Welcome to our clinic! We look forward to seeing your child for a screening and/or evaluation, treatment, family education, and training. These services fall under the category of health information. This notice describes how health information about your child as a patient of TherapyTown may be used and disclosed and how you can get access to his/her health information. This is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review this notice carefully.
Our commitment to your privacy
TherapyTown is dedicated to maintaining the privacy of your child’s health information. We are required by law to maintain the confidentiality of your child’s health information. We are also required by law to provide you with this notice of our legal duties and the privacy we maintain in our practice concerning your child’s health information. We realize these laws are complicated, but we must provide the following important information to you. We also reserve the right to amend or revise this Notice of Privacy Practices, as necessary.
Your rights regarding your health information
The health and billing records we maintain are the physical property of TherapyTown. However, the information in these records belongs to you. You have the right to:
- Request a restriction on certain disclosures and uses of your child’s health information in writing to our office. We are not required to grant the request, but we will comply with any request granted;
- Request that you be allowed to inspect and copy your child’s health record and billing record – you may exercise this request by delivering the request in writing to the office;
- Appeal a denial of access to your child’s protected health information except in certain circumstances;
- Request that your child’s health care record be amended to correct incomplete or incorrect information by delivering a written request to our office;
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
- Obtain an accounting of disclosures of your child’s health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends while providing care;
- Request that communication of your child’s health information be made by alternative means or at an alternative location by delivering the request in writing to our office; and
- Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.
If you would like to exercise any of the above rights, please contact the business office of TherapyTown in writing at:
TherapyTown, Inc.
3223 E 31st Street
Tulsa, OK 74105
We will assist you in the steps you should take to exercise your rights. For more information, contact TherapyTown’s Business Office at (918) 250-7093.
Use and disclosure of your health information in certain special circumstances
The following circumstances may require us to use or disclose your child’s health information:
- To caregivers, such as nurses, physicians, social workers, counselors, therapists, and teachers so that an integrated plan of care may be implemented and to ensure appropriate and effective provision of services;
- To health plan or health insurance carriers for payment of services. Health information about your child may be shared with government programs, such as Medicaid or Indian Health Services, in order to better manage your benefits and payments;
- To public health authorities that are authorized by law to collect information;
- To health oversight agencies for activities authorized by law. These may include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions: civil administrative and criminal procedures or actions, or other monitoring programs of the government;
- Lawsuits and similar proceedings in response to a court or administrative order. We may also share your child’s health information in response to a subpoena, discovery request, or other lawful process, if required to do so by federal, state, or local law;
- When necessary to reduce or prevent a serious threat to your child’s health and safety or the health and safety of another individual or the public. We will only make disclosures to a person or organization able to help prevent the threat;
- If your child becomes a member of U.S. or foreign military forces as requested and required by the appropriate authorities;
- To federal officials for intelligence and national security activities authorized by law;
- To correctional institutions or law enforcement officials if your child becomes an inmate or is under the custody of a law enforcement official;
- To coroners, medical examiners, and funeral directors as necessary to perform duties as authorized by law;
- If your child is an organ donor, we may provide your child’s health information for the purposes of an organ, eye, or tissue donation or transplant;
- For Workers’ Compensation and similar programs.
Other disclosures and uses
Notification
Unless you object, we may use or disclose your child’s protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your child’s care, about your child’s location, and about your child’s general condition, or your child’s death.
Communication with family
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your child’s care or in payment for such care if you do not object or in an emergency.
Right to a copy of this notice
You are entitled to receive a copy of this Notice of Privacy Practices. You may ask us to give a copy of this Notice to you at any time.
Right to change this notice
TherapyTown has the right to change this notice. We reserve the right to make any changed notice effective for the health information we already have about your child, as well as any information we create or receive in the future. We will give you a copy of any new notices within 60 days, as long as your child is actively receiving services. We will also post a copy of the current notices in our clinics.
Right to file a complaint
If you believe your privacy rights have been violated, you may file a complaint in writing to TherapyTown, 3223 E. 31st Street, Tulsa, OK 74105. You need to file a complaint within 180 days of when the problem occurred.
If you have any questions regarding this Notice of Privacy Practices, please contact:
TherapyTown
3223 E 31st Street
Tulsa, OK 74105
918-250-7093