Notice of Privacy Practices

Mustard Seed Therapy, LLC

Pediatric Occupational Therapy

14 B Professional Ct, Rome, GA, 30165

[Phone]

[Fax]

emclemore@mustardseedot.com

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU (OR YOUR CHILD) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

At Mustard Seed Therapy, LLC, we are committed to protecting the privacy of your child's Protected Health Information (PHI). PHI includes information that can be used to identify your child and that relates to their past, present, or future physical or mental health condition and related healthcare services.

1. USES AND DISCLOSURES OF PHI

We may use and disclose PHI for the following purposes:

Treatment: To provide, coordinate, or manage your child's care. For example, we may share information with your child's pediatrician or other specialists involved in their care.
Payment: To bill and get payment from health plans or other entities. For example, we may give your insurance company information about the therapy sessions provided.
Healthcare Operations: For clinic activities such as quality assessment, staff training, and general business management.
As Required by Law: We will disclose PHI when required to do so by federal, state, or local law, including reporting suspected child abuse or neglect.

In addition to Federal HIPAA standards, Georgia law provides specific protections. We use your child's Protected Health Information (PHI) for Treatment, Payment, and Healthcare Operations. Specifically under Georgia law:

Mental Health/Developmental Disabilities: If records contain information protected by O.C.G.A. § 37-3-166, we adhere to stricter disclosure requirements.
Subpoenas: Under Georgia law, we generally require a court order or specific patient authorization before releasing records in response to a subpoena in civil litigation (O.C.G.A. § 24-12-1).

2. YOUR RIGHTS REGARDING PHI

You have the following rights regarding the medical information we maintain about your child:

Right to Inspect and Copy: You have the right to inspect and receive a copy of your child's medical and billing records.
Right to Amend: If you feel that PHI we have is incorrect or incomplete, you may ask us to amend the information.
Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your child's PHI for purposes other than treatment, payment, or operations.
Right to Request Restrictions: You have the right to request a restriction on the PHI we use or disclose. While we are not always required to agree, we will comply if we are able.
Right to Confidential Communications: You may request that we communicate with you about medical matters in a certain way or at a certain location (e.g., only via a specific phone number).

3. OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing.
In accordance with O.C.G.A. § 19-7-5, as Occupational Therapists in the State of Georgia, we are mandated reporters. We are required by law to report any suspected child abuse or neglect to the Division of Family and Children Services (DFCS).

4. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Name: Emily McLemore

Phone: [Phone Number]

Email: emclemore@mustardseedot.com