Notice of Privacy Practices

About This Notice

This Notice of Privacy Practices ("Notice") describes how The Cognitive Coach may use and disclose your Protected Health Information (PHI) and your rights regarding your health information.

Provider: Doreen Bridgman, MS, CCC, SLP-CBHC
Practice: The Cognitive Coach
Licensed in: Florida & New Jersey
Contact: doreen@thecognitivecoach.net

We are required by law to maintain the privacy of your health information, provide you with this Notice of our legal duties and privacy practices, and notify you following a breach of your unsecured health information.

Your Health Information Rights

You have the following rights regarding your health information:

Right to Access

You have the right to inspect and obtain a copy of your health information maintained by us. To request access, submit a written request to our office. We may charge a reasonable fee for copying and mailing costs.

Right to Request Amendment

If you believe your health information is incorrect or incomplete, you may request an amendment. Your request must be in writing and provide a reason for the amendment. We may deny your request in certain circumstances but will provide you with a written explanation.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your health information. This accounting does not include disclosures for treatment, payment, or healthcare operations, or disclosures you authorized in writing.

Right to Request Restrictions

You may request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except for restrictions on disclosures to health plans for services you paid for in full out of pocket.

Right to Confidential Communications

You may request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we contact you only at work or by mail.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice upon request, even if you agreed to receive this Notice electronically.

How We May Use and Disclose Your Health Information

For Treatment

We may use and disclose your health information to provide cognitive coaching services to you. For example, we may use information about your cognitive challenges to develop and implement coaching strategies.

For Payment

We may use and disclose your health information to bill and collect payment for services. This may include providing information to your insurance company or other payers.

For Healthcare Operations

We may use and disclose your health information for our practice operations, such as quality improvement activities, training, and administrative functions.

With Your Written Authorization

Other uses and disclosures of your health information require your written authorization. You may revoke your authorization at any time in writing, except to the extent that we have already taken action based on your authorization.

Disclosures Without Your Authorization

We may use or disclose your health information without your authorization in the following circumstances:

As Required by Law

We will disclose health information when required to do so by federal, state, or local law.

Public Health Activities

We may disclose health information for public health purposes, such as preventing or controlling disease, injury, or disability.

Abuse, Neglect, or Domestic Violence

We may disclose health information to appropriate authorities if we believe you are a victim of abuse, neglect, or domestic violence.

Health Oversight Activities

We may disclose health information to health oversight agencies for activities authorized by law, such as audits, investigations, and inspections.

Judicial and Administrative Proceedings

We may disclose health information in response to a court order, subpoena, or other lawful process.

To Avert a Serious Threat to Health or Safety

We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of others.

Workers' Compensation

We may disclose health information as authorized by workers' compensation laws.

Our Responsibilities

We are required to:

• Maintain the privacy of your health information
• Provide you with this Notice of our legal duties and privacy practices
• Abide by the terms of the Notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests for confidential communications
• Notify you following a breach of your unsecured health information

Breach Notification

If a breach of your unsecured health information occurs, we will notify you as required by law. We will also notify the U.S. Department of Health and Human Services and, if required, the media.

Changes to This Notice

We reserve the right to change this Notice and make the new provisions effective for all health information we maintain. If we make a significant change to this Notice, we will post the revised Notice on our website and make copies available upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights.

To File a Complaint with Our Office:

Contact Doreen Bridgman, Privacy Officer
Email: doreen@thecognitivecoach.net

To File a Complaint with the Federal Government:

U.S. Department of Health and Human Services
Office for Civil Rights
Website: www.hhs.gov/ocr/complaints

You will not be retaliated against for filing a complaint.

Contact Information

For questions about this Notice or to exercise your rights, please contact:

Acknowledgment

By using our services and submitting health information through our website, you acknowledge that you have received this Notice of Privacy Practices and understand how your health information may be used and disclosed.