Effective: April 1, 2020
Important Notice of Privacy Practices. It is important to read and understand this Notice of Privacy Practices before signing the Informed Consent to ABA Services Agreement. If you have any questions about this Notice or would like further information concerning your privacy rights, please contact Acclaim Autism:
Acclaim Autism
2929 Arch St, Suite 1700
Philadelphia, PA 19104
This Notice of Privacy Practices (“Notice”) is meant to inform you of the uses and disclosures of Protected Health Information (PHI) that we may make. “Your PHI” is Protected Health Information for you, a child for whom you are a parent or legal guardian, and/or other household members that may receive treatment, training or other services from Acclaim Autism. It also describes your rights to access and control your PHI and certain obligations we have regarding the use and disclosure of your PHI. Your PHI is information about you, your child, and/or your other household members created and/or received by us, including demographic information, that may reasonably identify you and that relates to past, present, or future physical, behavioral and/or mental health or condition, or payment for the provision of services provided by Acclaim Autism. We are required by law to maintain the privacy of your PHI. We are also required by law to provide you with notice of our legal duties and privacy practices with respect to your PHI and to abide by the terms of this Notice. If you would like to receive a written copy of this Notice, you should contact Acclaim Autism or visit our website (www.AcclaimAutism.com).
Acclaim Autism provides Applied Behavior Analysis (ABA) and related services to clients and their families. If you or a child in your care receive services from us, Acclaim Autism may use your PHI for treatment, billing or health care operations, including but not limited to:
We will not sell your or your child’s PHI for a profit. We may work with government and research organizations on projects to benefit Autism research and treatment options, and provide treatment notes, treatment plans and other data related to your or your child, but will remove any personally identifiable information and PHI from said data. Acclaim Autism will not use or disclose PHI except as described in this notice, or otherwise authorized by law. We will use PHI for treatment. For example, a member of your or your child’s treatment team may receive information about your health condition and document it in your child’s record. This information may be used to determine the course of care that should work best for your child. We will use your or your child’s health information for payment. For example: a bill may be sent to you or an insurance organization you identified. The information on or accompanying the bill may include information that identifies you, your child, as well as diagnosis, procedures, and supplies used. We will use your health information for regular health operations. For example, members of a quality assurance team may use information in your or your child’s health record to evaluate the care and outcomes of services and others like it, as well as audit the completes of session notes. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.
We may disclose your PHI:
We will require written authorization to disclose the following PHI:
Federal and state laws may require separate authorizations to disclose other highly confidential health information as described below. Highly Confidential Health Information “Highly confidential health information” may include confidential information under Federal law governing alcohol and drug abuse information as well as state laws that often protect the following types of information:
In order to store and transmit patient data and allow our staff to retrieve data and communicate, there are companies we contract with to store and transmit data and make it accessible to our staff; for example, treatment plans and session notes are stored in software. Our contracts with other companies must include a Business Associates Agreement (BAA) since our professional relationships are governed by the Health Insurance Portability and Accountability Act (HIPAA). Acclaim Autism and companies we contract with that access PHI must securely store your PHI data to safeguard it, and regularly review and monitor data security. We may also contract with other healthcare providers to provide some of the services we offer. When these services are contracted, we may disclose your PHI only to the extent needed for our business associate to perform the job we’ve asked them to perform. We do require the business associate to appropriately safeguard your information.
Regarding your or your child’s PHI, you have the right to:
In most cases you can complete a secure form on our website to request copies of PHI or amendments to PHI. Alternatively, you may make the request in writing to the address on page one (1) of this notice
You have the right to request amendments to your PHI and/or PHI for a child in your care. Requests to amend PHI can be made to the addressed to: Acclaim Autism 2929 Arch St, Suite 1700 Philadelphia, PA 19104 We will respond to requests to amend PHI within 60 days. We will correct any errors we may have made. However, it is possible your request to amend PHI will be denied. In such cases we will notify you in writing. Denial reasons can include but are not limited to:
Acclaim Autism has a duty to:
Acclaim Autism may change its privacy practices within the limits of federal and state law and make new privacy practices effective for all PHI we maintain. Should our privacy practices change, we will provide you with a revised notice to the address you have supplied us, or in digital form if you agreed to communicate by email. For additional information or to report a problem, you may contact Acclaim Autism and ask for the Privacy Officer (888) 805-8206. If you believe your privacy rights have been violated, you may file a complaint with:
Privacy Officer
Acclaim Autism
2929 Arch St, Suite 1700
Philadelphia, PA 19104
(888) 805-8206
You may also file a complaint with the Office of Civil Rights, United States Department of Health and Human Services at:
Region III
Office for Civil Rights U.S. Department of Health and Human Services
150 South Independence Mall West Suite 372
Public Ledger Building
Philadelphia, PA 19106-9111
(215) 861-4441
Toll Free (800) 368-1019