HIPAA Notice of Privacy Practices
Last updated September 13th, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT PATIENTS MAY BE USED AND DISCLOSED AND HOW PATIENTS CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If the patient is a minor, the term “patient” refers to the patient’s parent(s) or legal guardian(s).
Our Commitment to Patient Privacy
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal law requiring that all medical records and other individually identifiable health information used or disclosed by Outreach Speech Therapy (“the Practice”), whether electronic, paper, or oral, be kept properly confidential. HIPAA gives patients important rights to understand and control how their health information is used and provides penalties for covered entities that misuse protected health information (“PHI”).
As required by HIPAA, the Practice is required to:
Maintain the privacy of the Patient’s PHI.
Provide the Patient with this notice of the Practice’s legal duties and privacy practices.
Abide by the terms of the notice currently in effect.
Notify affected patients following a breach of unsecured PHI, as required by law.
The Practice reserves the right to change the terms of this notice and to make the revised notice effective for all PHI it maintains. A revised notice will be posted at the Practice’s office, on its website, and provided to patients upon request.
How the Practice May Use and Disclose Health Information
Treatment, Payment, and Health Care Operations
Treatment means providing, coordinating, or managing health care and related services by one or more providers. For example, this may include a speech-language evaluation or therapy session.
Payment means activities such as obtaining reimbursement for services, confirming coverage, billing or collections, and utilization review. For example, this may include submitting a claim to a patient’s insurance carrier.
Health care operations include the business aspects of running the Practice, such as quality assessment, auditing, cost-management analysis, and customer service. For example, this may include an internal quality review of services provided.
Other Permitted Uses and Disclosures
The Practice may also use or disclose PHI, without the Patient’s authorization, in the following circumstances, as required or permitted by law:
To create and distribute de-identified health information, with all individually identifiable information removed.
To provide appointment reminders or share information about treatment alternatives or other health-related services that may be of interest to the Patient.
For public health activities, including reporting of suspected child, elder, or dependent adult abuse, or to prevent a serious threat to health or safety.
In response to a court order, subpoena, or other lawful legal process.
For health oversight activities, such as audits or investigations, and to coroners or medical examiners performing duties authorized by law.
When required by federal, state, or local law.
Disclosures to Family, Friends, or Others Involved in Care
The Practice may share PHI with a family member, friend, or other person identified by the patient as involved in the Patient’s care or payment for care (for example, a grandparent or caregiver bringing the Patient to sessions), unless the Patient objects to the disclosure, in whole or in part. In emergency situations, the opportunity to object may be obtained after the disclosure has already occurred.
Uses and Disclosures Requiring Authorization
Any use or disclosure of PHI not described above will be made only with the Patient’s written authorization. The Patient may revoke such authorization in writing at any time, except to the extent the Practice has already taken action in reliance on it.
No Marketing or Sale of PHI
The Practice will not use or disclose PHI for marketing purposes and will not sell PHI without the Patient’s written authorization.
Patient Rights
The Patient may exercise the following rights by submitting a written request to the Practice’s Privacy Officer, identified below:
The right to request restrictions on certain uses and disclosures of PHI, including disclosures to family members, relatives, or close personal friends. The Practice is not required to agree to a requested restriction, but if it does, it must abide by that restriction unless the Patient agrees in writing to remove it.
The right to request that PHI related to services paid for out-of-pocket, in full, not be disclosed to a health plan for payment or health care operations purposes. The Practice must honor this request.
The right to request confidential communication of PHI by alternative means or at alternative locations.
The right to inspect and obtain a paper or electronic copy of the Patient’s PHI, or to direct that a copy be sent to a third party designated by the Patient.
The right to request an amendment to the Patient’s PHI.
The right to receive an accounting of certain disclosures of PHI made by the Practice for purposes other than treatment, payment, or health care operations.
The right to be notified in the event of a breach of the Patient’s unsecured PHI.
The right to obtain a paper copy of this notice upon request, even if the Patient has agreed to receive it electronically.
Complaints
A patient who believes their privacy rights have been violated has the right to file a written complaint with the Practice, or with the U.S. Department of Health and Human Services, Office for Civil Rights. The Practice will not retaliate against a patient for filing a complaint.
Complaints to the Practice should be directed to the Privacy Officer listed below. Complaints to the federal government may be directed to:
U.S. Department of Health & Human Services, Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: (202) 619-0257 | Toll-Free: 1-877-696-6775
Effective Date
This notice is effective as of September 13th, 2026, and supersedes all prior versions.
Acknowledgement of Receipt
Outreach Speech Therapy is required by law to keep patient health information and records confidential. This information may include, among other things:
Notes from the Patient’s physician, teacher, or other health care provider
Medical history
Test results
Treatment notes
Insurance information
Privacy Officer / Contact
Questions about this notice, requests to exercise the rights described above, or complaints should be directed to:
Christy Hack, Privacy Officer
Outreach Speech Therapy
Phone: 415-255-5541 | Email: christy@outreachspeech.com
Patient Signature
By signing this document, the undersigned acknowledges that:
They have received a copy of Outreach Speech Therapy’s Notice of Privacy Practices, describing how the Practice uses and discloses PHI.
They have had the opportunity to read this notice and have had any questions answered to their satisfaction.
They understand that Outreach Speech Therapy will not disclose PHI other than as described in this notice.
They understand that Outreach Speech Therapy reserves the right to revise this notice, and that a revised notice will be made available at the Practice’s office, on its website, and upon request.