×

Parent Intake Questionnaire – Important Notice

This Parent Intake Questionnaire is the second step in enrolling with Blueview.

Please complete the Enrollment Inquiry Form first. Our team will review your child’s needs and contact you with the next steps. If you have already spoken with a Blueview staff member, you may proceed with the Parent Intake Questionnaire.

Enrollment Inquiry

Feel free to talk to us! 508-251-1976

Effective Date: July 15, 2026

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Blueview Autism Intervention Services LLC is committed to protecting the privacy and security of your Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and applicable Massachusetts law.

How We May Use and Disclose PHI

We may use or disclose your PHI to:

  • Provide treatment and ABA services.
  • Obtain payment from insurance companies and other payers.
  • Conduct healthcare operations, including quality improvement, supervision, training, accreditation, auditing, and compliance activities.
  • Work with contracted Business Associates who are required to protect your PHI.
  • Comply with legal obligations, including reporting required by law or responding to court orders or government requests.

Any other use or disclosure of your PHI requires your written authorization unless otherwise permitted or required by law.

Your Rights

You have the right to:

  • Inspect and obtain copies of your records.
  • Request amendments to your records.
  • Request restrictions on certain uses or disclosures.
  • Request confidential communications.
  • Receive an accounting of certain disclosures.
  • Receive a paper copy of this Notice.
  • File a privacy complaint without fear of retaliation.

Our Responsibilities

Blueview is required to:

  • Maintain the privacy and security of your PHI.
  • Follow the terms of this Notice.
  • Notify affected individuals if a reportable breach of unsecured PHI occurs.
  • Train workforce members on HIPAA privacy and security requirements.

Questions or Complaints

If you have questions or believe your privacy rights have been violated, please contact:

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Filing a complaint will not affect the quality of services you receive from Blueview.

Changes to this Notice

Blueview reserves the right to revise this Notice at any time. The current version will be available upon request and on our website.