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Practice Policies and Legal Documents

HIPAA Compliance & Privacy Practices

This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. We are committed to maintaining the confidentiality of your health information and follow all federal and state laws regarding Protected Health Information (PHI).

Release of Information (ROI)

To provide the most comprehensive care, we often collaborate with teachers, pediatricians, and other specialists. Our Release of Information form allows you to authorize the exchange of verbal or written information with specific individuals or organizations involved in your child's care.

Attendance & Cancellation Policy

Consistency is key to your child's progress. We require a 24-hour notice for all cancellations. Late cancellations or no-shows may be subject to a fee. We understand that emergencies happen, especially with little ones, and we strive to be flexible whenever possible.

Consent for Evaluation and Treatment

By enrolling in our services, you provide legal consent for Breakthrough Speech, Language and Feeding Therapy to perform necessary evaluations and therapeutic interventions. This document outlines the nature of our services, professional boundaries, and our shared goals for your child's success.

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Parental Consent and Privacy Acknowledgement

We are honored to partner with your family in your child’s speech and feeding journey. Protecting your child's privacy is our highest priority, and we ask that you carefully review our HIPAA Compliance & Privacy Practices to understand how we safeguard your sensitive information. By signing this form, you confirm that you have read and understand these practices and consent to the use and disclosure of your child’s protected health information for treatment, payment, and healthcare operations. Additionally, you certify that all information provided to Breakthrough Speech, Language and Feeding Therapy is true and correct to the best of your knowledge.

Medical Release of Information

Speech Therapy Practice

Child's Date of Birth
Month
Day
Year
Types of Records to be Released
Today's Date
Month
Day
Year

Please enter the current date.

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