ACE Speech and Language Clinic, LLC is committed to ensuring that your private health information held in our possession is maintained in a secure and confidential manner.  You should be aware that ACE Speech and Language Clinic, LLC is required by applicable federal and state law to maintain the privacy of your information.  ACE Speech and Language Clinic, LLC is also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information.  This notice is effective April 14, 2003.

Our privacy practices and the terms of this Notice could change in the future and we reserve that right.  For example, if privacy laws change we would change our privacy practices to comply with the new laws.  Changes that are made to this Notice must be permitted under applicable law.  Any changes that may be made to our privacy practices and the new Notice will apply to all health information that we maintain, including health information we created or received before we made the changes.  Before any significant change is made in our privacy practices, this Notice will be modified to reflect the changes and then the modified Notice will be available upon request.

When we refer to “you” or “your” in this Notice, we refer to the patient.  When we refer to types of disclosures of information to “you”, we mean disclosures to the patient, patient’s guardian, or person legally authorized to receive information about the patient.
 You may request a copy of our Notice at any time.  If you require more information about our privacy practices or require an additional copy of this notice, please contact the ACE Speech and Language Clinic, LLC Privacy officer listed at the end of this Notice

Permitted Uses and Discloses of Health Information by ACE Speech and Language Clinic, LLC

ACE Speech and Language Clinic, LLC uses and discloses health information about you for treatment, payment, and healthcare operations.  The following are examples of disclosures we are allowed by law to make without your authorization

Treatment:  We may use or disclose your health information to healthcare providers (i.e., doctors, other speech language pathologists, psychologists or other caregivers) that are providing treatment to you.

Payment:  To receive payment for speech services we provide to you it may be necessary for us to use and disclose your health information (i.e. billing insurance companies).

Health Care Operations:  To perform health care operations it may be necessary to use and disclose your health information.  Healthcare operations cover a number of internal functions such as:

• Quality assessment and improvement activities
• Competence and qualification review of healthcare professionals
• Accreditation, certification, licensing or credentialing activities
• Provider performance evaluations
• In the presentation of training programs

Other Uses and Disclosures

Your Authorization:  Any uses and disclosures not addressed in this notice will require a written authorization from you, the patient.  You can give us written authorization to use your health information or to disclose it to anyone for any purpose.  Keep in mind that if you give us an authorization, you may revoke it in writing at any time.  The revocation will not affect any use or disclosures permitted by your authorization while it was in effect. The following disclosures will be made only with your (the patient's, parent or guardian's) authorization.

• Most uses and disclosures of psychotherapy notes.
• Uses and disclosures of PHI for marketting purposes including subsuduzed treatment communications
• Disclosures that constitute a sale of PHI

If you have paid for services out of pocket, in full, and you request us to not disclose your PHI related solely to those services to a health plan, we will accommodate your request unless we are required by law to make the disclosure.

Others involved in your health care:

• Family – Unless we are notified in writing, we may disclose billing information (status of a claim, amount paid, payment date) to a family member.  At no time will we disclose medical information such as diagnosis, treatment plans, or providers.
• Persons involved in your care - We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location or your general condition.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare

Required by Law:  We may use or disclose your health information when we are required to do so by state or federal law.  This can include disclosures to the U.S. Department of Health and Human Services.

Abuse or Neglect:  We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

Legal Proceedings:  We may disclose your health information in the course of any legal proceeding.  This could be in response to a court order or administrative judge and, in certain cases, in response to a subpoena, discovery request or other lawful process.

Workers Compensation:  We may disclose your health information as required by worker’s compensation laws.

Public Health Issues:  we may disclose your personal health information to an authorized public health authority for public health activities in controlling disease, injury or disability.

Law enforcement:  We may disclose your health information to law enforcement officials.  As an example, a disclosure may be made in response to a warrant or subpoena or for the purpose of identifying or locating a suspect, witness or missing persons or to provide information concerning victims of crimes.

Health Supervision and Control activities:  We may disclose your health information to a government agency authorized to conduct health care system or governmental procedures.  Governmental procedures could include audits, clinic examinations and investigations, inspections and licensure activity.
National Security:  We may disclose your health information to military authorities under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. 

Correctional institutions:  We may disclose to a correctional institution or law enforcement official having lawful custody of protected health information of inmates or patients under certain circumstances.

Appointment Reminders:  We may use or disclose your health information when we contact you to provide appointment reminders.  (Reminders may take the form of letters, postcards or voicemail messages).

Patient Rights

As a patient of ACE Speech and Language Clinic, LLC you have rights regarding your personal health information.  These rights are detailed below.
 
You have the right to access your records:  You have the right to examine or get copies of your health information with limited exceptions.  If you require that copies of your health information be in another format other than photocopies, you must make that request in writing.  We will make a best effort to deliver your health information in the format you require providing we can do so.  A completed form, available from the ACE Speech and Language Clinic, LLC Privacy Officer, is required to access your personal health information.  There is a nominal fee (cost-based) to cover expenses for copies and labor.  Our fees for copies are $.35 for each page and $13.00 per hour for labor to compile and copy your health information plus postage if you want the copies mailed to you.  If you request your personal health information to be delivered in an alternate format, we will charge a cost-based fee for providing your health information in that format.  If you prefer, we will prepare a summary or an explanation of your health information for a fee.

You have the right to information regarding disclosures:  You have the right to request in writing an accounting of disclosures of your health information except for the following reasons:

• Treatment, payment, or health care operations (described earlier in this notice).
• Disclosures that you have authorized (including disclosures that your personal representative has authorized)
• Certain other disclosures, such as disclosures for national security purposes.

The requirement that we provide you with this disclosure list applies for 6 years from the date of the disclosure, but not before April 14, 2003.  If you request this list more than once in a 12 month period we may charge you a reasonable, cost-based fee for responding to these additional requests.

Right to restriction:  You have the right to request restrictions regarding the way ACE Speech and Language Clinic, LLC handles and discloses your health information for treatment, payment or health care operations.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).  Whether we agree or disagree with your restrictions, we will notify you in writing.

Right to alternative communication:  You have the right to request that we communicate with you about your health information by alternative means or to alternative locations.  We will make every effort to accommodate reasonable requests however, your request must be in writing.  Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

Right to amend your health information:  You have the right to request that we amend your health care information.  The request must be in writing and it must explain what information should be amended and why it should be amended.  Your request may be denied under certain circumstances.

Right of hard copy notice:  If you have received this Notice on our Web site or by electronic mail (e-mail), you do have the right to receive this Notice in a hard copy written form.

Right to notification of a breach of PHI:  We are required by law to notify you if a breach (unauthorized disclosure) of your PHI occurs.

Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact our Privacy Officer.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information your may either:

1. File a complaint with the ACE Speech and Language Clinic, LLC Privacy Officer.  The contact phone number is listed at the end of this notice.
2. Contact the Minnesota Department of Commerce at (651) 296-2488 or toll free at 1-800-657-3602.
3. Notify the Secretary of the U.S. Department of Health and Human Services (HHS).  Send your complaint to:

Medical Privacy Complaint Division
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, DC  20201

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

 

 

Privacy Officer: John Olcott
Telephone Number: (651) 222-7768
Fax:  (651) 698-8994