Privacy Policy

Cornerstone Speech Therapy
“Your Partner in Speech Services”
Notice of Privacy Practices

Effective 4/1/2009
Version CST.01

This Notice Describes How Your Individually Identifiable Health Information May Be Used and Disclosed and How You Can Get Access to This Information.Please Review it Carefully.

Cornerstone Speech Therapy is required by federal and state law to safeguard and maintain the privacy of individually identifiable patient health information. This notice provides an explanation of how we handle your protected health information. We are committed to protecting this information and helping you understand your rights.

How We May Use and Disclose Your Health Information

We are permitted, but not required, to use and disclose protected health information without an individual’s authorization for the following situations:

Individual – We may use and disclose protected health information to the individual who is the subject of the information.

Treatment – We may use and disclose protected health information during the treatment process to those who have a legitimate need for such information to include (but not limited to) Cornerstone Speech Therapy personnel and others involved in your case such as family members, physicians, and other health care providers for purposes related to your treatment. We also may use and disclose your protected health information to inform you of, and assist you in, identifying and obtaining resources, or recommending possible treatment options, alternatives, or other health related benefits and services that will be of interest to you.

Payment – We may use and disclose protected health information to obtain payment for speech services
such as determining coverage, eligibility, billing, and reimbursement. We may share this information
with you, other providers, insurance companies, and third parties that may be responsible for such costs,
such as family members.

Operation – We may use and disclose protected health information during routine health care operations
including quality of care assessment and improvement activities; competency assurance activities;
conducting or arranging for medical review audits; legal activities; business planning; development; and any other general business management activities (including appointment reminders) of Cornerstone
Speech Therapy.

Business Associates – We may use and disclose protected health information to business associates that
are contracted to perform business functions for Cornerstone Speech Therapy. These arrangements
require Business Associates to keep your information confidential.

Marketing and Fundraising – We may contact you to inform you of new or potential treatment options
or alternatives, or health-related benefits or services that may be of interest to you; to send you
newsletters, annual reports, or other information about Cornerstone Speech Therapy; to inform you of
seminars, special events, or giving opportunities. If you do not want to be contacted for marketing or
fundraising activities, you must notify in writing, Cornerstone Speech Therapy Privacy Official at P.O.
Box 16092, Columbus, Ohio 43216.

Special Situations

The following categories are unique situations that require an accounting of but do not require your
written consent or permission to use and disclose your protected health information.

• As required by law – federal, state, or local
• To public health authorities
• To report child abuse, neglect, and/or domestic violence
• For health oversight activities such as audits and investigations
• For judicial or administrative proceedings
• For law enforcement purposes
• To funeral directors, coroners, and medical examiners
• For purposes of organ or tissue donation
• For research purposes as approved by the Privacy Board.
• To prevent a serious threat to Health and Safety
• For essential government functions
• To comply with worker’s compensation laws and other similar programs providing benefits for
work-related injuries or illnesses

Cornerstone Speech Therapy is not obligated to have your written consent or permission to use and
disclose your protected health information to provide treatment, obtain payment, conduct health care operations, and/or under the special situations section of this privacy notice. Other uses and disclosures
require your written authorization to release the protected health information.

Your Rights Regarding Your Health Information

While all the records concerning your speech services are the property of Cornerstone Speech Therapy,
you have the following rights regarding your protected health information:

Access – Individuals have the right to review and obtain a copy of their protected health information. In
certain limited circumstances, we may be required to deny your request. We may impose reasonable,
cost-based fees for copying, postage, labor and supplies associated with your request.

Amendment – Individuals have the right to amend their protected health information if you believe it is
incorrect or incomplete. If we accept the amendment request, we must make reasonable efforts to provide
the amendment to persons that the individual has identified as needing it, and to persons that we know
might rely on the information to the individuals detriment. If we deny the amendment request, we must
provide you with a written denial and allow you to submit a statement of disagreement for inclusion in
your protected health information.

Disclosure Accounting – Individuals have the right to an accounting of the disclosures of your protected
health information. We do not have to provide an accounting for uses and disclosures related to
treatment, payment, health care operation, however, we are required to provide an accounting of the
special situations outlined in this privacy notice.

Restriction Request – Individuals have the right to request a restriction or limitation on the health
information we use and disclose for treatment, payment, or health care operations to family members,
relatives, close personal friends, or other individuals involved in your care. We do not have to agree to do
this, but if we agree, we must honor the restriction that you want, except for purposes of treating the
individual in a medical emergency, required by law or when the information is necessary to treating you.
If you provide us permission to use or disclose health information about you, you may revoke that
permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose
health information about you for the reasons covered by your written authorizations.

Confidential Communications – Individuals have the right receive confidential communication of your
protected health information by alternative means or at alternative locations. We must accommodate
reasonable request if you indicate that the disclosure of all or part of the protected health information
could endanger the individual. We may not question your statement of endangerment.

Notice of Privacy Practices – Individuals have the right to receive a copy of this Notice of Privacy
Practices.

File a Compliant – Individuals have the right to file a compliant if you believe your privacy rights have
been violated. To file a compliant, contact the Privacy Official at Cornerstone Speech Therapy (P.O. Box
16092, Columbus, Ohio 43216) or with the Secretary of the Development of Health and Human Services t the Office for Civil Rights in Washington D.C.. All complaints must be submitted in writing. You will
not be penalized for filling a compliant.

Further Information

To obtain additional information, please contact Cornerstone Speech Therapy’s Privacy Official at (614)
973-9755 or by e-mail at info@cornerstonespeechtherapy.com

Changes To This Notice

Cornerstone Speech Therapy will abide by the terms of the notice currently in effect and reserves the right
to change the terms of its notice and to make the new notice provisions effective for all protected health
information that it maintains. You will receive the most current notice at your next schedule visit.