Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Legal Duty: We understand that health information about your child is personal, and we are committed to protecting it. Federal and state laws require us to maintain the privacy of your and your child’s protected health information (PHI). We are also required to provide this notice about our privacy practices, our legal duties and your rights regarding PHI, and to notify you if there is a breach of unsecured PHI.
PHI includes all individually identifiable health information such as past, present or future physical or mental health, demographic data, test results, insurance information, and other data that may identify you or your child, including name, address, phone numbers, payment history, and other information. This notice describes how PHI may be used and disclosed and how you can get access to information. Wonder Land Occupational Therapy and Wellness will maintain the privacy of PHI according to all applicable federal and state laws.
Uses and Disclosures of Health Information: We use and disclose PHI for treatment, payment and health care operations. For example:
Treatment: We may use and disclose PHI to our employees. We may use and disclose your child’s PHI as part of assessment and intervention procedures. In addition, we may use and disclose your PHI with other caregivers, professionals, or persons working with you and/or your child, only when you give written consent. If a parent/legal guardian would like consultation with other caregivers/professionals/persons, the parent/legal guardian shall sign and submit a Release of Information form, which we will provide upon request.
Wonder Land OT and Wellness uses photography and video at times during treatment sessions. Images and recordings may be shared with the parent/legal guardian or your child as part of the therapeutic process. These will never be shared with other parties without your explicit and written consent via the Release and Information Form we have given you. You may opt out of the use of photography or video in your child’s sessions by signing an opt-out form, which we will provide upon request.
Payment: We may use and disclose PHI, with your written consent, in order to assist you or us in obtaining payment for the services we provide. This may include, but is not limited to, evaluation and progress reports, treatment notes, billings including treatment codes, or other documentation required by your payment source.
Marketing: We will not use PHI for marketing purposes without a written release from you. We may contact you about products or services related to your child’s treatment, case management or care coordination or to propose other treatments or health-related benefits and services in which you may be interested.
Health Care Operations: We may use and disclose PHI in order to perform various health care operational activities. This may include, but not be limited to, quality assessment and improvement activities; reviewing the competence, qualifications, or performance of our health care professionals; and conducting training programs, accreditation, certification, or credentialing activities.
Health Oversight Activities: We may be legally obligated to disclose PHI to agencies responsible for auditing, investigations, inspections and licensure.
You and Your Family and Friends. We must disclose PHI to you, as described in the Patient Rights section of this notice. You have the right to request restrictions on disclosure to family members, other relatives, close personal friends, or any other person identified by you
Appointment Reminders: We may use and share your PHI to remind you of a scheduled appointment for a treatment or medical services. We may contact you or your child to provide you or your child with appointment reminders via text, voicemail, postcards, or letters. We may also leave a message with the person answering the phone if you are not available, unless you instruct us not to do so in writing.
Required by Law: We may use or disclose PHI when we are required to do so by law. We are mandated reporters. We are obligated to make a report to an appropriate law enforcement or county child welfare agency whenever we have knowledge of or observe a child whom we know or reasonably suspect has been the victim of child abuse or neglect.
National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may be obligated to use or disclose PHI as required for national security: to authorized federal officials as required for lawful intelligence, counter-intelligence, and other national security activities, or to correctional institution or law enforcement official, having lawful custody of health information of inmates or patients under certain circumstances.
Your Authorization: You may give us written authorization (Release of Information) to use PHI or disclose it to any individual or entity for any purpose. If an authorization is provided to us for any individual or entity you may revoke the authorization in writing at any time. Revoking your authorization will not affect any disclosures permitted by your authorization while it was in effect. We cannot use or disclose your child’s health information for any reason except those described in the authorization without your further written authorization.
Patient Rights
Inspect and Copy: You have the right to review and request a copy of your child’s health information that may be used to make decisions about your child’s care. All requests for access to your child’s health information must be in writing.
Access: You have the right to look at or get copies of your or your child’s PHI, with limited exceptions. You must make the request in writing to obtain access to PHI. We will provide the copies via photocopies but we will use an alternate format you request unless we cannot practicably do so. We may charge you a reasonable cost-based fee for expenses such as copies, the alternate format, and staff time.
Right to Amend: If you feel that the PHI we have is incorrect or incomplete, you may ask us to amend the information. All requests to amend PHI must be in writing by you. We may deny your request for an amendment if it is not in writing by you, it does not include a reason to support the request, the information or record was not created by us or is not part of the PHI we keep, or the requested amendment is not accurate and complete.
Right to an Accounting of Disclosures: You have a right to receive a list of instances in which we disclosed PHI for purposes other than treatment, payment, health care operations and certain other activities for the last six years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable cost-based fee for responding to these additional requests.
Right to Request Restrictions: You have the right to request additional restrictions or limitations on the PHI we use or share. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in emergency or if legally mandated). In the event you pay out-of-pocket and in full for services rendered, you may request that we not share PHI with your health plan and we will agree (except if legally mandated).
Right to Request Method of Communications: You have the right to request that we communicate with you about PHI in a certain way or at a certain location so long as such requests are feasible and reasonable. For example, you can ask that we only contact you at your work phone number or home phone number or by mail to a certain address. All requests for specific communication methods regarding PHI must be in writing and specify which location or method you want PHI communicated. We will not send you unsecured emails pertaining to PHI without your prior authorization. If you do authorize such communications via unsecured email, you have the right to revoke the authorization in writing at any time.
Right to receive a “Good Faith Estimate”: You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises
More Information: For more information about our privacy practices, a paper copy of this notice, or to file a complaint if you believe we have violated your privacy rights, please email jackie@wonderlandot.com or at 415.342.0964. You will not be retaliated against for filing a complaint.
Changes: We reserve the right to change our privacy policies and practices and the terms of this Notice at any time, as permitted by federal and state law. If we change the privacy practices, we will issue a revised notice of privacy practices and make it available upon request. This Notice takes effect June 1st, 2021, and will remain in effect until replaced.