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HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE SUED 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 you rights to access and control your protected
health information. “Protected health information” is information abut 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. Pathways Pediatric Therapy, LLC, our office staff and others outside od our office
that are involved in your care and treatment for the purpose of providing health care services to you, to pay your
healthcare 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 compliant 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 Pathways Pediatric Therapy,
LLC, the information belongs to you. Below is a list of your rights.
• The right to request restriction 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 and 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/her privacy rights have been violated. You will be not retaliated against for filing a
complaint.
• The right to use another Healthcare Professional.