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Speech & Occupational Therapy Specialists

Notice of Privacy Practices

Patient Consent for Use and Disclosure of Protected Health Information for

Treatment, Payment, and Healthcare Operations

1. Speech & Occupational Therapy Specialists, LLC abides by Federal and Virginia Laws applicable to the

safeguarding of our patients’ private health and personal information. Patient information is only

accessible to the SOTS employees who must use the information to provide services, procure

reimbursement, and/or to carry out support functions for customer service, quality control and scheduling.

Records are stored in a manner which prohibits unauthorized persons exposure to protected health


2. The practice may use and disclose protected health information for treatment, payment and healthcare

operations. Examples of these include, but are not limited to, requested preschool, or sports physicals,

referral to nursing homes, foster care homes, home health agencies and/or referral to other providers for

treatment. Payment examples include, but are not limited to, insurance companies for claims including

coordination of benefits with other insurers and collection agencies. Healthcare operations include, but are

not limited to, internal quality control and assurance including auditing of records.

3. The practice is permitted or required to use or disclose protected health information without the individual’s

written consent or authorization in certain circumstances. Two examples of such are for public health

requirements or court orders.

4. The practice will not make any other use or disclosure of a patient’s protected health information without

the individual’s written authorization. Such authorization may be revoked at any time. Revocation must be


5. The practice will abide by the terms of this notice currently in effect at the time of the disclosure.

6. The practice reserves the right to change the terms of its notice and to make new notice provisions effective

for all protected health information that it maintains. The practice will provide each patient with a copy of

any revisions of its Notice of Privacy Practices at the time of their next visit, or at their last known address

if there is a need to use or disclose any protected health information of the patient. Copies may also be

obtained at any time at our offices.

7. Any patient, guardian, or personal representative has the right to object to the use of their health

information for directory purposes.

8. Any patient, guardian, or personal representative has the right to request to inspect and obtain copies of

medical records.

9. Any patient, guardian, or personal representative has the right to request amendments be made to their

medical records.

10.Any patient, guardian, or personal representative has the right to request a three-year accounting of all

disclosures of their medical record. The history will be provided within 60 days of the request and a

reasonable charge may be assessed for any copies after the first request in a 12-month period.

11.Any patient, guardian, or personal representative has the right to request restrictions as to how their health

information may be used or disclosed to carry out treatment, payment, or healthcare operations. The

practice is not required to agree to the restrictions requested, but if the practice does agree, the practice

must abide by those restrictions.

12.Any person/patient may file a complaint to the practice and to the Secretary of Health and Human Services

if they believe their privacy rights have been violated. To file a complaint with the practice please contact

the Privacy Officer at the following address and /or phone number: SOTS Privacy Officer, P.O. Box 10864,

Danville, VA 24543. The phone number is 434-799-7732. The fax number is 434-799-7733. All

complaints will be addressed and the results will be reported to the Privacy Officer.

13.It is the policy of the practice that no retaliatory action will be made against any individual who Submits or

conveys a complaint of suspected or actual non-compliance of the privacy standards.

14.Appointment Reminders: We may use medical information to contact you as a reminder that you have an

appointment for treatment at the office. You may be contacted by a therapist, post card, office personnel, or

an automated appointment reminder system. If you choose not to be reminded of upcoming appointments

in this manner you will be held responsible for missed appointments (no shows).

15.The practice is permitted to use photographs of the patient in a patient's chart for the purpose of

identification, whether hard copy or EMR (electronic medical records).

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