Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Lark Behavior Group, LLC (“Lark Behavior,” “we,” “us”) is required by law to protect the privacy of health information about our clients, give you this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect. Because our clients are children, “you” in this notice also means a parent or legal guardian acting as the child’s personal representative.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your health records

• You can ask to see or get an electronic or paper copy of your child’s health records and other health information we have about your child. Ask us how to do this.
• We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your records

• You can ask us to correct health information you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, a particular phone number) or to send mail to a different address.
• We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say “no” if it would affect your child’s care.
• If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for purposes of payment or our operations. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your child’s health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all disclosures except for those about treatment, payment and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

• If you are your child’s parent or legal guardian, or if someone has medical power of attorney, that person can exercise your rights and make choices about the health information.
• We will make sure the person has this authority and can act for the client before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Officer using the information at the end of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with family, close friends or others involved in your child’s care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share information if we believe it is in your child’s best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information

Our uses and disclosures

Treatment

We can use your child’s health information and share it with other professionals who are treating your child, such as your child’s pediatrician, speech therapist or occupational therapist, to coordinate care.

Running our organization

We can use and share health information to run our practice, improve your child’s care and contact you when necessary. This includes clinical supervision, staff training and quality review.

Billing for our services

We can use and share health information to bill and get payment from health plans, including Medi-Cal and commercial insurers, or other entities. For example, we give information about your child to your health insurance plan so it will pay for our services and authorize treatment.

Business associates

We may share information with companies that perform services for us, such as billing, data systems or IT support. These companies must agree in writing to protect your information.

How else can we use or share your health information?

We are allowed or required to share information in other ways, usually in ways that contribute to the public good. We have to meet many conditions in the law before we can share information for these purposes.

Help with public health and safety issues

• Preventing disease
• Reporting suspected abuse, neglect or domestic violence, as required of mandated reporters under California law
• Preventing or reducing a serious threat to anyone’s health or safety

Do research

• We can use or share information for health research, subject to the protections required by law.

Comply with the law

• We will share information if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Address workers’ compensation, law enforcement and other government requests

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law, such as audits by Medi-Cal or other government programs
• For special government functions such as military, national security and presidential protective services

Respond to lawsuits and legal actions

• We can share health information in response to a court or administrative order, or in response to a subpoena.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

California law

California law, including the Confidentiality of Medical Information Act, may give your child’s health information additional protection. When state law is more protective of your privacy than federal law, we follow the more protective law.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about your child. The new notice will be available upon request, in our office and on our website.

Contact us

If you have questions about this notice or want to exercise your rights, contact our Privacy Officer:

Privacy Officer

Lark Behavior Group, LLC

18200 Rinaldi Pl, Porter Ranch, CA 91326

Phone: (818) 916-0295

Email: hello@larkbehavior.com