Uses and Disclosures

 

Patient Health Information

Under federal law, your Medical Information is protected and confidential.  Patient Medical Information includes information about test results, diagnosis, treatment, and related Medical Information.  Your Medical Information also includes payment, billing, and insurance information.

 

How We Use Your Patient Health Information

We use your Medical Information about treatment, to obtain payment, and for health care operations, including administrative purposes and evaluation of the quality of care that you receive.  Under some circumstances, we may be required to use or disclose your Medical Information even without your permission.

 

Examples of Treatment, Payment and Health Care Operations

• Treatment:  We will use and disclose your Medical Information to provide treatment services.  For example, therapists and other members of your child’s treatment team will record information in their records and use it to determine the most appropriate course of care.  We may also disclose the information to other health care providers who are participating in your child’s treatment and to caregivers who are helping with their direct care.

• Payment:  We will use and disclose your Medical Information for payment purposes.  For example, we need to obtain authorization from your insurance company before providing certain types of treatment.  We will submit bills and maintain records of payments from your health plan. We may also share your Medical Information with a collection agency if a bill is overdue.

• Health Care Operations:  We will use and disclose your Medical Information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment and to assess the care and outcomes of your child’s case and others like it. We may use and share your Medical information to follow laws and regulations, conduct training, improve care and services, complete an audit, evaluate staff, maintain credentialing/licensure/certification/accreditation and find out patient satisfaction ratings.

 

Special Uses

We may use your Medical Information to contact you to provide appointment reminders, schedule services and follow up on your care. We may leave voice messages at the phone number provided to us. If you choose to receive contact by text messaging, texting charges may apply per your carrier plan.

 

Other Uses and Disclosures

We may use or disclose your Medical Information for other reasons, even without your consent.  Subject to certain requirements, we are permitted to give out your Medical Information without your permission for the following purposes:

• Required by Law: We may be required by law to report suspected abuse or neglect, or similar injuries and events.

• Public Health Activities:  As required by law, we may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.

• Health Oversight:  We may be required to disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.

• Judicial and administrative proceedings:  We may disclose information in response to an appropriate subpoena or court order.

• Law enforcement purposes: Subject to certain restrictions, we may disclose information required by law enforcement officials.

• Deaths: We may report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.

• Serious threat to health or safety:  We may use and disclose information when necessary to prevent a serious threat to your child’s health and safety or the health and safety of another person, or the general public.

• Military and Special Government Functions:  If you are a member of the armed forces, we may release information as required by military command authorities.  We may also disclose information to correctional institutions or for national security purposes.

• Research: We may use or disclose information for approved medical research.

• Workers Compensation:  We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.

In any other situation, we will ask for your written authorization before using or disclosing any identifiable Medical Information.  If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

 

Individual Rights

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You have the following rights regarding your Medical Information.  Please contact the person listed below to obtain the appropriate form for exercising these rights.​

• Request Restrictions:  You may request restrictions on certain uses and disclosures of your Medical Information.  We are not required to agree to such restrictions; should we agree on restriction terms, we are required to follow them.

• Confidential Communications:  You may ask us to communicate with you confidentially by, for example, sending notices to a special address.

• Inspect and Obtain Copies:  In most cases, you have the right to look at or get a copy of your Medical Information.

• Amend Information:  If you believe that information in your Medical Information is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

• Accounting of Disclosures:  You may request a list of instances where we have disclosed your Medical Information for reasons other than treatment, payment, or health care operations.

• Obtain a Paper Copy of the Notice of Privacy Practices:  You may request a paper copy of the Notice of Privacy Practices, even if an electronic copy has already been provided.

 

Organization’s Duties

• Organization is required by law to maintain the privacy of protected health information, to provide individuals with notice of its legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured PHI;

• Organization must abide by the terms of the Notice currently in effect; and

• If Organization desires to reserve the right to amend the Notice, the Notice must state that Organization reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all PHI it maintains. This statement also explains how the Organization will provide individuals with a revised Notice.

 

Our Legal Duty

We are required by law to protect and maintain the privacy of your Medical Information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect.

 

Revisions to the Notice of Privacy Practices

We may change our policies at any time.  Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area and each treatment room.  You can also request a copy of our Notice at any time.  For more information about our privacy practices, contact the owner listed below.

• The Organization must promptly revise and distribute its Notice whenever there is a material change to privacy practices, including practices regarding PHI uses and disclosures, individual’s rights, and Organization's legal duties, or other privacy practices stated in the Notice.

• Organization must make the revised notice available upon request.

• Organization must post the revised notice on its website.

• Unless Organization reserved the right to amend its Notice within the previous Notice, it may not make any changes applicable to PHI created or received prior to the effective date of the new Notice.

 

Notice Dissemination and Publication Requirements

• The Organization must provide the Notice to individuals no later than the date of the first service delivery by a direct care provider. The Notice may also be given to an individual by e-mail, if the individual agrees to such electronic notice. If the Organization knows that the e-mail transmission has failed, it must provide a hard paper copy. If the first service is delivered electronically, the Organization must send the notice electronically and contemporaneously with provision of the service.

• The Organization must make the Notice available for individuals to take with them. (When the individual is not physically present, the Notice may be sent by first class mail.)

• The Notice shall be posted prominently on the Organization’s website (if any) and shall be available electronically through the website.

• In the case of patients who are minors, the Notice should be given to the minor’s parent or guardian.

 

Acknowledgement of Notice of Privacy Practices

• The Organization will make a good faith effort to obtain a written Acknowledgement that the individual received the Notice. If an individual refuses to sign the Acknowledgement, then we will document the good faith efforts taken and the reason why the Acknowledgement was not obtained.

• A “good faith effort” to obtain written acknowledgment is not required when emergency treatment or stabilization is needed. Additionally, if Organization mails the notice to the correct address even if the individual does not return the acknowledgment form, the Organization does not need to make further good faith efforts to obtain a written acknowledgment.

• In non-emergency situations, Organization will seek to obtain acknowledgement of the Notice during the intake process.

 

Record Retention

All versions of the Organization approved Notice of Privacy Practices will be archived and maintained by the Privacy Officer for a period no less than six (6) years from the date of its creation or the date when it was last in effect, whichever is later. Any acknowledgments of receipt or good faith efforts to obtain such acknowledgements must also be retained no less than six (6) years from the date when it was received or the date when it was last in effect, whichever is later.

 

Complaints

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If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made regarding your Medical Information, you may file a complaint with the Organization and/or the Secretary of the U.S. Department of Health and Human Services. You will not be penalized in any way for filing a complaint.

 

Contact Information

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If you have any questions, requests, or complaints, please contact:

 

Pastiche Partners, LLC

Tamar Robinson, Owner/Privacy Officer

615-663-8872

615-628-8935 (fax)

 

Office for Civil Rights, Region IV, DHHS

Atlanta Federal Center

61 Forsyth Street SW, Suite 3B70

Atlanta, GA 30323

 

Effective Date

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​The effective date of this Notice is April 1, 2013

Revised: January 28, 2025