Notice of Privacy Practices
Effective date: August 6, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Power of Play Speech Therapy is required by law to maintain the privacy of your child’s protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. We are also subject to the California Confidentiality of Medical Information Act (CMIA), which in some cases provides greater privacy protections than HIPAA. California law applies when it is more protective of your rights.
How we may use and disclose your child’s health information
Treatment. To provide, coordinate, and manage your child’s speech-language pathology care. For example, we may share information with other treating providers such as a pediatrician or occupational therapist, with your consent.
Payment. To bill and collect for services. Because we are a private-pay practice, this generally means providing you with an invoice or a superbill that you may submit to your insurer yourself.
Health care operations. For internal activities such as quality review, training, recordkeeping, and legal compliance. We do not sell protected health information.
Uses and disclosures that may be made without your authorization
- As required by federal, state, or local law.
- Mandated reporting. As a California mandated reporter, we are required to report known or reasonably suspected child abuse or neglect to the appropriate authorities (California Penal Code § 11166).
- Public health activities, as required or permitted by law.
- Health oversight activities by government agencies, including the California Speech-Language Pathology, Audiology & Hearing Aid Dispensers Board.
- Judicial or administrative proceedings, in response to a court order or subpoena.
- To avert a serious and imminent threat to health or safety.
- To business associates who perform services on our behalf under a signed Business Associate Agreement requiring them to protect your information.
Uses that require your written authorization
All other uses and disclosures will be made only with your written authorization, which you may revoke at any time in writing. This includes marketing communications, any sale of health information, and sharing records with your child’s school or another family member.
Additional California privacy rights (CMIA)
- We may not share your child’s medical information for marketing purposes without your explicit written authorization.
- You may request that we not share your child’s information with certain entities, even where federal law might permit it.
- We comply with whichever of federal HIPAA or California CMIA is more protective.
Your rights regarding your child’s health information
- Inspect and copy. You may inspect and receive a copy of your child’s records. Submit a written request; we will respond within 15 days. A reasonable copying fee may apply, consistent with California Health & Safety Code § 123110.
- Request an amendment. If you believe information is incorrect or incomplete, you may request an amendment in writing. We may deny the request in certain circumstances and will explain any denial in writing.
- Accounting of disclosures. You may request a list of disclosures other than those for treatment, payment, or operations. The first accounting each year is free.
- Request restrictions. You may ask us to restrict how we use or disclose information. We are not required to agree, but if we do, we will honor the restriction except in an emergency.
- Confidential communications. You may ask us to contact you a certain way or at a certain location. We will accommodate reasonable requests.
- Paper copy. You may request a paper copy of this notice at any time.
- Breach notification. We will notify you promptly in the event of a breach of unsecured protected health information.
Records retention
Clinical records are retained for a minimum of seven (7) years from the date of last service, or until the client reaches age 25, whichever is later, in accordance with California Health & Safety Code § 123111 and Title 16, California Code of Regulations § 1399.167.5.
Changes to this notice
We reserve the right to change our privacy practices and the terms of this notice. Changes will apply to information we already hold as well as new information. A revised notice will be posted on this page.
How to file a complaint
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. You will not be retaliated against for filing a complaint.
- Privacy Officer: Ariel Gomez, M.S., CCC-SLP · (213) 826-2529 · ariel@powerofplayspeechtherapy.com
- U.S. Dept. of Health & Human Services, Office for Civil Rights: hhs.gov/hipaa/filing-a-complaint · 1-800-368-1019
- California Attorney General (CMIA): oag.ca.gov · 1-800-952-5225
Your Right to a Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your child’s care will cost.
Under federal law, health care providers must give patients who are uninsured or who are not using insurance an estimate of the expected charges for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
What this means at Power of Play
Power of Play Speech Therapy is a private-pay practice. We do not accept insurance and do not bill insurers directly, so this right applies to every family we serve. You will receive a written Good Faith Estimate before your first session, and an updated one any time your child’s recommended services change.
On request, we will also provide a superbill — an itemized receipt with procedure and diagnosis codes — that you may submit to your insurer for possible out-of-network reimbursement. Reimbursement is not guaranteed, varies by plan, and is determined solely by your insurer.
Questions about anything on this page? Call or text (213) 826-2529, or email ariel@powerofplayspeechtherapy.com. We would rather answer a question now than have you wonder about it later.