Child Language & Developmental Speech is required, by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of Your Health Care Information

Treatment
We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with Child Language & Developmental Speech.

Payment
We may disclose your health information to your insurance provider for the purpose of payment or health care operations.

Emergencies
We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency.

Public Health
As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings.
We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement.
We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Marketing.
We may contact you for marketing purposes through the use of newsletters or emails. Additionally, appointment reminders will be sent to the email of your choice. If you have signed a waiver, then you consent that Child Language & Developmental Speech may use photographs or video for marketing purposes, such as, but not limited to website, emails, newsletters or other printed media.

Change of Ownership.
In the event that Child Language & Developmental Speech is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

• You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Child Language & Developmental Speech is not required to agree to the restriction that you requested.
• You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
• You have the right to inspect and copy your health information.
• You have a right to request that Child Language & Developmental Speech amend your protected health information. Please be advised, however, that Child Language & Developmental Speech is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s)and information about how you can disagree with the denial.
• You have a right to receive an accounting of disclosures of your protected health information made by Child Language & Developmental Speech. 
• You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices
Child Language & Developmental Speech reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, Child Language & Developmental Speech is required by law to comply with this Notice.

Child Language & Developmental Speech is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact Margaret Pashoian by calling this office at 704-845-0561.

If Margaret Pashoian is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

Complaints
Complaints about your Privacy rights, or how Child Language & Developmental Speech has handled your health information should be directed to Margaret Pashoian by calling this office at 704-845-0561 If Margaret Pashoian is not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201

This notice is effective as of 10/5/2010

I have read the Privacy Notice and understand my rights contained in the notice.

By way of my signature, I provide Child Language & Developmental Speech with my authorization and consent to use and disclose my protected health care information for the purposes of treatment, payment, and health care operations as described in the Privacy Notice.