School Bridge, LLC 1489 Chain Bridge Road, #203, McLean, Virginia 22101 www.testingld.com
Privacy Notice 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. School Bridge, LLC. (the PRACTICE) is required by the Health Insurance Portability and Accountability Act (HIPAA), a federal law, to maintain the privacy of your health information and to provide you with this notice. The PRACTICE is required to meet all procedures and standards defined in this notice. Your
Privacy is Important The PRACTICE understands your privacy is important. The PRACTICE will handle information about you only as allowed by federal and state law and PRACTICE policy. If at any time you believe your privacy rights have been violated, you may verbally or in writing contact: 1. PRACTICE Privacy Officer 2. United States Secretary of Health and Human Services Addresses and phone numbers to use for this contact are listed at the end of this notice. You will not suffer a change in your services or retaliation for filing a complaint. Each time you receive services from the PRACTICE, the evaluator makes a record of the visit. Typically, this record contains your assessment, service plan, progress notes, diagnoses, and plan for future care or recommended treatment.
Your Federally Defined Rights under HIPAA. There are several rights concerning your health information in the record that the PRACTICE wants you to be aware of 1. You have the right to request access to your record in order to inspect, copy, amend, or correct it. This right is not absolute. In certain situations, such as if access would cause harm, the PRACTICE can deny access. You must make this request in writing to the evaluator. 2. You have the right to receive at any time accounting of the PRACTICE's disclosure of your record. You have the right to receive information from the PRACTICE through the means you prefer (e.g., telephone, mail 3. You have the right to request a restriction with regard to the use or disclosure of your record. This request will be given serious consideration and you will be informed promptly whether the PRACTICE will be able to use the restriction and still offer effective services, receive payment, and maintain operations. Legally the PRACTICE is not required to abide by any restrictions you request.
Use and Disclosure of Your Information The PRACTICE uses and discloses necessary information about you internally and with business associates in order to provide service, receive payment for service provided, and conduct day-to-day business practices. For example: In order effectively to provide service, the evaluator may consult with or seek supervision from other service providers associated with the PRACTICE. During those consultations or supervisions, health information about you the client, and family may be shared. In order to receive payment for services provided, your health information may be sent to those companies or groups responsible for payment, or that you designate as your third-party payor. In addition, the PRACTICE sends a monthly bill to the responsible party identified by you and noted on your financial form. Patient bills outstanding for more than (3) three months will be submitted by School Bridge, LLC www.testingld.com the PRACTICE to a collection agency or attorney for litigation. In day-to- day business practices, trained staff may handle your physical records in order to have the record assembled and available for review by your evaluator and to file documentation. Certain data elements are entered into the PRACTICE's computer system.