NOTICE OF PRIVACY PRACTICES
Peach State Pediatric Therapy, Inc.
Buford, Georgia
Phone: 770-904-6419
Website: www.peachstatetherapy.com
Effective Date: To be entered upon clinic approval
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Our Commitment to Your Privacy
Peach State Pediatric Therapy, Inc. is committed to protecting the privacy and confidentiality of the children and families we serve.
We understand that medical, developmental, and therapy-related information is sensitive and deserves appropriate protection.
This Notice of Privacy Practices explains how we may use and disclose protected health information (PHI), your rights regarding that information, and our legal responsibilities under the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws.
This notice applies to protected health information maintained by Peach State Pediatric Therapy in connection with its healthcare services.
2. How We May Use and Disclose Health Information
We may use or disclose protected health information without separate written authorization when permitted or required by applicable law.
Treatment
We may use and share health information to provide, coordinate, or manage your child's healthcare and therapy services.
For example, our occupational therapists, physical therapists, speech-language pathologists, and other authorized healthcare professionals may share relevant information to coordinate your child's treatment.
We may also communicate with physicians, specialists, or other healthcare providers involved in your child's care.
Payment
We may use and disclose health information to obtain payment for services.
Examples include:
Submitting claims to insurance companies.
Verifying insurance eligibility.
Obtaining treatment authorizations.
Processing payments.
Responding to insurance inquiries.
Coordinating billing and reimbursement.
Healthcare Operations
We may use or disclose protected health information to operate and improve our clinic.
Examples include:
Quality assurance activities.
Staff training and clinical supervision.
Reviewing treatment effectiveness.
Administrative management.
Healthcare compliance activities.
Maintaining patient records.
Coordinating scheduling and clinical services.
3. Other Uses and Disclosures Permitted by Law
We may use or disclose protected health information in other circumstances permitted or required by law, including:
Public Health Activities: Reporting certain diseases, injuries, or other information to appropriate public health authorities.
Abuse or Neglect: Reporting suspected child abuse, neglect, or other circumstances when required or permitted by law.
Health Oversight: Providing information to authorized government agencies conducting inspections, audits, investigations, or licensing activities.
Legal Proceedings: Responding to lawful court orders, subpoenas, or other legally authorized requests, subject to applicable restrictions.
Law Enforcement: Disclosing information when specifically permitted or required by law.
Serious Threats: Sharing information when necessary and legally permitted to prevent or lessen a serious and imminent threat to health or safety.
Workers' Compensation: Disclosing information when authorized by applicable workers' compensation laws.
Research: Using or disclosing information for research when applicable legal requirements and safeguards are satisfied.
Other Legally Authorized Purposes: Disclosures involving medical examiners, funeral directors, organ donation, or other permitted circumstances when applicable.
We will comply with any additional restrictions imposed by federal or Georgia law.
4. Uses and Disclosures Requiring Written Authorization
Certain uses and disclosures of protected health information require written authorization.
These generally include:
Most uses or disclosures for marketing purposes.
The sale of protected health information.
Most uses or disclosures of psychotherapy notes, if applicable.
Other uses or disclosures not otherwise permitted or required by law.
When written authorization is required, we will obtain it before using or disclosing the information.
You may revoke an authorization in writing, except to the extent we have already acted in reliance on it or as otherwise permitted by law.
5. Additional Protections for Certain Substance Use Disorder Records
Certain substance use disorder treatment records are protected by federal confidentiality regulations under 42 CFR Part 2.
If Peach State Pediatric Therapy receives or maintains records subject to these regulations, additional restrictions may apply.
Such records, or testimony describing their contents, generally cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual without the individual's written consent or an appropriate court order accompanied by a subpoena or other legal requirement.
Other special protections and consent requirements may apply to these records.
We will follow applicable federal and state confidentiality requirements when handling specially protected information.
6. Your Rights Regarding Health Information
You and your child's authorized personal representative have certain rights regarding protected health information.
Right to Inspect and Obtain Copies
You may request access to or copies of your child's medical and therapy records, subject to applicable law.
We generally must respond to requests for access within 30 days, subject to legally permitted extensions.
Reasonable, cost-based fees may apply where permitted by law.
Right to Request Corrections
You may request that we correct or amend information you believe is inaccurate or incomplete.
We may deny certain requests when permitted by law, but we will provide an explanation and information about applicable rights.
Right to Request Restrictions
You may request limitations on how we use or disclose certain health information for treatment, payment, or healthcare operations.
We are not generally required to agree to every request.
However, when you pay in full out of pocket for a healthcare service, you may request that we not disclose information about that service to your health plan for payment or healthcare operations purposes, subject to applicable legal exceptions.
Right to Confidential Communications
You may request that we communicate with you through a particular method or at an alternative address or telephone number.
We will accommodate reasonable requests.
Right to an Accounting of Disclosures
You may request an accounting of certain disclosures of protected health information made during the preceding six years.
Some disclosures, including many disclosures for treatment, payment, and healthcare operations, are excluded from the accounting requirement.
Right to a Paper Copy
You may request a paper copy of this notice at any time, even if you previously received it electronically.
Right to Choose a Personal Representative
A parent, legal guardian, or other individual with legally recognized authority may exercise applicable privacy rights on behalf of a patient.
We may request documentation establishing this authority.
Certain laws may limit parental access to particular information or give minors independent confidentiality rights in specific circumstances.
7. Parents, Guardians, and Children's Privacy
Because Peach State Pediatric Therapy specializes in pediatric care, many privacy requests are made by parents or legal guardians.
Parents and legal guardians generally may exercise HIPAA rights on behalf of their minor children when legally authorized.
However, certain federal and state laws may provide minors with independent confidentiality rights or restrict parental access to particular medical information.
Peach State Pediatric Therapy will follow applicable laws when determining whether patient information may be shared with a parent, guardian, or other representative.
8. Your Choices Regarding Information Sharing
In certain circumstances, you may tell us your preferences regarding the sharing of health information.
For example, you may identify family members or other individuals involved in your child's care or payment for services.
When permitted by law, we may share relevant information with those individuals consistent with your preferences and the patient's best interests.
If your preferences cannot be obtained, we may use professional judgment as permitted by law.
We may also disclose information for disaster relief or other legally authorized purposes.
9. Electronic Communications and Online Registration
Peach State Pediatric Therapy may use electronic systems to assist with patient registration, scheduling, communications, and maintaining healthcare records.
Our website may provide electronic patient registration and contact forms.
We will use and disclose information submitted through these systems in accordance with applicable privacy laws and our established privacy and security procedures.
Electronic communications may involve privacy and security risks.
Patients and guardians may contact our office to discuss available communication methods.
This notice does not replace separate website privacy disclosures or consent requirements that may apply to electronic communications.
10. Our Legal Responsibilities
Peach State Pediatric Therapy is required by applicable law to:
Maintain the privacy and security of protected health information.
Provide patients with notice of our legal duties and privacy practices.
Follow the terms of the Notice of Privacy Practices currently in effect.
Notify affected individuals following a breach of unsecured protected health information when required by law.
Comply with applicable federal and state privacy requirements.
We maintain policies and procedures intended to protect confidential patient information.
Access to protected health information is limited according to applicable law and legitimate operational needs.
11. Business Associates and Service Providers
Peach State Pediatric Therapy may use third-party service providers to assist with billing, technology, administrative services, and other healthcare operations.
When required by HIPAA, we enter into Business Associate Agreements with organizations that create, receive, maintain, or transmit protected health information on our behalf.
Such agreements establish applicable privacy and security responsibilities.
12. Complaints and Privacy Concerns
If you believe your privacy rights or your child's privacy rights have been violated, you may file a complaint with Peach State Pediatric Therapy.
Please contact:
Peach State Pediatric Therapy, Inc.
Attention: Privacy Officer
Buford, Georgia
Phone: 770-904-6419
You may also file a complaint with the:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/hipaa/filing-a-complaint
You will not be retaliated against for filing a privacy complaint.
13. Changes to This Notice
Peach State Pediatric Therapy reserves the right to revise this Notice of Privacy Practices and make revised provisions effective for protected health information we maintain, including information created or received before the revision.
When changes are made, the updated notice will be available:
At our clinic.
Upon request.
On our website at www.peachstatetherapy.com.
The effective date will appear at the beginning of the notice.
14. Availability of This Notice
A copy of this Notice of Privacy Practices is available to patients and authorized representatives upon request.
The notice will also be available at our clinic and prominently accessible through our website.
We will make a good-faith effort to obtain written acknowledgment of receipt when required by law.
An acknowledgment of receipt confirms that the notice was provided. It does not constitute authorization for additional uses or disclosures of protected health information.
15. Contact Information
For questions about this notice, medical records, privacy rights, or confidentiality concerns, please contact:
Peach State Pediatric Therapy, Inc.
Attention: Privacy Officer
Buford, Georgia
Phone: 770-904-6419
Website: www.peachstatetherapy.com
© 2026 Peach State Pediatric Therapy, Inc. All rights reserved.