SHINE THERAPY, LLC 

HIPAA NOTICE OF PRIVACY PRACTICES 

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE  USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS  INFORMATION. PLEASE REVIEW IT CAREFULLY. 

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The terms of this Notice of Privacy Practices (“Notice”) apply to Shine Therapy, LCC, its affiliates  and its employees. Shine Therapy, LLC will share protected health information of patients as  necessary to carry out treatment, payment, and health care operations as permitted by law.  

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We are required by law to maintain the privacy of our patients' protected health information  and to provide patients with notice of our legal duties and privacy practices with respect to  protected health information. We are required to abide by the terms of this Notice for as long  as it remains in effect. We reserve the right to change the terms of this Notice as necessary and  to make a new notice of privacy practices effective for all protected health information  maintained by Shine Therapy, LLC. We are required to notify you in the event of a breach of  your unsecured protected health information. We are also required to inform you that there  may be a provision of state law that relates to the privacy of your health information that may  be more stringent than a standard or requirement under the Federal Health Insurance  Portability and Accountability Act (“HIPAA”). A copy of any revised Notice of Privacy Practices or  information pertaining to a specific State law may be obtained by mailing a request to the  Privacy Officer at the address below.  

 

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION: 

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Authorization and Consent: Except as outlined below, we will not use or disclose your  protected health information for any purpose other than treatment, payment or health care  operations unless you have signed a form authorizing such use or disclosure. You have the right  to revoke such authorization in writing, with such revocation being effective once we actually  receive the writing; however, such revocation shall not be effective to the extent that we have  taken any action in reliance on the authorization, or if the authorization was obtained as a  condition of obtaining insurance coverage, other law provides the insurer with the right to  contest a claim under the policy or the policy itself. 

Uses and Disclosures for SMS/MMS:  Personal information is shared only as needed for information sharing, billing, and coordination of therapeutic services.  Outside of these purposes, personal information will not be shared with a 3rd party without your explicit consent. SMS consent or phone numbers for the purpose of SMS are not shared with any 3rd parties. 

Uses and Disclosures for Treatment: We will make uses and disclosures of your protected  health information as necessary for your treatment.  

Uses and Disclosures for Payment: We will make uses and disclosures of your protected health  information as necessary for payment purposes. We may forward information regarding your  medical procedures and treatment to your insurance company to arrange payment for services. 

Uses and Disclosures for Health Care Operations: We will make uses and disclosures of your  protected health information as necessary, and as permitted by law, for our health care  operations, which may include audits by insurance companies or government appointed  agencies as part of their quality assurance and compliance reviews. 

Individuals Involved In Your Care: We disclose protected health information to designated  family, friends and others who are involved in your child’s care, with your permission. 

Appointments and Services: We may contact you to provide appointment updates or  information about your treatment or other health-related benefits and services that may be of  interest to you. This may include letters, voicemail messages, or electronic reminders. You have  the right to request that we communicate with you in a certain way. 

Therapist Training: We may use and disclose protected health information for training  purposes. Your health information will never be disclosed to other professionals without your  written consent. 

Other Uses and Disclosures: We are permitted and/or required by law to make certain other  uses and disclosures of your protected health information without your consent or  authorization for the following: 

• Any purpose required by law; 

• To a government oversight agency conducting audits, investigations, civil or criminal  proceedings; 

• Court or administrative ordered subpoena or discovery request; 

• To law enforcement officials as required by law if we believe you have been the victim of  abuse, neglect or domestic violence. We will only make this disclosure if you agree or when  required or authorized by law;  

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RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION: 

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Confidential Communication: You have the right to request that we communicate with you in a  certain way. You may request that we only communicate your health information privately with  no other family members present or through mailed communications that are sealed. We will  make every effort to honor reasonable requests.  

Access to Your Protected Health Information: You have the right to copy and/or inspect much  of the protected health information that we retain on your behalf. For protected health  information that we maintain in any electronic designated record set, you may request a copy  of such health information in a reasonable electronic format, if readily producible. Requests for  access must be made in writing. We may charge a small amount for copy fees. 

Amendments to Your Protected Health Information: You have the right to request in writing  that protected health information that we maintain about you be amended or corrected. All  amendment requests, must be in writing, signed by you or legal representative, and must state  the reasons for the amendment/correction request. Your request may be denied if the health  information in question did not originate from Shine Therapy, is not part of our records, or if  the records are determined to be accurate and complete.  

Accounting for Disclosures of Your Protected Health Information: You have the right to receive  an accounting of certain disclosures made by us of your protected health information. Requests  must be made in writing and signed by you or your legal representative.  

Restrictions on Use and Disclosure of Your Protected Health Information: If you paid out-of pocket (or in other words, you have requested that we not bill your health plan) in full for a  specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or  health care operations, and we will honor that request.  

Right to Notice of Breach: We take very seriously the confidentiality of our patients’  information, and we are required by law to protect the privacy and security of your protected  health information through appropriate safeguards. We will notify you in the event a breach  occurs involving or potentially involving your unsecured health information and inform you of  what steps you may need to take to protect yourself.  

Paper Copy of this Notice: You have a right, even if you have agreed to receive notices  electronically, to obtain a paper copy of this Notice. To do so, please submit a request to  shinetherapyllc@yahoo.com.