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Dynamic Pediatric Therapies

1221 N. LaSalle Dr.

Chicago, IL 60610 


Phone: 312.265.0016





When it comes to your privacy, you have certain rights and we have certain responsibilities. This notice describes how medical information about your child may be used and disclosed and how you may access this information. We respect patient privacy and only release medical information about your child in accordance with state and federal laws. We reserve the right to update this policy at any time. An updated policy will be made available at your request. 


Definition: “You” refers to any individual supported by Dynamic, their parents, and/or legal guardians.


Your Private Health Information (PHI) may exist in one or more of the following forms:

  • Written documentation and records 

  • Electronic documentation and records

  • Web-based forms, password protected and accessible only by Dynamic permission 


Minimum Necessary: we only share as much information as necessary, in accordance with these guidelines:

  • Only Dynamic employees who have direct involvement with your case will access your PHI

  • All Dynamic employees sign a confidentiality agreement that prohibits them from sharing your PHI unlawfully and unethically

  • PHI will only be shared between staff members as necessary to provide high quality care

  • If other entities require your PHI, consent of release of information will be obtained from you


Use and Disclosure of PHI: to provide effective and high quality care, there are times we must use and disclose your child’s medical information with others beyond our practice. This includes circumstances of:

  • Treatment/Care Coordination: to coordinate care among providers or with others who are providing care to your child and to coordinate follow-up appointments and care at Dynamic.

  • Payment: to secure payment for services, including from third-party payers (insurance companies). 

  • Healthcare Operations: to set up appointments, review your care, train staff, file paperwork, etc.

  • Emergencies: to provide emergency care, at the discretion of Dynamic staff and trained healthcare professionals, for your child when a parent or emergency contact cannot be reached.

  • Disaster Relief: to aid a legal representative in providing disaster relief services. 

  • Funeral Director, Coroner, Medical Examiner: to help carry out duties as they pertain to an individual who has died.

  • Specialized Government Functions: to aid in issues of national security, intelligence activities, law enforcement, correctional institution efforts, and procurement of public benefits. 

  • Concerns of Public Health: to aid in preventing or controlling disease, injury or disability, including child abuse or neglect. When legally authorized to do so, we may also notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

  • Health Oversight: for the purpose of audits, investigations, and inspections. Oversight agencies include but are not limited to government agencies that oversee the healthcare system, government benefit programs, and other governmental programs and civil rights laws.

  • Abuse and Neglect: to help secure the safety of your child if we reasonably believe your child is a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.

  • Legal Proceedings: in response to an order of a court or administrative tribunal, in response to a subpoena, discovery request, or other lawful process.

  • Law Enforcement/Criminal Activity: as requested by enforcement authorities and required by law.

  • Worker’s Compensation: when authorized or necessary to comply with applicable laws.


Client Rights to PHI

  • You have the right to obtain and inspect a copy of your PHI. You may request a copy of your PHI by submitting this form request: or by emailing our Practice Manager at with the details of your request.

  • If you feel your PHI is incorrect, you have the right to request it be amended. Notice of any amendments will be made to anyone who received the original documentation.

  • You can request restrictions on the use and disclosure of your PHI. Dynamic may deny the request.

  • Your PHI may be mailed to your home. You may request alternative delivery methods. 

  • If a disclosure of PHI was made for a reason other than treatment, payment or other healthcare operations, you have a right to receive notice.

  • You can request, print or otherwise save a copy of this Notice of Privacy Practices at any time.

  • If you believe your rights have been violated, you may submit a complaint to:

Dynamic Pediatric Therapies, LLC. 

Attn: Clinic Administrator

1221 N. LaSalle Dr.

Chicago, IL 60610

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