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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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