⚠️ 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.
Theotokos ABA Therapy ("Practice," "we," "our," or "us") is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to PHI, and to notify you following a breach of unsecured PHI. We are required to abide by the terms of this Notice currently in effect.
1. What Is Protected Health Information (PHI)?
PHI is any information about your health, treatment, or payment for healthcare services that can be linked to you as an individual. This includes information we create, receive, maintain, or transmit — in any form (paper, electronic, or verbal) — in connection with providing ABA therapy services.
Examples of PHI we may collect include your child's name and date of birth, diagnosis, behavioral assessment results, treatment plans, progress notes, insurance information, and billing records.
🔒 Your child's PHI is never collected through our website forms. Web-based contact and intake forms are for scheduling purposes only. All clinical information is collected through our secure intake process by phone or in person.
2. How We May Use and Disclose PHI
We may use and disclose your PHI for the following purposes without requiring your separate written authorization:
Treatment
We use PHI to provide, coordinate, and manage your child's ABA therapy services. For example, we share information among our Board Certified Behavior Analysts (BCBAs), Registered Behavior Technicians (RBTs), and any consulting professionals involved in your child's care.
Payment
We may use and disclose PHI to obtain payment for services, including submitting claims to your insurance carrier, obtaining prior authorizations, and verifying coverage.
Healthcare Operations
We may use PHI for internal business activities including quality improvement, staff training and supervision, compliance activities, and administrative functions necessary to run our practice.
Other Permitted Uses and Disclosures
Without your authorization, we may also use or disclose PHI:
- As required by law: including mandatory reporting obligations (e.g., suspected child abuse or neglect)
- Public health activities: reporting communicable diseases or vital statistics to authorized agencies
- Health oversight activities: to government agencies for audits, inspections, or licensure proceedings
- Judicial and administrative proceedings: in response to a court order or lawful subpoena
- Law enforcement: to identify or locate a suspect, victim, or missing person when required
- Emergency situations: to prevent or lessen a serious and imminent threat to the health or safety of a person or the public
- Workers' compensation: to comply with workers' compensation laws
3. Uses and Disclosures Requiring Your Authorization
We will not use or disclose your PHI for the following purposes without your written authorization:
- Marketing purposes
- Sale of PHI
- Most uses of psychotherapy notes (where applicable)
- Any other use or disclosure not described in this Notice
You may revoke any authorization you have given us at any time, in writing. Revocation will not affect uses or disclosures we already made in reliance on your authorization.
4. Business Associates
We may share PHI with certain third-party vendors and service providers ("Business Associates") who perform services on our behalf, such as billing companies, electronic health record systems, and practice management software. We require all Business Associates to enter into a Business Associate Agreement (BAA) that obligates them to protect your PHI in accordance with HIPAA.
5. Your Rights Regarding Your PHI
You have the following rights with respect to your PHI:
Right to Access: You may request a copy of your (or your child's) medical records and PHI that we maintain. We will provide access within 30 days of your request. A reasonable fee may apply for copies.
Right to Amend: You may request that we correct or amend PHI you believe is inaccurate or incomplete. We may deny your request in certain circumstances.
Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI, excluding disclosures for treatment, payment, and healthcare operations.
Right to Request Restrictions: You may request restrictions on how we use or disclose your PHI. We are not required to agree to all requests but will try to accommodate reasonable ones.
Right to Confidential Communications: You may request that we communicate with you in a specific way or at a specific location (e.g., call you only at a certain phone number).
Right to a Paper Copy of This Notice: You may request a paper copy of this Notice at any time, even if you received it electronically.
Right to Notification of Breach: You will be notified if there is a breach of your unsecured PHI as required by law.
To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information in Section 8 below.
6. Minimum Necessary Standard
When using or disclosing PHI or requesting PHI from others, we make reasonable efforts to limit PHI to the minimum amount necessary to accomplish the intended purpose of the use, disclosure, or request.
7. Changes to This Notice
We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. If we revise this Notice, we will post the updated version on our website at theotokosaba.org/npp.html and provide a copy upon request. The effective date appears at the top of this Notice.
8. Complaints and Contact
If you believe your privacy rights have been violated, you may file a complaint with us or directly with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. We will not retaliate against you for filing a complaint.
To file a complaint with us or exercise your rights, contact our Privacy Officer:
- Business: Theotokos ABA Therapy
- Privacy Officer: Practice Director / BCBA
- Address: Santa Clarita, CA 91351
- Phone: (818) 401-6975
- Email: [email protected]
To file a complaint with HHS:
- U.S. Department of Health & Human Services, Office for Civil Rights
- 200 Independence Avenue, S.W., Washington, D.C. 20201
- Phone: 1-877-696-6775 (toll-free)
- Website: hhs.gov/hipaa/filing-a-complaint
This Notice is provided in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, and the HIPAA Omnibus Rule (2013). See also our Website Privacy Policy.