may identify you and that relates to your past, present or
future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our
organization, Cooper River Pediatric Therapy, LLC, our office staff and others outside of our office that are involved in your
care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the
operation of the organization, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage health care and
any related services. This includes the coordination or management of your health care with a third party. For example, we
would disclose protected health information, as necessary, to a home health agency or physician to ensure necessary
information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services.
The terms of the notice may change, if so, you will be notified at your next visit to update your signature/date.
Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights
have been violated by us. You may file a complaint with us by notifying your child’s therapist of your complaint. We will not
retaliate against you for filing a complaint.
Your Health Information Rights:
While your health record is the physical property of Cooper River Pediatric Therapy, LLC,
the information belongs to you. Below is a list of your rights
• The right to request restrictions on certain uses and disclosures of PHI.
• The right to receive confidential communications of PHI, as permitted by law.
• The right to inspect and copy PHI.
• The right to amend PHI, as permitted by law.
• The right to receive an accounting of disclosures of PHI.
• The right of an individual to obtain a paper copy of the notice, upon request.
• The right to complain to the covered entity and to the Secretary of Health and Human Services if an individual
believes his or her privacy rights have been violated. You will not be retaliated against for filing a complaint.