Notice of Privacy Practices

Effective Date 4/15/03

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to protect the privacy of health information that may reveal your child’s identity, and to provide you with a copy of this notice which describes the health information privacy practices of our practice and any affiliated
health care providers that jointly perform payment activities and business operations with our practice. A copy of our current notice will always be posted in our reception area. You will also be able to obtain your own copies by calling Technology and Language Center, Inc. at 847-682-1596, or asking for one at the time of your next visit.

If you have any questions about this notice or would like further information, please contact Jill E Senner at 847-682-1596.

Requirement for Acknowledgment of Notice of Privacy Practices.
We will ask you to sign a form that will serve as an acknowledgment that you have received this Notice of Privacy Practices.

Requirement For Written Authorization.
We will generally obtain your written authorization before using your health information or sharing it with others outside our group practice. If you provide us with written authorization, you may revoke that authorization at any time, except to the extent that we have already relied upon it. To revoke an authorization, please write to Jill E Senner.
Some examples of protected health information are:

• information about health care services your child has received or may receive in the future (such as specific therapy);
• geographic information (such as where your child lives or attends school);
• demographic information (such as your child’s race, gender, or ethnicity)
• unique numbers that may identify your child (such as your social security number, address, or phone number); and
• other types of information that may identify who your child is.

Exceptions To Requirement.
There are some situations when we do not need your written authorization before using your health information or sharing it with others. They are:
• Exception For Treatment, Payment, And Business Operations. We are allowed to use and disclose your health information without your consent to other therapists in our practice to treat your condition, your insurance company to collect payment for that treatment, or to others in order to conduct our practice's normal business operations.
• Exception For Disclosure To Friends And Family Involved In Your Child’s Care. We will ask you whether you have any objection to sharing information about your child’s health with your friends and family involved in his/her care.
• Exception In Emergencies Or Public Need. We may use or disclose your child’s health information if your child needs emergency treatment but are unable to obtain your consent.
• As Required By Law. We may use or disclose your child’s health information if we are required by law to do so. We also will notify you of these uses and disclosures if notice is required by law.
• Exception If Information Does Not Identify Your Child. We may use or disclose your child’s health information if we have removed any information that might reveal who your child is.
• Victims Of Abuse, Neglect, Or Domestic Violence. We may release your child’s health information to a public health authority that is authorized to receive reports of abuse, neglect, or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission.
• Lawsuits And Disputes. We may disclose your child’s health information if we are ordered to do so by a court that is handling a lawsuit or other dispute. We may also disclose your child’s information in response to a subpoena, discovery request, or other lawful request by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain a court order protecting the information from further disclosure.
• Health Oversight Activities. We may release your child’s health information to government agencies authorized to conduct audits, investigations, and inspections of our facility.
• Research. In most cases, we will ask for your written authorization before using your child’s health information to conduct research. However, under some circumstances, we may use and disclose your child’s health information without your authorization if we obtain approval through a special process to ensure that research without your authorization poses minimal risk to your privacy. Under no circumstances, however, would we allow researchers to use your child’s name or identity publicly.

How To Access Your Child’s Health Information.
You generally have the right to inspect billing statements, evaluation documents and progress reports generated by Technology and Language Center. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies we use to fulfill your request.

We ordinarily will respond to your request within 30 days if the information is located in our facility, and within 60 days if it is located off-site at another facility. If we need additional time to respond, we will notify you in writing within the time frame above to explain the reason for the delay and when you can expect to have a final answer to your request.

Under certain very limited circumstances, we may deny your request to inspect or obtain a copy of your information. If we deny part or all of your request, we will provide a written denial that explains our reasons for doing so, and a complete description of your rights to have that decision reviewed and how you can exercise those rights.

How To Correct Your Health Information.
You have the right to request that we amend your child’s health information if you believe it is inaccurate or incomplete as long as the information is kept in our records. To request an amendment, please write to Jill E Senner. Your request should include the reasons why you think we should make the amendment. Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we will notify you in writing within 60 days to explain the reason for the delay and when you can expect to have a final answer to your request.
If we deny part or all of your request, we will provide a written notice that explains our reasons for doing so.

How To Keep Track Of The Ways Your Health Information Has Been Shared With Others.
You have the right to receive a list from us, called an "accounting list," which provides information about when and how we have disclosed your health information to outside persons or organizations. The list will identify non-routine disclosures of your information, but routine disclosures will not be included. The list will not include disclosures you have authorized.

How To Request Additional Privacy Protections.
You have the right to request further restrictions on the way we use your health information or share it with others. We are not required to agree to the restriction you request, but if we do, we will be bound by our agreement.

How To Request More Confidential Communications.

You have the right to request that we contact you in a way that is more confidential for you, such as at home instead of at work. We will try to accommodate all reasonable requests.

How Someone May Act On Your Behalf.
You have the right to name a personal representative who may act on your child’s behalf to control the privacy of your child’s health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.

How To Obtain A Copy Of This Notice.
You have the right to a paper copy of this notice. You may request a paper copy at any time, even if you have previously agreed to receive this notice. To do so, please call Jill E Senner at 8470-682-1596. You may also obtain a copy of this notice by requesting a copy at your next visit.

How To Obtain A Copy Of Revised Notices.
We may change our privacy practices from time to time. If we do, we will revise this notice so you will have an accurate summary of our practices. The revised notice will apply to all of your child’s health information, and we will be required by law to abide by its terms. We will post any revised notice in our reception area. You will also be able to obtain your own copy of the revised notice by calling our office at 847-682-1596, or asking for one at the time of your next visit. The effective date of the notice will always be located in the top left corner of the first page.

How To File A Complaint.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact Jill E Senner at 847-682-1596. No one will retaliate or take action against you for filing a complaint.