PATIENT NOTIFICATION OF PRIVACY POLICIES (HIPAA AUTHORIZATION)
YOUR PRIVACY RIGHTS

         This notice describes how medical information about you may be used and disclosed and how you can get access to this information. The Speech and Language Therapy Center, LLC is dedicated to ensuring the privacy of your child’s speech and/or language evaluation findings and course of therapy treatment. In serving our patients, we create records regarding treatment and services that are provided in order to have accurate information and ensure the appropriateness and efficiency of treatment services. Federal law requires us to strictly protect any personally identifying information on your child. This notice discloses our policies regarding the storage, use, and sharing of confidential patient information. PLEASE REVIEW THIS NOTICE CAREFULLY
The Speech and Language Therapy Center, LLC is required by law to keep your health information safe.

This information may include:
∙ Notes from your doctor, teacher, or other health care provider
∙ Your medical history
∙ Your test results
∙ Treatment notes
∙ Insurance information

A government rule requires that you get a copy of this privacy notice. This rule is called the Health Insurance Portability and Accountability Act, or HIPPA for short. We will ask you to sign a paper acknowledging that you have been given this notice.
Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy