Privacy Policy


This notice describes how health information about you and your child may be used and disclosed and how you can get access to this information. It is effective January 1, 2010, and applies to all protected health information contained in your and your child’s health records maintained by us.

We have the following DUTIES regarding the maintenance, use, and disclosure of your child’s health records:

    • We are required by law to maintain the privacy of the protected health information in your & your child’s records and to provide you with this Notice of our legal duties and privacy practices with respect to that information.

    • We are required to abide by the terms of this Notice currently in effect.

    • We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and records that we have and continue to maintain.

All changes in this Notice will be prominently displayed and available at our office.

There are a number of situations in which we may use or disclose to other persons or entities your child’s confidential health information.

Certain uses and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices. These include treatment, payment, and health care operations. Any use or disclosure of your or your child’s protected health information required for anything other than treatment, payment, or health care operations requires you to sign an Authorization. Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization. Under any circumstance, we will use or disclose only the minimum amount of information necessary from your child’s medical records to accomplish the intended purpose of the disclosure.

We will attempt in good faith to obtain your signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.


We will use your child’s health information to make decisions about the provision, coordination, or management of your child’s healthcare, including analyzing his or her behavioral excesses or deficits in view of determining the appropriate treatment. It may also be necessary to share your child’s health information with another health care provider whom we need to consult with respect to your child’s care. These are only examples of uses and disclosures of medical information for treatment purposes that may or may not be necessary in your case.


We may need to use or disclose information in your child’s health record to obtain reimbursement from you, from your health-insurance carrier, or from another insurer for our services rendered to your child. This may include determinations of eligibility or coverage under the appropriate health plan, precertification and pre-authorization of services, or review of services for the purpose of reimbursement. This information may also be used for billing, claims management and collection purposes, and related healthcare data processing through our system.


Your child’s health records may be used in our business planning and development operations, including improvements in our methods of operation and general administrative functions. We may also use the information in our overall compliance planning, healthcare review activities, and arranging for legal and auditing functions.

There are certain circumstances under which we may use or disclose your child’s health information without first obtaining your Acknowledgement or Authorization. Those circumstances generally involve public health and oversight activities, law-enforcement activities, judicial and administrative proceedings, and in the event of death. Specifically, we may be required to report to certain agencies information concerning certain communicable diseases, sexually transmitted diseases, or HIV/AIDS status. We may also be required to report instances of suspected or documented abuse, neglect, or domestic violence. We are required to report to appropriate agencies and law-enforcement officials’ information that you, your child, or another person is in immediate threat of danger to health or safety as a result of violent activity. We must also provide health information when ordered by a court of law to do so.

Others Involved in Your Healthcare:

Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your child’s protected health information that directly relates to that person’s involvement in your child’s health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your or your child’s best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your child’s care of your or your child’s location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your child’s healthcare.

Communication Barriers and Emergencies:

We may use and disclose your child’s protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we need to use an interpreter. We may use or disclose your child’s protected health information in an emergency treatment situation. If this happens, we will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If we are required by law or as a matter of necessity to treat your child, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your child’s protected health information to treat him or her. Except as indicated above, your child’s health information will not be used or disclosed to any other person or entity without your specific Authorization, which may be revoked at any time.

You have certain RIGHTS regarding your child’s health record information, as follows:

    • You may request that we restrict the uses and disclosures of your child’s health record information for treatment, payment and operations, or restrictions involving your child’s care or payment related to that care. We are not required to agree to the restriction; however, if we agree, we will comply with it, except with regard to emergencies, disclosure of the information to you, or if we are otherwise required by law to make a full disclosure without restriction.

    • You have a right to request receipt of confidential communications of your child’s medical information by an alternative means or at an alternative location.

    • You have the right to receive a copy of your child’s therapy treatment plan and to be involved in your child’s care.

    • If this notice was initially provided to you electronically, you have the right to obtain a paper copy of this notice for your personal records.


You may file a written complaint to us or to the Secretary of Health and Human Services if you believe that your or your child’s privacy rights with respect to confidential information in your child’s health records have been violated.

All complaints must be in writing and must be addressed to the Privacy Officer (in the case of complaints to us) or to the person designated by the U.S. Department of Health and Human Services if we cannot resolve your concerns. You will not be retaliated against for filing such a complaint. More information is available about complaints at the government’s web site,

All questions concerning this Notice or requests made pursuant to it should be addressed to:

Behavioral Learning Systems, Inc.