• 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.
  • You have the right to:
    •  See or get a copy of your paper or electronic medical record. A copy or summary will be provided – usually within 30 days of your request.  A reasonable fee may apply.
    • Correct your paper or electronic medical record if you think it is incorrect or incomplete. Your request may be denied with a written explanation within 60 days.
    •  Ask us not to use or share certain health information for treatment, payment, or our operations. Your request may be denied, especially if it would interfere with your care.
    • Ask us not to share information with your health insurer for the purpose of payment or our operations if you pay for a service or health care item out-of-pocket in full. We will comply unless a law requires us to share that information.
    • Get a list of those with whom we’ve shared your information for six years prior to the date you ask, who we shared it with, and why. We will provide one list a year for free if requested, but will charge a reasonable fee if you ask for another one within 12 months.
    • Get a copy of this privacy notice
    • Choose someone to act for you. That person can exercise your rights and make choices about your health information.
    •  File a complaint if you believe your privacy rights have been violated. You can send a letter to the U.S. Dept of Health and Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, call 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints/.  We will not retaliate against you for filing a complaint.
    For certain health information, you can tell us your choices about what we share.  You can tell us how we should:
    • Share information with your family, close friends, and others involved in your care.
    • Share information in a disaster relief situation.
    • Share information for marketing purposes. In these cases, we never share your information unless you give us written permission.
    • Contact you for fundraising. We may contact you for fundraising, but you can tell us not to contact you again.
    We may use and share your information as we:
    •  Treat you. We may share your information with other professionals who are treating you.
    • Run our organization and contact you when necessary.
    • Bill for your services and receive payment from health plans or other entities.
    • Help with public health and safety issues, such as product recalls or reporting suspected cases of abuse or neglect.
    • Do health research with your written permission.
    • Comply with the law, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
    • Address workers’ compensation, law enforcement, and other government requests.
    • Respond to lawsuits and legal actions, as in a court order or subpoena.
    Our responsibilities:
    • We are required by law to maintain the privacy and security of your protected health information.
    • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
    • We must follow the duties and privacy practices described in this notice and give you a copy of it.
    • We will not use or share your information other than as described here without written permission.  You may revoke that permission at any time with written notice.
    • For more info, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
    Video and Photography Notification: During the course of evaluation and therapy, audio and video recordings, as well as still photography may be used.  Samples may be used:
    • To have a transcription record (take a language sample, do a fluency count, assess a voice)
    • To document baseline performance and/or progress
    • For client self-assessment
    • For modeling, analyzing and practicing social skills or oral performances (speeches/skits, etc)
    The images/recordings from these mediums are protected information and will not be shared with anyone not directly involved in therapy (ie: clinician, student, parents) without specific permission. In the case of social skills groups, video may be shared among members of the group with the understanding that “what happens in the group, stays in the group” and with an emphasis on positive behaviors and observations.
    • Your rights and choices, as well as our uses and responsibilities, of video and photography are the same as other protected healthcare information described above.  Should you have any questions or concerns, please fee free to contact our director, Ellen Edwards, at 703-904-8334 or email her at eedwards@restonspeech.com.
      • Changes to the Terms of this Notice
          Terms of this notice may change as necessary and the changes will apply to all personal health information. The new notice will be available upon request, in our office, and on our website.                                     Revised 7/22/14