Terms & Conditions
Confidentiality Agreement
Here at Neurocommunication and Swallow LLC we take client confidentiality and the security of your data very seriously. To begin therapy we require some of your person details such as: your name, address, date of birth, details of your medical provider and other professionals involved in your care, telephone and e-mail details, and insurance provider details. In some cases we may also need details of any medical interventions which you have had and the professionals involved. If we are providing therapy for your child we may additionally need information from for example your child’s school or daycare. In the best interests of your therapy we sometimes need to liaise and share information with other professionals. We will only do this with your express written permission – see our Privacy Policies. Information stored on paper such as your case notes will be shredded seven years after the last payment for services was received. We follow all HIPAA (Health Insurance Portability and Accountability Act of 1996) requirements for privacy.
This Confidentiality Agreement (the “Agreement”) is made and entered into between (“Legal Guardian”) and Neurocommunication and Swallow LLC
The parties acknowledge that Legal Guardian may incidentally or inadvertently encounter, view or access certain Confidential Information maintained by Covered Entity which may qualify as Protected Health Information (“PHI”) or electronic PHI within the meaning of the Health Insurance Portability and Accountability Act of 1996, as amended, and the privacy and security standards promulgated pursuant thereto (“HIPAA”).
NOW, THEREFORE, in consideration of the mutual promises contained herein, as well as other good and valuable consideration, the parties hereto agree as follows:
“Confidential Information” means any and all non-public, medical, financial and personal information in whatever form (written, oral, visual or electronic) possessed or obtained by either party. Confidential Information shall include all information which (i) either party has labeled in writing as confidential, (ii) is identified at the time of disclosure as confidential, (iii) is commonly regarded as confidential in the healthcare industry, or (iv) is Protected Health Information as defined by HIPAA.
Legal Guardian agrees to maintain the confidentiality of any Confidential Information, including Protected Health Information that it may incidentally or inadvertent encounter, view or have access to while providing the services under the terms and conditions set forth in this Agreement.
Legal Guardian agrees not to further use or disclose any Confidential Information, including Protected Health Information that it incidentally or inadvertently views or obtains access to and further agrees to implement appropriate safeguards to prevent any further use or disclosure of any Confidential Information that is incidentally or inadvertently access
Legal Guardian agrees to report to the Covered Entity any use or disclosure of Confidential Information in violation of this Agreement, HIPAA or any other federal, state or local law or regulation.
Legal Guardian agrees to comply with all applicable laws and regulations, including HIPAA and the HITECH Act, to the extent applicable, in meeting their obligations under this Agreement.
The obligations of confidentiality and non-use and non-disclosure under this Agreement will continue indefinitely from the effective date of this Agreement.
This Agreement may be modified or amended only with the written consent of both parties.
No waiver of any provision of this Agreement, including this paragraph, shall be effective unless the waiver is in writing and signed by the party making the waiver.
Access to records
In accordance with the Health Insurance Portability and Accountability Act 45 CFR § 164.524, Upon request, Legal Guardians have the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice. Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created; whether the information is maintained in paper or electronic systems onsite, remotely, or is archived; or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.).
Payment
Payment must be made immediately after the session and can be made via cash, check, Venmo, or Zelle.
Cancellation/Unattendance
Cancellation is expected with at least 24 hours’ notice. If your appointment must be canceled by Neurocommunication and Swallow LLC, we will aim to inform you at least 24 hours in advance and may be able to reschedule another appointment for you. If more than 2 sessions in a row are canceled or missed we will discuss putting your/your child’s therapy on hold until your personal circumstances permit regular attendance.
Cancellation/Unattendance
If you are receiving speech and language therapy from your school system. You must inform Neurocommunication and Swallow LLC. The school therapist should also be informed of the involvement of Neurocommunication and Swallow LLC.
Termination of Services
Neurocommunication and Swallow LLC may terminate therapy or intervention with 24 hours’ notice. The client may also terminate therapy or intervention with 24 hours’ notice.