Therapy Treatments & Resources for Families with Children
Affected by Autism & Related Disabilities in Cleveland / Akron Ohio.

POLICIES

Notice of Privacy Practice

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

Peak Potential Therapy LLC's client/family's confidential information will be upheld to the fullest extent possible. Peak Potential Therapy LLC will follow HIPAA rules. For more information on HIPAA rules and your rights, visit US Department of Health and Human Services website, www.hhs.gov/ocr/hipaa/, or call Health and Human Services toll-free, 866-627-7748.

Peak Potential Therapy LLC is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:

1. For treatment - We may share with your physician copies of your treatment plan or evaluation to update him/her on your progress or for his/her approval or recommendations.
2. For health care operations - We may access your health information for purposes of quality improvement within our facility.
3. For payment - We may send information to your health insurance plan for them to review and determine level of coverage for therapy services.

Peak Potential Therapy LLC is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization.

Other uses and disclosures will be made only with the Individual's written authorization, and the individual may revoke such authorization.

Peak Potential Therapy LLc intends to engage in one or more of the following activities:

1. Peak Potential Therapy LLC may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient.
2. A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.

The Individual has the following rights regarding protected health information:

1. The right to request restrictions on certain uses and disclosures of protected health information. Peak Potential Therapy LLC is not required to agree to a requested restriction, however.
2. The right to receive confidential communications of protected health information, as applicable.
3. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
4. The right to amend protected health information, as provided in the Privacy Regulation.
5. The right to receive an accounting of disclosures of protected health information.
6. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.

Peak Potential Therapy LLC is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.

Peak Potential Therapy LLC is required to abide by the terms of the Notice currently in effect.

Peak Potential Therapy reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.

Peak Potential Therapy LLC will provide individuals or patients with a revised Notice by emailing a notice.

Individuals may complain to Peak Potential Therapy LLC and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:

COMPLAINTS: Peak Potential Therapy LLC clients and/or their guardian have the right to voice their complaints. Complaints should be made in writing to Holly Reimann at Peak Potential Therapy LLC, 8870 Darrow Rd. F106 #289, Twinsburg, OH 44087 (telephone: 267-259-6461). Upon receipt of a complaint, an action plan to resolve the problem will be implemented. Peak Potential Therapy LLC will in no way retaliate because of a complaint.

Peak Potential Therapy LLC contact person for matters relating to complaints is:
Holly Reimann, MA CCC-SLP
(330)405-8776
8870 Darrow Rd. F106 #289, Twinsburg, OH 44087

This Notice is first in effect on July 20, 2008.
Peak Potential Therapy LLC elects to limit the uses or disclosures that it is permitted to make, as follows: Peak Potential Therapy LLC is committed to limiting the disclosure of PHI (protected health information) only to the degree necessary for the purposes of treatment, payment and healthcare operations.

Health & Safety

Peak Potential Therapy LLC follows health and safety guidelines to ensure the safety of the clients and herself. Precautions that the therapist uses includes wearing gloves while handling bodily fluids and disinfecting toys/materials that have come in contact with bodily fluids. All bodily fluids are treated as if infections.

Services

The therapist primarily works with children with various disabilities. It is understood that children with disabilities need specialty treatment in the realms of social communication, emotional regulation, behavior modification, and or specific objectives from their Individualized Education Plan.

If a service is provided at a location where the therapist drives less than 15 miles, pricing for services are as follows:

Cost of Services

Note: Payments should made out to Peak Potential Therapy. For any returned check, a $35 return fee will be charged and applied at the next session.

The cost of any service increases by 10% for each additional 5 miles driven beyond the 15 mile service radius.

Billing Policy

Peak Potential Therapy LLC is committed to providing the best treatment for our clients and we charge in accordance of what is usual and customary for our area. The client's guarantor is financially responsible for the services provided. A guarantor is a person held responsible by our practice for medical expenses incurred on a client's behalf. This may be the client's parent(s), legal guardian(s) or agent(s), or may be the client if aged 18 or older or if emancipated.

Payment is required at the time service is rendered, unless service has been prepaid or the family and Peak Potential Therapy LLC have a predetermined set arrangement in regards to billing and payment to a third party (i.e.: PASSS, etc.). Services billed to PASSS are provided in sessions, each consisting of 15 minutes of treatment time. A 10% service charge is applied when service is billed to a third party.

For your convenience, we accept cash, check, PayPal, and all major credit cards, such as VISA, MasterCard, Discover, & American Express. A $35 service charge is assessed on all returned checks.

Financial Assistance - Care Credit

If you need financial assistance, we can provide you with information on an outside lending agency, Care Credit. Upon acceptance by this credit company, you can receive a no interest, no fee loan for up to 18 months. For information go to their website at www.carecredit.com

Delinquent Accounts

If payment in full is not received within 90 days of the date of service, we will send you notice, by mail, that your account has become delinquent. If payment is not received within 10 days of the delinquency notice, your account will be referred to a collection agency unless you have arranged an installment payment plan. In order to arrange a payment plan, you must come to the office and sign a promissory note within 10 days of the date on the delinquency notice that you receive from us. A 2% interest rate will be charged monthly to delinquent accounts ($5 minimum). If your account is referred to a collection agency, it cannot be retrieved and your credit rating may be damaged.

New Client Intake

An individual becomes a client of Peak Potential Therapy LLC once a complete intake has been done and services have been started. An initial consultation is suggested to help the client transition to and start building rapport with the therapist. The first hour of Consult, Observation, and or Meeting time will be free of charge. The initial Consult may be at any location within 15 miles of the office, and or may be over the phone depending on the family's needs. All following Consult time will be billed at the corresponding rate, as noted in the Speech and Language Cost of Services table. If the consult takes place outside the 15 mile service area, the new client will pay 10% of $93 for each additional 5 miles driven beyond the 15 miles.

Cancellation / No Show Policy

Peak Potential Therapy LLC understands there may be times when you may miss an appointment due to emergencies or unforeseen obligations to work or family. Appointments must be cancelled with at least a 24-hour notice, and will not result in any charges. Families may cancel a session for any reason. Failure to cancel the appointment in advance, the family will be invoiced 50% of the cost for that appointment and will make payment at the following session. The family MUST call to cancel an appointment, 330-405-8776. If the client who is canceling is part of a group, the group members will be contacted and a decision will be made with all families to determine if the entire session will be cancelled or will continue as scheduled. The resulting group members may choose to pay a higher rate or have a decreased session length, which keeps the cost to time ratio at the same rate.

Peak Potential Therapy LLC understands that emergencies and unforeseeable things happen, which is why each client receives 1 FREE cancellation that is provided within the 24-hour notice period per quarter (January-March; April-June; July-September; October-December).

If the therapist arrives at the client's home for the scheduled session and the client is a no-call / no-show, the full cost of the session will be invoiced to the client and payment will be due at the next scheduled session.

Photograph / Video Release

All photographs taken by Peak Potential Therapy LLC staff or agents must obtain a signed release form from any person or guardian of children under the age of 18 years old who is visibly recognizable in the photograph. Crowd scenes where no single person is the dominant feature are exempt.

These rules govern photographs intended for use in any Peak Potential Therapy LLC publication of a marketing or a public relations nature, such as newsletters, brochures, viewbooks, promotional items, or other such material. Releases also must be obtained for photographs used on the Web. These rules are not in effect when photographs are taken of news events, but photographs taken for news purposes require a release for reuse in marketing materials.

This release form has been approved by the Peak Potential Therapy LLC's Office of General Counsel.

Client Progress Reports

Progress will be reported quarterly to the client's family in an individualized Progress Report. There is no additional fee for the Progress Report. Data reported comes from progress during sessions, which is recorded on each child's objectives on a Daily Progress Note. Progress reported will reflect client's progress and compared to baseline data.

Termination of Services

Peak Potential Therapy LLC or family can decide termination of services at any time or for any reason. Family satisfaction is critical to our organization. If a client/family has any questions, concerns, comments, or ideas, he/she is free to disclose the information as soon as possible. Therapist will discharge client from speech-language services when the client has reached all of his/her goals and has stabilized progress for three months.

Client Loyalty Rewards Program - Terms and Conditions

1. No purchase is necessary to receive a Client Loyalty Rewards card.
2. All rights reserved. Only one active card per family at a time is allowed. If and when a card becomes replaced, the old card becomes disabled and should be discarded. The Client Loyalty Rewards is intended for individual use only. Loyalty Hours may not be accumulated for a business entity.
3. Client Loyalty Rewards are available on qualifying In-Home Respite Care hours accumulated. One Loyalty Hour is earned for every 1-hour of qualifying In-Home Respite Care. Card must be presented immediately following each In-Home Respite visit to be credited for that visit. Each box will be stamped in numerical order. Only Peak Potential Therapy LLC stamp or respite staff's signature is valid.
4. Peak Potential Therapy LLC reserves the right, at its sole discretion, to terminate the Client Loyalty Rewards Program, and to amend, limit, modify or add to the terms and conditions, including but not limited to imposing time limits and changes in Loyalty Hours values, rewards and reward levels, all without prior notice, at any time.
5. Client Loyalty Rewards are not transferable.
6. Client Loyalty Rewards can be redeemed when presenting your card to operating manager of Peak Potential Therapy LLC. Client Loyalty Rewards card must be redeemed within 90-days of accumulating 30-Loyalty Hours. At time of redemption, client's account balance must be current with no past due amounts owed to Peak Potential Therapy LLC. To redeem Client Loyalty Rewards card you must currently be a client of Peak Potential Therapy LLC and receive services.
7. Except where required by law, Loyalty Hours have no cash value and are surrendered for award redemption only. Redemption value is limited to one (1) restaurant gift certificate valued at $50 and two (2) movie theatre tickets. Peak Potential Therapy LLC is not responsible for Terms and Conditions of restaurant gift certificate or the movie theater tickets.
8. Peak Potential Therapy LLC may engage in periodic audits of a member's account. Peak Potential Therapy LLC reserves the right to discontinue membership privileges and/or void all or a portion of a member's Loyalty Hours balance if the Loyalty Hours have been issued, received or redeemed through computer error, fraud or theft, through illegal means or in a manner not authorized in the Terms and Conditions or in other legal or equitable remedy which may be available for the Client Loyalty Rewards Program under applicable law. Photocopies of the Client Loyalty Rewards card will not be valid.
9. Accumulated Loyalty Hours are not member property and may be revoked, cancelled, limited or modified at any time, even though such action may affect a member's right to previously accumulated Loyalty Hours.
10. Loyalty Hours cannot be credited for In-Home Respite visits prior to membership in the Client Loyalty Rewards.
11. Federal and state tax liabilities are the sole responsibility of the recipient.
12. Peak Potential Therapy LLC employees and family members or people living in the same household of Peak Potential Therapy LLC employees are not eligible to participate in the Client Loyalty Rewards Program.
13. Peak Potential Therapy LLC reserves the right to cancel the Client Loyalty Rewards at any time.
14. Peak Potential Therapy LLC is not responsible for Loyalty Hours or awards lost due to fraudulent or unauthorized use, including fraud caused by lost or stolen cards.
15. Client Loyalty Rewards is subject to applicable state, federal and local laws and regulations.
16. These Terms and Conditions shall be governed by, subject to, and construed in accordance with the laws of the state of Ohio, United States of America, excluding all conflict of law rules. If any provision(s) of these Terms and Conditions are held to be invalid or unenforceable, all remaining provisions will remain in full force and effect. To the extent permitted by law, the right to litigate, seek injunctive relief or make any other recourse to judicial or any other procedure in case of disputes or claims resulting from or in connection with the Client Loyalty Rewards Program are hereby excluded, and all members expressly waive any and all such rights.
17. By joining of Client Loyalty Rewards Program, you agree that exclusive jurisdiction for any dispute, claim, or demand related in any way to the Client Loyalty Rewards will be decided by binding arbitration. All disputes between you and Peak Potential Therapy LLC and/or its affiliates of whatsoever kind or nature arising out of these Terms and Conditions shall be submitted to judicial arbitration under its rules then in effect in the Ohio, USA area, before one (1) arbitrator to be mutually agreed upon by both parties. The parties agree to share equally in the arbitration costs incurred.

Gift Certificate - Terms and Conditions

These Gift Certificate Terms and Conditions (hereinafter "Terms and Conditions") govern the purchase, use and redemption of gift certificates purchased from Peak Potential Therapy LLC, d/b/a Peak Potential Therapy ("Peak Potential Therapy"). For questions, comments or suggestions, please contact Peak Potential Therapy at:

               Peak Potential Therapy
               8848 Commons Blvd., Ste. 101
               Twinsburg, OH 44087
               (330) 405-8776
               contact@peakpotentialtherapy.com

Purchasing, Sending and Receiving Gift Certificates

• Gift certificates are void where prohibited or restricted by law.
• Gift certificates cannot be used to purchase gift certificates.
• Except as provided herein, gift certificates have no cash value.
• Gift certificates are not valid until payment has been received and successfully processed by Peak Potential Therapy.
• Peak Potential Therapy reserves the right to refuse service or reverse any gift certificate purchase for any reason and return the funds to the purchaser.

Redeeming Gift Certificates

• Gift certificates are only redeemable at Peak Potential Therapy for the amount or service specified on the gift certificate. Peak Potential Therapy reserves the right to convert service-based gift certificates to their monetary value, equivalent to what was paid for the gift certificate, at its option and sole discretion.
• Gift certificates cannot be used or redeemed for services or products provided by Peak Potential Therapy affiliates, or with any third party accessible from Peak Potential Therapy.
• Except as required by law, gift certificates are not redeemable for cash and cannot be returned for a cash refund.
• Any unused balance of the gift certificate will remain until redeemed.
• If a purchase exceeds the amount listed on the gift certificate, the redeemer is responsible for paying the difference at time of purchase.
• For security purposes, a recipient may be required to show valid ID before he or she can redeem the gift certificate.
• Use and redemption of our gift certificates are also governed by our Privacy Policy.
• Peak Potential Therapy, its agents and vendors, may provide gift certificate purchasers with information about the redemption status of gift certificates.

Cancellation and Expiration of Gift Certificates

• Peak Potential Therapy reserves the right to immediately invalidate gift certificates, without notice, should it receive a credit card chargeback, returned check or other form of repudiated payment made towards the gift certificate.
• Peak Potential Therapy is not responsible for lost or stolen gift certificates. Reasonable and prudent steps are taken to verify the legitimacy of a redeemer and upon full redemption; the gift certificate will be identified as not valid for payment of any kind.
• Peak Potential Therapy reserves the right to dishonor the gift certificate, if it reasonably believes it was not validly purchased, has already been redeemed, or the redeemer stole or is otherwise not the intended beneficiary of the purchaser.
• Gift certificates expire 12 months after date of purchase, except where prohibited by law.
• Peak Potential Therapy may, at its sole option and discretion (unless required by law) replace a lost gift certificate, provided the original gift certificate is valid, has not been redeemed and the replacement is issued to the verifiable beneficiary of such gift certificate. Such replacement will be the beneficiary's sole remedy for such lost or misplaced gift certificates.

Miscellaneous Terms and Conditions

• Gift certificates are in U.S. dollars.
• Peak Potential Therapy reserves the right to change these Terms and Conditions from time to time in its sole discretion.
• PEAK POTENTIAL THERAPY, ITS AGENTS AND AFFILIATES, MAKE NO WARRANTIES, EXPRESS OR IMPLIED, WITH RESPECT TO GIFT CERTIFICATES, INCLUDING WITHOUT LIMITATION, ANY EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IN THE EVENT A GIFT CERTIFICATE NUMBER OR BAR CODE IS NON-FUNCTIONAL, YOUR SOLE REMEDY, AND PEAK POTENTIAL THERAPY'S SOLE LIABILITY, SHALL BE THE REPLACEMENT OF SUCH GIFT CERTIFICATE.
• Gift certificates, and these Terms and Conditions, are subject to and governed by the laws of Ohio, without reference to its principles of conflicts of law.
• If any provision of these Terms and Conditions should, for any reason, be held invalid, prohibited by law or unenforceable in any respect, such term will not apply. However, the remainder of these Terms and Conditions shall be enforced to the full extent permitted by law. A court of competent jurisdiction is hereby empowered to modify the invalid, prohibited or unenforceable provision to make it valid and enforceable.
• Risk of loss will pass to the purchaser of the gift certificate upon the electronic transmission of such gift certificate to the recipient or purchaser.

Website Information Disclaimer

The Peak Potential Therapy LLC website is designed for educational purposes only. The contents of this website are not medical, legal, technical or therapeutic advice and must not be construed as such. The information contained herein is not intended to substitute for informed professional diagnosis, advice or therapy. Visitors should not use this information to diagnose or treat Autism Spectrum Disorder or Related Disorders without also consulting a qualified medical, psychological or educational professional. Listing of opinions, treatments, professionals and organizations on this website does not imply endorsement by Peak Potential Therapy LLC.

Peak Potential Therapy LLC does not discriminate on the basis of race, ethnicity, national origin, religion, gender, disability, age, or ancestry.

If any policies or procedures change, Peak Potential Therapy LLC will notify the family immediately and obtain a new, signed "Policies & Procedure Statement of Agreement."

Thank you for choosing to receive therapeutic services from "Holly" Natalie Reimann, MA CCC-SLP at Peak Potential Therapy LLC. We look forward to working with your family.