Esperanza, A Pediatric Therapy Center, is required by law to maintain the privacy of your child’s health information.  This notice explains how your child’s healthcare information may be used and/or disclosed.  We will not disclose your child’s personal health information without parent/legal guardian authorization unless we are required or authorized to so by law.

Federal laws protect the privacy of all healthcare information we create or obtain during your child’s treatment.  Examples of protected health information include: symptoms, diagnosis, treatment plans, treatment outcomes, healthcare information received from other providers, billing and payment information, test results.  By law, we are allowed to use protected health information for the purpose of treatment and healthcare operations, which include billing third party payers.

Esperanza protects you healthcare information by training all employees upon hiring and at least yearly on privacy practices.  We also have confidentiality agreements with our business associates who provide us with services such as vendors, billing companies, independent contractors.  Physical, electronic and procedural safeguards are in place to protect personal information related to your child’s treatment.

Examples of How We Use and Disclose Your and/or Your Child’s Personal Health Information for Treatment, Payment and Operations:

   1.   Payment:  We may use protected information to receive authorization and reauthorization for    
         treatment from your insurance company. We will send billing information for services to third  
         party payers and our billing company (business associate).

2. Treatment:  Information will be shared among relevant team members for effective therapy treatment and planning while at our clinic.  Evaluation and progress reports will be sent to primary care physicians and any other healthcare/school specialist that is relevant for your child’s care.  Information can be shared with emergency responders in case of medical emergency or natural disaster.  In the event of an emergency, if parents/guardians are not present information may be given to any family or friend/emergency contact in order for the child to receive care. 

3. Routine Healthcare Operations: In order to ensure quality of treatment and outcomes our quality improvement team consisting of clinic directors may audit your information.  This helps evaluate the performance of our staff caring for your child.

4. Other Disclosures:  Information may also be disclosed for the following reasons: we may share information with our business associates such as our billing company, upon your request all information can be disclosed to you or your authorized representative, we must disclose information in response to situation that are required by law such as court order, subpoena, we may disclose limited information to law enforcement, we may disclose information to authorizes federal officials for national security activities, we may disclose information as mandatory reporting in cases of suspected child abuse, neglect, child welfare situation.

Your Rights Regarding Protected Health Information

Under federal law you have the right to the following:

1. Receive a written copy of this notice by request and ask questions.
2. Right to request restrictions:  You have the right to request restrictions of the information we share for the purposes of treatment, payment and internal operations.  We are not required to agree with your request.  Please contact our privacy officer to request restrictions.
3. Right to receive confidential communications:  You have the right to specify how we may contact regarding protected health information.  We may send evaluation, progress reports, billing invoices and leave phone messages regarding appointments at a phone number and address you designate.  For example you may request we contact you at home rather than work.
4. Right to inspect and copy you or your child’s protected health information:  You have the right to request to inspect or receive a copy of information such as billing, treatment notes, and reports.  We may deny your request in limited circumstances.  A reasonable fee to cover labor, postage and copying may be charged.
5. Right to amend:  You have the right to request we amend certain information that is generated by Esperanza if you feel it is faulty.  Please put this request in writing and a reason for the request.  We reserve the right to deny your request in certain circumstances.
6. Receive an accounting of all disclosures:  You have the right to receive an accounting of all disclosures not related to treatment, billing and internal operations for a period of 6 years.  A reasonable fee may be charged.

Complaints

You have the right to file a complaint if you feel your or your child’s privacy has been violated.  Esperanza, A Pediatric Therapy Center, will not retaliate in any way if a complaint is filed. 

You may speak with our privacy officer during business hours or file a written complaint with our privacy officer:

Amy Meyers-Stein, MS, OTR/L

Clinic Director/Privacy Officer

9200 Holman Road NW

Seattle WA 98117

206-706-3300

You may also file a written complaint with:

U.S. Department of Health and Human Services

Office for Civil Rights

2201 Sixth Avenue-Mail Stop RX-11

Seattle, WA 98121

206-615-2290       206-615-2296(TDD)    206-615-2297-FAX

This notice takes effect May 3, 2007.  We reserve the right to make any changes to our privacy practices as permitted by law.  You may request a copy of this notice at any time at the front desk or by calling 206-706-3300.