This Notice Describes how Medical Information about you may be Used & Disclosed and how you can get Access to the Information.

Medical Information: Behavioral Innovation understands that your treatment information is personal to you, that is why we are committed to protecting your information. A record is created for you when you first come in. This record has information of the services that your child receives. You have the right to limit the disclosure to insure proper treatment and payment.

Disclosures of Medical Information: The following are descriptions of different ways we may disclose your information. Not every disclosure is listed; however we are permitted to use this information that may fall in one of these categories.

Coordination of Services: We may disclose your child’s information to another service provider if you have signed a release of records consent.

Emergency Situations: We may disclose basic information about your child to provide emergency medical treatment in case of an emergency. This could be doctors, nurses or other emergency staff.

Payment: We may disclose information about your child to an insurance company so we may bill and collect on the services that your child received.

Individuals Involved in Your Child’s Care: We may release treatment information about your child to family members or family friends who are involved in your child’s treatment.

As Required by Law: We will disclose medical information about your child when required to do so by federal, state, and local law.

Healthcare Audits: We may disclose this information to an audit agency for activities authorized by the law. These audits may include investigation, inspections, and credentialing.

The Right to Records: You have a right to your child’s treatment information. You can do this by calling BI’s Administrative Department. An appointment will be set for you to come in and review them. You may also have copies your records, although we will need a 30 day notice to collect them for you.

Restriction Right: You have the right to restrict the disclosure of your child’s treatment information. You also have the right to limit the information we disclose about your child to someone involved in your child’s care, such as family.

To request restrictions, you must make the request in writing to outline what information you want limited and whom you want the information limits to apply towards (Please see Medical Release Form).

Right to Request Confidential Communication: You have the right to request that we communicate your child’s information to you in a certain way or at a certain location. For example, you can ask us to only contact you at work.

To request confidential communications, the request must be in writing and include how we may get in touch with you. We will try to accommodate all reasonable requests.

Right to Have a Copy o f the Privacy Notice: You have the right to have a copy of this notice. You may ask us for this copy at any time.

Changes to this Notice: We reserve the right to change this notice. We reserve the right to revise without prior notice and you will receive a copy.

Complaints: If you believe that your privacy has been violated, you may file a complaint with our office.

Other: If you provide us with permission to use or disclose information about your child you may revoke it at any time. This must be in writing with your written authorization. You understand that we are unable to take back any disclosures that were already made with your permission.