Autism Unchained is committed to protecting the privacy, confidentiality, and security of your child’s protected health information (PHI). Protected health information includes information that may identify your child and relates to your child’s health condition, diagnosis, treatment, services received, payment for services, and any other health related information maintained by Autism Unchained. This acknowledgement is provided to confirm that you have been given access to the Autism Unchained Notice of Privacy Practices and that you understand Autism Unchained may use and disclose your child’s PHI as permitted or required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HIPAA Privacy Rule, and applicable state and federal confidentiality laws. This acknowledgement does not replace the full Notice of Privacy Practices and does not limit your rights under the law.
Autism Unchained may use or disclose PHI forвеL)l for purposes of treatment, payment, and healthcare operations. Treatment includes activities such as clinical assessment, treatment planning, ABA therapy services, supervision, caregiver training, coordination of care, referrals, and clinical consultation with relevant providers when permitted. Payment includes activities required to obtain reimbursement for services, such as billing insurance, verifying benefits, obtaining prior authorization, and communicating with payers regarding medical necessity or coverage decisions. Healthcare operations include activities that support business and clinical functioning such as quality improvement, staff training, supervision, audit preparation, compliance monitoring, licensing standards, and required documentation to support ethical and appropriate service delivery. Autism Unchained may also disclose PHI without authorization when required by law, such as in cases of suspected abuse or neglect, mandated reporting responsibilities, court orders, public health reporting obligations, or situations involving serious and imminent threats to health or safety, consistent with HIPAA standards.
You have specific rights regarding your child’s PHI. These rights include the right to request access to your child’s records, request amendments to records if you believe information is inaccurate or incomplete, request restrictions on certain uses or disclosures of PHI, request confidential communications by alternative means or at alternative locations, and request an accounting of certain disclosures made outside of treatment, payment, and healthcare operations. Autism Unchained will make reasonable efforts to honor valid requests in accordance with HIPAA and applicable state laws; however, some requests may not be granted when disclosures are required or permitted under law. You also have the right to receive a paper copy of the Notice of Privacy Practices at any time, even if you previously received the notice electronically. If you believe your privacy rights have been violated, you have the right to file a complaint with Autism Unchained and/or with the U.S. Department of Health and Human Services Office for Civil Rights without fear of retaliation.
Autism Unchained takes privacy and security seriously and uses reasonable safeguards to protect PHI. Safeguards may include secure record storage, limited access to clinical documentation, workforce training on privacy requirements, and secure communication practices. Despite safeguards, no system can guarantee complete security, especially when communication occurs electronically. When caregivers request communication through less secure methods such as standard email or text messaging, Autism Unchained will use professional judgment and minimum necessary standards when sharing information; however, caregivers should understand that these methods may involve additional privacy risks. Autism Unchained will not disclose psychotherapy notes or release PHI to non-involved parties without a valid written authorization unless otherwise permitted or required by law.
Emergency situations may require Autism Unchained to use or disclose relevant PHI to support safety and continuity of care. In the event of a medical emergency, behavioral safety emergency, or welfare concern, Autism Unchained may contact emergency services and/or the emergency contacts listed below, and may share only the minimum information necessary to support safety, location identification, and immediate clinical or medical response. Autism Unchained encourages caregivers to keep emergency contact information current so safety planning can be implemented efficiently. Caregivers are also encouraged to provide additional trusted contacts when appropriate, such as a secondary caregiver, family member, or authorized pickup person, to support coordination when the primary caregiver cannot be reached.
By signing below, I acknowledge that I have been offered and/or received a copy of the Autism Unchained Notice of Privacy Practices. I understand that Autism Unchained may use and disclose protected health information about my child for treatment, payment, and healthcare operations, and in other circumstances permitted or required by law, consistent with HIPAA and applicable confidentiality requirements. I understand that I have the right to ask questions about privacy practices and to request additional information at any time.