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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact our
Privacy Officer at the number listed at the end of this Notice.
Each time you visit a healthcare provider, a record of your visit
is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, a plan for future care or
treatment, and billing-related information. This Notice applies
to all of the records of your care generated by your health care
provider.
Our Responsibilities
Neurocare, Inc. is required by law to maintain the privacy of your
health information and to provide you with a description of our
legal duties and privacy practices regarding your health information.
The current Notice will be posted in the administrative and clinical
reception areas. The notice will include the effective date. In
addition, we will make our best effort to provide you with a copy
of this notice that we request you acknowledge with your signature.
We are required by law to abide by the terms of this Notice and
notify you if we make changes to this Notice, which may be at any
time. Changes to the Notice will apply to your medical information
that we already maintain as well as new information received after
the change occurs. If we change our Notice, it will be posted in
the administrative and clinical reception areas. You may also request
that a revised Notice be sent to you in the mail or you may ask
for one at your next appointment or appropriate visit. This Notice
will also serve to advise you as to your rights with regard to your
medical information.
How We May Use and Disclose Medical Information About You.
The following categories describe examples of the way we use and
disclose medical information:
For Treatment: We may use medical information about you to
provide, coordinate and manage your treatment or services. We may
disclose medical information about you to other doctors, nurses,
technicians (e.g. clinical laboratories or imaging companies), medical
students, or other personnel who are involved in your care. We may
use your health information to determine whether you meet the criteria
for inclusion into research trials. If you do, we will seek your
permission before using or disclosing your information. We may communicate
your information either orally or in writing by mail or facsimile.
We may also provide a subsequent healthcare provider with copies
of various reports that should assist him or her in treating you.
For example, your medical information may be provided to a physician
to whom you have been referred so as to ensure that the physician
has appropriate information regarding your previous treatment and
diagnosis.
For Payment: We may use and disclose medical information
about your treatment and services to bill and collect payment from
you, your insurance company or a third party payer. For example,
we may need to give your insurance company information before it
approves or pays for the health care services we recommend for you
For Health Care Operations: We may use or disclose, as needed,
your health information in order to support our business activities.
These activities may include, but are not limited to quality assessment
activities, employee review activities, licensing, legal advice,
accounting support, information systems support and conducting or
arranging for other business activities. In addition, we may also
call you by name in the waiting room when your physician is ready
to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment by
telephone or reminder card.
Business Associates: There are some services provided in
our organization through contracts with business associates. Examples
include transcription, medical records storage, quality assurance,
accreditation and software support. When these services are contracted,
we may disclose your health information to our business associate
so that they can perform the job that we have asked them to do and
bill you or your third-party payer for services rendered. To protect
your health information, however, we require the business associate
to appropriately safeguard your information through a written contract.
Other Permitted and Required Uses and Disclosures
That May Be Made With Your Consent, Authorization or Opportunity
to Object
We also may use and disclose your health information as
set forth below. You have the opportunity to agree or object to
the use or disclosure of all or part of your health information
in these instances. If you are not present or able to agree or object
to the use or disclosure of the health information (such as in an
emergency situation), then your clinician may, using professional
judgment, determine whether the disclosure is in your best interest.
In this case, only the information that is relevant to your health
care will be disclosed.
Individuals Involved in Your Care or Payment for Your Care: Unless
you object, we may release medical information about you to a friend
or family member who is involved in your medical care or who helps
to pay for your care. In addition, we may disclose medical information
about you to an entity assisting in a disaster relief effort so
that your family can be notified about your condition, status and
location.
Future Communications: We may communicate to you via newsletters,
mailings or other means regarding treatment options, information
on health-related benefits or services; to remind you that you have
an appointment for medical care; or other community based initiatives
or activities in which our facility is participating. If you are
not interested in receiving these materials, please contact our
Privacy Officer.
Other Permitted and Required Uses and Disclosures
That May Be Made Without Your Authorization or Opportunity to Object
We may use or disclose your health information in the following
situations without your authorization or without providing you with
an opportunity to object. These situations include:
As required by law: We may use and disclose health information to
the following types of entities, including but not limited to:
• Food and Drug Administration
• Public Health or Legal Authorities charged with preventing
or controlling disease, injury or disability
• Correctional Institutions
• Workers Compensation Agents
• Organ and Tissue Donation Organizations
• Military Command Authorities
• Health Oversight Agencies
• Funeral Directors, Coroners and Medical Directors
• National Security and Intelligence Agencies
• Protective Services for the President and Others
• Authority that receives reports on abuse and neglect
Law Enforcement/Legal Proceedings: We may disclose health
information for law enforcement purposes as required by law or in
response to a valid subpoena.
State-Specific Requirements: Many states have requirements
for reporting including population-based activities relating to
improving health or reducing health care costs.
Your Health Information Rights
Although your health record is the physical property of the Neurocare,
Inc. that compiled it, you have the right to:
Inspect and Copy: You have the right to inspect and copy
medical information that may be used to make decisions about your
care. We ask that you submit these requests in writing. Usually,
this includes medical and billing records, but does not include
psychotherapy notes or information compiled in reasonable anticipation
of, or for use in, a civil, criminal, or administrative action or
proceeding. We may deny your request to inspect and copy in certain
very limited circumstances. If you are denied access to medical
information, you may request that the denial be reviewed. The person
conducting the review will not be the person who denied your request.
We will comply with the outcome of the review. Requests for access
to and copies of your medical information must be submitted to Neurocare,
Inc. in writing. The practice may charge up to $20 per hour for
clerical time and 25 cents per page for copies of the medical record
Amend: If you feel that medical information we have about
you is incorrect or incomplete, you may ask us to amend the information
by submitting a request in writing. You have the right to request
an amendment for as long as we keep the information. We may deny
your request for an amendment and if this occurs, you will be notified
of the reason for the denial.
An Accounting of Disclosures: You have the right to request
an accounting of our disclosures of medical information about you
except for certain circumstances, including disclosures for treatment,
payment, health care operations or where you specifically authorized
a disclosure. Neurocare, Inc. will provide the first accounting
to you in any 12-month period without charge. The cost for subsequent
requests for an accounting within the 12-month period will be $10.00.
We ask that you submit these requests in writing.
Request Restrictions: You have the right to request a restriction
or limitation on the medical information we use or disclose about
you for treatment, payment or health care operations. You also have
the right to request a limit on the medical information we disclose
about you to someone who is involved in your care or the payment
for your care, like a family member or friend. For example, you
could ask that we not use or disclose information about a procedure
that you had. We ask that you submit these requests in writing.
We are not required to agree to your request. If we do agree, we
will comply with your request unless the information is needed to
provide you with emergency treatment.
Request Confidential Communications: You have the right to
request that we communicate with you about medical matters in a
certain way or at a certain location. We will agree to the request
to the extent that it is reasonable for us to do so. For example,
you can ask that we use an alternative address for billing purposes.
We ask that you submit these requests in writing.
A Paper Copy of This Notice: You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice
at any time. Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice.
To exercise any of your rights, please obtain the required forms
from the Privacy Officer and submit your request in writing.
Complaints
If you believe your privacy rights have been violated, you may file
a complaint with us by calling (617) 796-7766 and asking for the
Privacy Officer or by contacting the Secretary of the Federal Department
of Health and Human Services. All complaints must be also submitted
in writing. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by
this Notice or the laws that apply to us will be made only with
your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will
no longer use or disclose medical information about you for the
reasons covered by your written authorization. However, we are unable
to take back any disclosures we have already made with your permission
and we are required to retain our records of the care that we provided
to you.
Privacy Officer: June Roberts
Telephone: (617) 796-7766
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