LEGAL OBLIGATIONS:
Parent-Child Services Group, Inc. (PCSG) is required by law to maintain the privacy of all medical information within its organization; provide this notice of privacy practices to all clients; inform clients of our legal obligations; and advise clients of additional rights concerning their medical information. PCSG must follow the privacy practices contained in this notice from its effective date of April 14, 2003, and continue to do so until this notice is changed or replaced.

PCSG reserves the right to change our privacy practices and the terms of this notice at any time, provided applicable law permits the changes. Any changes made in these privacy practices will be effective for all medical information that is maintained including medical information created or received before the changes were made. All clients will be notified of any changes by receiving a new notice of privacy practices.

You may request a copy of this notice of privacy practices at any time by contacting PCSG at 1225 E. Weisgarber Road, Suite 180 South, Knoxville, TN 37909.


WHO IS COVERED BY THIS NOTICE:
This notice describes the practices of PCSG employees for any sites and locations. For any student observers, a confidentiality notice will be signed by the student and reasonable efforts will be made to inform you of their visit to our facilities. All student employees sign confidentiality notices and are advised of confidentiality policies.

USES AND DISCLOSURES OF MEDICAL INFORMATION:
Your medical information may be used and disclosed for treatment, payment, and health care operations, for example:

TREATMENT: Your medical information may be disclosed to a doctor or hospital that asks for it to provide treatment to you. Departments or therapists within PCSG may share information with one another to improve recommendations for your child’s care.

PAYMENT: Your medical information may be used or disclosed to insurers or contract agencies to pay claims for services provided to you by therapists within PCSG’s facilities.

APPOINTMENT REMINDERS / ROUTINE COMMUNICATIONS: Unless otherwise notified by you in writing, PCSG may contact you for appointment information or other necessary communications at any of the numbers or addresses provided by you and contained within our files.

HEALTH CARE OPERATIONS: Your medical information may be used and disclosed for routine operations such as to determine insurance coverage for services, to conduct quality assessment and improvement activities, to engage in care coordination or case management, to pursue Right of Recovery and Reimbursement/Subrogation, for accreditation, for conducting and arranging legal services, for accounting purposes, for contract typing of PCSG reports etc.

AUTHORIZATIONS: You may provide written authorization to use your medical information or to disclose it to anyone for any purpose. You may revoke an authorization for release of information in writing at any time but this
revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give written authorization, we cannot use or disclose your medical information for any reason except those described in this notice.

VIDEOTAPING / PHOTOGRAPHY: Parent-Child Services Group, Inc. therapists may videotape or photograph your child in the course of providing therapy. These photographs or videotapes may be used for the purpose of preparing personally-identifiable therapy materials (e.g., schedules, task boards) and to monitor your child’s progress. These tapes or photographs will not be shared with anyone without your signed release except as indicated in other sections of this summary.

USE OF PCSG LIBRARY FACILITIES: If you choose to use the library facilities at PCSG, your name may be added to a check-out card which may be viewed by others in the course of checking out materials.

PERSONAL REPRESENTATIVE: Your medical information may be disclosed to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care but only if you agree we may do so, as described in the Individual Rights section of this notice below.

MARKETING: Your medical information will not be used for marketing without your signed consent. Typical requests for use of your information would be for use of comments on PCSG’s website (if you have completed a form requesting these comments) or in brochures or other documents created to demonstrate satisfaction of services.

RESEARCH: Your medical information may be used or disclosed for research purposes in limited circumstances. This research information will not contain any personally-identifiable names or addresses but may be summarized in the form of cumulative test scores or demographics.

AS REQUIRED BY LAW: Your medical information may be used or disclosed as required by state or federal law. For example, medical information must be disclosed to the U.S. Department of Health and Human Services upon request for purposes of determining compliance with federal privacy laws. Medical information may be disclosed when required by workers' compensation or similar laws; to a government agency authorized to oversee the health care system or government programs or its contractors; and to public health authorities for public health purposes.

COURT OR ADMINISTRATIVE ORDER: Medical information may be disclosed in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances (i.e. court order, warrant, or grand jury subpoena), medical information may be disclosed to law enforcement officials. In addition, medical information may be disclosed to law enforcement officials concerning a suspect, fugitive, material witness, crime victim or missing person. Medical information may be disclosed to law enforcement officials or correctional institution regarding an inmate or other person in lawful custody, in certain circumstances.

VICTIM OF ABUSE: Medical information may be released to appropriate authorities under reasonable assumption that you or your child are possible victims of abuse, neglect or domestic violence or the possible victim of other crimes. Medical information may be released to the extent necessary to avert a serious threat to your or your child’s health or safety or to the health or safety of others. Medical information may be disclosed when necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has escaped from lawful custody.

MILITARY AUTHORITIES: Medical information of Armed Forces personnel may be disclosed to Military authorities under certain circumstances. Medical information may be disclosed to authorized federal officials as required for lawful intelligence, counterintelligence, and other national security activities.

INDIVIDUAL RIGHTS:
You have the right to look at or get copies of your medical information, with limited exceptions. You may request a format other than photocopies, which will be used unless the company cannot practicably do so. You must make the request in writing to obtain access to your medical information. You may obtain a form to request access by using the contact information at the end of this notice or you may send us a letter requesting access to the address located at the end of this notice. If you request copies amounting to more than 10 pages, there will be a charge
of $.25 per page, $10 per hour for staff time to copy your medical information, and postage if you want the copies mailed to you. If you request an alternative format, the charge will be cost-based for providing your medical information in that format. If you prefer, we will prepare a summary or explanation of your medical information for an hourly fee (based on current hourly therapy rates). For a more detailed explanation of the fee structure, please use the information at the end of this notice to contact our office.

You have the right to receive an accounting of the disclosures of your medical information by our company or by a business associate of our company. This accounting will list each disclosure that was made of your medical information for any reason other than treatment, payment, health care operations and certain other activities since April 14, 2003. This accounting will include the date the disclosure was made, the name of the person or entity the disclosure was made to, a description of the medical information disclosed, the reason for the disclosure, and certain other information. If you request an accounting more than once in a 12-month period, there may be a reasonable cost-based charge for responding to these additional requests. For a more detailed explanation of the fee structure, please use the information at the end of this notice to contact our office.

You have the right to request restrictions on the company's use or disclosure of your medical information. The company is not required to agree to these additional requests, but if in agreement, the company will honor the agreement, except in an emergency. Any agreement to restrictions on the use and disclosure of your medical information must be in writing and signed by a person authorized to make such an agreement on behalf of the company. The company will not be bound unless the agreement is so memorialized in writing.

You have the right to request confidential communications about your medical information by alternative means or alternative locations. You must inform the company that confidential communication by alternative means or to alternative location is required to avoid endangering you. You must make your request in writing and you must state that the information could endanger you if it is not communicated by the alternative means or to the alternative location requested. The company must accommodate the request if it is reasonable, specifies the alternative means or location, and continues to permit use to collect payment from you or your insurer under your health plan.

You have the right to request that the company amend your medical information, typically history information contained in reports. Your request must be in writing and it must explain why the information should be amended. The company may deny your request if the medical information you seek to amend was not created by our company or for certain other reasons. Interpretation of scores or analysis of behaviors by the therapists are not amendable in the record. If your request for amendment is denied, the company will provide a written explanation of the denial. You may respond with a statement of disagreement to be appended to the information you wanted amended. If the company accepts your request to amend the information, the company will make reasonable efforts to inform others, including the people you name, of the amendment and to include the changes in any future disclosures of that information.

If you received this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form as well. To obtain this notice in written form, please use the information at the end of this notice to contact our office.

If you want more information concerning the companies' privacy practices or have questions or concerns, please contact us as indicated below.

If you are concerned that the company has violated your privacy rights, or you disagree with a decision made about access to your medical information, or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information below. You may also submit a written complaint to the U.S. Department of Health and Human Services. The address to file a complaint with the U.S. Department of Health and Human Services will be provided upon request.

Parent-Child Services Group, Inc. supports your right to protect the privacy of your medical information. There will be no retaliation in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Lynne F. Harmon, M.A., CCC-SLP, President
Parent-Child Services Group, Inc.
1225 E. Weisgarber Road, Suite 180 South
Knoxville, TN 37909
(865) 584-5558
(865) 584-6607 FAX
lynneh@parent-childservices.com