The Notice of
Privacy Practices covers services provided to you by Neurology & Sleep
Medicine. We are required by law to maintain the privacy of protected
health information and to provide you with the Notice of our legal
duties and privacy practices with respect to protected health information. “Protected
health information” is information about you, including demographic
information, that may identify you and that relates to your past,
present or future physical or condition and related health care
services.
The Notice describes how we may use and disclose your protected health
information to carry out treatment, payment or health care operations.
Other uses and disclosures of your protected health information will
be made only with your written authorization, unless otherwise permitted
or required by law. The Notice also describes your rights to access
and control your protected health information. Further, the Notice
informs you of your rights to complain to us or Department
of Health and Human Services if you believe your privacy
rights have been violated by us.
We are required to abide by the terms of the Notice. We may change
the terms of our notice, at any time.
Please read the attached Notice carefully.
NOTICE OF PRIVACY PRACTICES
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.
We are required by law to maintain the privacy of protected
health information and to provide you with this Notice of our legal
duties and privacy practices with respect to protected health information. “Protected
health information” is information about you, including demographic
information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related
health care services.
We are required to abide by the terms of this Notice currently in
effect. We may change the terms of our notice, at any time. The new
notice will be effective for all protected health information that
we maintain at that time.
1. USES
AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information
for Treatment, Payment, or Operations
Your protected health information may be used by your health care
provider for treatment, payment and health care operations as described
in this Section 1 without authorization from you. Your protected
health information may be used and disclosed by your health care
provider, our office staff and others outside of our office that
are involved in your care and treatment for the purpose of providing
health care services to you. Your protected health information may
also be used and disclosed to pay your health care bills and to support
the operation of the health care provider’s practice.
Following are examples of the types of uses and disclosures of your
protected health care information that the health care provider’s
office is permitted to make without your specific authorization.
These examples are not meant to be exhaustive, but to describe the
types of uses and disclosures that may be made by our office.
Treatment: We will use and disclose
your protected health information to provide, coordinate,
or manage your health care and any related services. This
includes the coordination or management of your health care
with a third party, consultations with another health care
provider, or your referral to another health care provider
for your diagnosis and treatment. For example, we would disclose
your protected health information, as necessary, to a home
health agency that provides care to you.
Payment: Your protected health information
will be used, as needed, to obtain or provide payment for
your health care services, including disclosures to other
entities. This may include certain activities that your health
insurance plan may undertake before it approves or pays for
the health care services we recommend for you such as making
a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical
necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require
that your relevant protected health information be disclosed
to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use
or disclose, as needed, your protected health information
in order to support the business activities of your health
care provider’s practice. These activities include,
but are not limited to: quality assessment and improvement
activities; reviewing the competence or qualifications of
health care professionals; training of sleep technicians,
medical students/and or any training related to sleep within
this entity; securing stop-loss or excess of loss insurance;
obtaining legal services or conducting compliance programs
or auditing functions; business planning and development;
business management and general administrative activities,
such as compliance with the Health Insurance Portability
and Accountability Act; resolution of internal grievances;
due diligence in connection with the sale or transfer of
assets of your health care provider’s practice; creating
de-identified health information; and conducting or arranging
for other business activities.
For example, we may disclose your protected health information to
medical school students and or sleep student/trainee technicians
that see patients at our office. In addition, we may use a sign-in
sheet at the registration desk where you will be asked to sign your
name and your arrival time. We may also call you by name in the waiting
room when your treating provider 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, or to discuss disease management
or wellness programs with you.
We will share your protected health information with third party “business
associates” that perform various activities (e.g., billing,
transcription services, accounting services, legal services, IT services,
laboratory, home healthcare agencies, accreditation organizations,
collection agencies, for the practice. Whenever an arrangement between
our office and a business associate involves the use or disclosure
of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected
health information.
We may use or disclose your protected health information, as necessary,
to provide you with information about a product or service to encourage
you to purchase or use the product or services for the following
limited purposes: (1) to describe our participation in a health care
provider network or health plan network, or to describe if, and the
extent to which, a product or service (or payment for such product
or service) is provided by our practice or included in a plan of
benefits; (2) for your treatment; or (3) for your case management
or care coordination, or to direct or recommend alternative treatments,
therapies, health care providers, or settings of care.
In addition, we may disclose your protected health information to
another provider, health plan, or health care clearinghouse for limited
operational purposes of the recipient, as long as the other entity
has, or has had, a relationship with you. Such disclosures shall
be limited to the following purposes: quality assessment and improvement
activities, case management, conducting training programs, accreditation,
certification, licensing, credentialing activities, and health care
fraud and abuse detection and compliance programs.
Uses and Disclosures of Protected Health Information
Based upon Your Written Authorization
Other uses and disclosures of your protected health information will
be made only with your written authorization, unless otherwise permitted
or required by law. You may revoke this authorization, at any time,
in writing, except to the extent that your health care provider or
the provider’s practice has taken an action in reliance on
the use or disclosure indicated in the authorization.
2. YOUR RIGHTS
Following is a statement of your rights with respect to your protected
health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected
health information. This means you may inspect and
obtain a copy of protected health information about you that
is contained in a designated record set for as long as we maintain
the protected health information. A “designated record
set” contains medical and billing records and any other
records that your health care provider and the practice uses
for making decisions about you.
Under federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative
action or proceeding; and protected health information that is subject
to law that prohibits access to protected health information. Depending
on the circumstances, a decision to deny access may be reviewable.
In some circumstances, you may have a right to have this decision
reviewed. Please contact our Privacy Contact if you have questions
about access to your medical record.
You have the right to request a restriction of your
protected health information. This means you may ask
us not to use or disclose any part of your protected health
information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected
health information not be disclosed to family members or friends
who may be involved in your care or for notification purposes
as described in this Notice. Your request must state the specific
restriction requested and to whom you want the restriction
to apply.
Your health care provider is not required to agree to a restriction
that you may request. If your health care provider believes it is
in your best interest to permit use and disclosure of your protected
health information, your protected health information will not be
restricted. If your health care provider does agree to the requested
restriction, we may not use or disclose your protected health information
in violation of that restriction unless it is needed to provide emergency
treatment. With this in mind, please discuss any restriction you
wish to request with your health care provider. You may request for
special restrictions form verbally or in writing, once we receive
the appropriate form necessary steps will be taken by our privacy
officer.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative
location. We will accommodate
reasonable requests. We may also condition this accommodation
by asking you for information as to how payment will be handled
or specification of an alternative address or other method
of contact. We will not request an explanation from you as
to the basis for the request. Please make this request in writing
to our Privacy Officer.
You may have the right to have your provider amend
your protected health information. This means you
may request an amendment of protected health information
about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request
for an amendment. If we deny your request for amendment,
you have the right to file a statement of disagreement with
us and we may prepare a response to your statement and will
provide you with a copy of any such response. Please contact
our Privacy Officer to determine if you have questions about
amending your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health
information. This right applies to disclosures for
purposes other than treatment, payment or healthcare operations
as described in this Notice. It excludes disclosures we may
have made to you, for a facility directory (if applicable),
to family members or friends involved in your care, or for
notification purposes, or disclosures for which you have
signed an authorization. You have the right to receive specific
information regarding these disclosures that occurred after
April 14, 2003. You may request a shorter timeframe. The
right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right to obtain a paper copy of this
Notice from us, upon request, even if you have agreed
to accept this Notice electronically.
3. COMPLAINTS
You may complain to us or to the Department of Health and Human Services
if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our Privacy Officer of
your complaint. We will not retaliate against you for filing a complaint.
This Notice becomes effective upon signing.
Note: You
may also download this page in PDF format at DOWNLOADABLE
FORMS
