Fleur Speech Therapy, LLC – Terms and Conditions
The following Terms and Conditions apply to speech language services provided at Fleur Speech Therapy, LLC. as well as all instruction and/or services rendered by Fleur Speech Therapy, LLC.
Legal Notice
These are the terms and conditions for receiving services at Fleur Speech Therapy, LLC. This document is known as the “Terms and Conditions”. In addition to these Terms and Conditions all patients participating in speech language services must agree to and follow the Policies and Procedures found at www.fleurslp.com .
To receive services at Fleur Speech Therapy, LLC., you agree to be bound by the Terms and Conditions which include:
Confidentiality Agreement
Cancellation Policy
Access to Records Policy
Medical Necessity Statement
Termination and Dismissal Statement
Policies and Procedures Statement
Fleur Speech Therapy’s Terms and Conditions are posted and periodically updated on our website at www.fleurslp.com. It is the responsibility of all Patients/Legal Guardians to review and understand these informational documents. Please direct any questions regarding these documents to Lauren@fleurslp.com.
Confidentiality Agreement
This Confidentiality Agreement (the “Agreement”) is made and entered in between (“Legal Guardian”) and Fleur Speech Therapy, LLC. (“Covered Entity”).
RECITALS: The parties acknowledge that Legal Guardian may incidentally or inadvertently encounter, view and/or access certain Confidential Information maintained by Covered Entity which may qualify as Protected Health Information (“PHI”) or electronic PHI within the meaning of the Health Insurance Portability and Accountability Act of 1996, as amended, and the privacy and security standards promulgated pursuant thereto (“HIPAA”).
NOW, THEREFORE, in consideration of the mutual promises contained herein, as well as other good and valuable consideration, the parties hereto agree as follows:
“Confidential Information” means any and all non-public, medical, financial and personal information in whatever form (written, oral, visual or electronic) possessed or obtained by either party. Confidential Information shall include all information which (i) either party has labeled in writing as confidential, (ii) is identified at the time of disclosure as confidential, (iii) is commonly regarded as confidential in the healthcare industry, or (iv) is Protected Health Information as defined by HIPAA.
Legal Guardian agrees to maintain the confidentiality of any Confidential Information, including Protected Health Information that it may incidentally or inadvertent encounter, view or have access to while providing the services under the terms and conditions set forth in this Agreement.
Legal Guardian agrees not to further use or disclose any Confidential Information, including Protected Health Information that it incidentally or inadvertently views or obtains access to and further agrees to implement appropriate safeguards to prevent any further use or disclosure of any Confidential Information that is incidentally or inadvertently access
Legal Guardian agrees to report to the Covered Entity any use or disclosure of Confidential Information in violation of this Agreement, HIPAA or any other federal, state or local law or regulation.
Legal Guardian agrees to comply with all applicable laws and regulations, including HIPAA and the HITECH Act, to the extent applicable, in meeting their obligations under this Agreement.
The obligations of confidentiality and non-use and non-disclosure under this Agreement will continue indefinitely from the effective date of this Agreement.
This Agreement may be modified or amended only with the written consent of both parties.
No waiver of any provision of this Agreement, including this paragraph, shall be effective unless the waiver is in writing and signed by the party making the waiver.
Cancellation Policy
A copy of Fleur Speech Therapy, LLC’s Cancellation Policy can be found on our website at www.fleurslp.com or by request. The Cancellation Policy must be executed prior to receiving therapy services.
Access to records
In accordance with the Health Insurance Portability and Accountability Act 45 CFR § 164.524, Upon request, Patients and Legal Guardians have the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice. Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created; whether the information is maintained in paper or electronic systems onsite, remotely, or is archived; or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.).
Medical Necessity & Termination of Services
According to the American Speech Language Association (2018), Audiology and Speech-Language Pathology services are medically necessary to treat speech-language, swallowing, cognitive communication, hearing, and balance disorders. Many of these disorders—such as head injury, Parkinson’s disease, stroke, autism, and cerebral palsy—have a neurological basis. Determining medical necessity takes into consideration whether a service is essential and appropriate to the diagnosis and/or treatment of an illness, injury, or disease. The U.S. National Library of Medicine defines disease as “an impairment of the normal state.” Loss of hearing, impaired speech and language, and swallowing difficulties all reflect an impairment of the normal state, and services to treat such impairment must be regarded as meeting medical necessity.
Habilitation services, referenced in the ACA definition of medical necessity, treat illness, injury, condition, and diseases (or symptoms) and, thus, should be included in definitions of medical necessity. Developmental deficits requiring habilitation services meet medical necessity. A diagnosis of developmental deficit in a child indicates an abnormal state of function, and speech, language, and hearing services are as medically necessary for this patient as they are for an adult who has suffered a stroke and has lost speech and language function.
Dismissal & Termination Statement
Dismissal/Termination of Speech Services either permanently or for some specified time period, are set forth in accordance with the American Speech-Language Hearing Association Code of Ethics. The factors for dismissal/termination taken into account include: 1. Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected. 2. Individuals shall not guarantee the results of any treatment or procedure, directly or by implication; however, they may make a reasonable statement of prognosis. Further, Fleur Speech Therapy, LLC has the right to terminate services at any time. Read more about termination and dismissal from services in our Policies and Procedures.
Policies and Procedures
Fleur Speech Therapy, LLC is committed to providing every Patient with medically necessary Speech-Language services. Prior to beginning services, all Patients/Legal Guardians will be provided and asked to sign a copy of our Policies and Procedures. Our Policies and Procedures are available on our website at www.fleurslp.com.