`THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. OUR DUTIES
We are required by law to:
• Maintain the privacy of your Protected Health Information (PHI).
• Provide this Notice of our legal duties and privacy practices with respect to your PHI.
• Abide by the terms of this Notice currently in effect.
• Notify you following a breach of unsecured PHI.
We must follow the privacy practices described in this Notice, but we reserve the right to change our privacy practices and the terms of this Notice at any time. Revised terms will apply to PHI we already have and PHI we receive in the future. If we revise our Notice, we will make the new Notice available upon request and on our website (if applicable).
2. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The law permits or requires that we use or disclose your PHI for purposes of treatment, payment, and health care operations without your specific authorization:
Treatment
We may use or disclose PHI to provide, coordinate, or manage your speech therapy treatment and related services.
Payment
We may use or disclose PHI so that we or others may bill and receive payment from health plans and others for services provided.
Health Care Operations
We may use and disclose PHI to support our internal operations — for example, to evaluate quality, train staff, or comply with legal requirements.
Other Uses Permitted by Law
We may use or disclose PHI in certain situations without your written authorization for public health activities, law enforcement purposes, research (with protections), and when required by law.
3. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION
Except for the purposes listed above, we will not use or disclose your PHI without your written Authorization. You may revoke an Authorization at any time, except to the extent we have already acted based on your prior Authorization.
Examples of uses requiring your Authorization include most uses of psychotherapy notes, marketing purposes, or sale of PHI.
4. SPECIAL RULE FOR SUBSTANCE USE DISORDER (SUD) RECORDS
If Golden Speech Therapy creates, receives, maintains, or transmits records related to substance use disorder treatment that are subject to Federal confidentiality protections under 42 CFR Part 2, then the following applies:
• SUD records have enhanced confidentiality protections beyond the basic HIPAA Privacy Rule.
• SUD records generally cannot be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order.
• If we use or disclose Part 2-protected records, we must provide you specific notice of those protections and your rights regarding those records.
If applicable, attach or provide the SUD notice required under 42 CFR 2.22 alongside this Notice. (§2.22(b)(1)).
5. YOUR INDIVIDUAL RIGHTS
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI, with limited exceptions.
Right to Amend
You may ask us to amend your PHI if you believe it is incorrect or incomplete.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI.
Right to Restrict Certain Uses and Disclosures
You may request restrictions on certain uses and disclosures of PHI. We are not required to agree, except in specific circumstances (e.g., if you pay out-of-pocket in full for a service).
Right to Confidential Communications
You may request that we communicate with you by alternative means or at an alternative location.
Right to Opt Out of Fundraising Communications
You have the right to decline receiving fundraising communications from us.
6. POSSIBILITY OF REDISCLOSURE
When we disclose PHI to others, such as other health care providers, insurers, or their business associates, that information may be redisclosed by the recipient. Once PHI is disclosed outside of HIPAA protections, it may no longer be protected under HIPAA unless federal or state law continues to apply.
7. COMPLAINTS
If you believe your privacy rights have been violated, you may complain to:
• Golden Speech Therapy’s Privacy Officer: Suzanne Golden sgolden@goldenspeechtherapy.com
• U.S. Department of Health and Human Services, Office for Civil Rights (OCR).
You will not be retaliated against for filing a complaint.
8. CONTACT INFORMATION
Privacy Officer: Suzanne Golden
Phone: 781-603-8529
Email: sgolden@goldenspeechtherapy.com
Mailing Address: 116 Long Pond Rd. Suite 6 Plymouth, MA 02360
9. ACKNOWLEDGEMENT OF RECEIPT OF NOTICE
I acknowledge that I have received a copy of the Golden Speech Therapy Notice of Privacy Practices.
Patient/Personal Representative Name: ____________________
Signature: ____________________
Date: ____________________
Effective Feb. 16, 2026.
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