Effective Date: April 2025
At Leap Pediatric Therapy LLC, we understand that health information about your child is personal. We are required to protect the privacy and security of your child’s Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
This notice describes how health information about your minor child (as a patient of this practice) may be used and disclosed and how you can get access to your individually identifiable health information. We will note use, release, or disclose your health information except as described in this Privacy Policy, unless specifically authorized by you in writing. We are also required by law to notify you if a breach occurs that may have compromised the privacy or security of your child’s information. In providing professional medical services to you, we will create, maintain, and store your protected health information.
Please review this notice carefully.
Examples of Disclosures:
The following categories describe the ways that we may use, release, and disclose your protected health information for treatment, payment, and healthcare operations without the need for a signed authorization from you.
a) Treatment: We will use your protected health information for the coordination of your healthcare. For example we may disclose all or any portion of your medical record as part of your care and continued treatment to your attending physician and other healthcare providers who have a legitimate need for such information.
b) Payment: We may may use and disclose your protected health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your protected health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your protected health information to bill you directly for services and items. We may disclose your protected health information to other health care providers and entities to assist in their billing and collection efforts.
c) Health care operations: We may use and disclose protected health information to run our clinic and ensure quality care. For example, we may use your information for internal audits, quality assessment, or staff training.
d) Appointment Reminders/Communications: We may use and disclose your protected health information in order to contact you and remind you of an appointment. We may use and disclose your protected health information via email or text, if you prefer for us to not use such communication please submit your request in writing to Leap Pediatric Therapy LLC.
e) Family/Friends: We may release your protected health information to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the therapy session. In this example, the babysitter may have access to this child’s medical information.
f) Disclosures required by law: We will use and disclose your PHI when we are required to do so by federal, state or local law.
Use and disclosure of your PHI in certain special circumstances:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information without your authorization:
a) Regulatory Agencies: Your protected health information may be disclosed to a health oversight agency for activities authorized by law including, but not limited to, licensure, certification, audits, investigations, and inspections.
b) Law Enforcement/Litigation: Your protected health information may be disclosed to a law enforcement official for law enforcement purposes as required by law or in response to a valid subpoena or court order.
C) Public Health Risks: Your protected health information may be disclosed to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
d) Serious Threat to Health or Safety: Your protected health information may be used or disclosed to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
e) Military/Veterans/National Security: Your protected health information may be disclosed as required by military command authorities if you are a member of the armed forces. In addition Leap Pediatric Therapy LLC may disclose your protected health information to federal officials for intelligence and national security activities authorized by law.
f) Required by Law: Your protected health information may be used or disclosed when required to do so by law.
g) Coroners, Medical Examiners, Funeral Directors: Your protected health information may be used or disclosed to a coroner, medical examiner, or to funeral directors as necessary to carry out their duties.
h) Research: Your protected health information may be used or disclosed for research purposes in certain limited circumstances.
I) Workers’ Compensation: Your protected health information may be used or disclosed to release medical information about you to Workers’ Compensation or similar programs as required under Alabama Law.
Your Rights:
You have the following rights regarding your protected health information. Please note that in order to exercise any of the privacy rights described below, you must complete a written request and send it to Leap Pediatric Therapy LLC’s Privacy Officer.
Request that Leap Pediatric LLC communicate with you about your health in released issues in a particular manner or at a certain location.
You have the right to inspect and obtain a copy of the protected health information that may be used to make decisions about you, including patient medical records and billing records. We do not charge to email records. However, we charge a fee for the costs of copying, mailing, labor, and supplies associated with your request. The cost is $20.00 for 5 pages or less, and $0.50 per page for any additional pages. Payment will need to be made in advance by paying in person at one of our clinics, mailing a check or calling and have the cost charged to a credit or debit card. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
Obtain an accounting of the use or disclosure of your health information. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before January 6, 2025. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Request restrictions on certain uses and disclosures of your medical information. Leap Pediatric Therapy LLC may not agree to honor your request for restrictions. however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you.
Receive a paper copy of this Privacy Policy, upon request.
Revoke any authorization allowing Leap Pediatric Therapy LLC to use or disclose your protected health information except to the extent that action has already been taken by Leap Pediatric Therapy LLC.
You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information
Right to file a complaint to Leap Pediatric Therapy LLC and/or the government if you think any of your rights were denied.
Questions or Complaints:
If you have questions or concerns about this policy or believe your privacy rights have been violated, you may contact our privacy officer:
Jillian Moscicki at Leap Pediatric Therapy LLC, 2020 CR 33, Pelham AL 35124. All complaints must be submitted in writing. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate for filing a complaint.
Changes to this Notice:
Leap Pediatric Therapy LLC reserves the right to change the terms of its Privacy Policy and to make the new policy effective for all PHI we maintain. You will be notified of any material changes and a copy will be available upon request and on our website.