THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Neuromonitoring Associates (“NMA”) understands that health information about you is personal and we are committed to maintaining the privacy of health information that specifically identifies you and relates to your health condition, your care, or to payment for your health care (“Protected Health Information”). Furthermore, we are required by law to keep health information about you private; to give you this Notice of Privacy Practices (the “Notice”) of our privacy practices, our legal obligations and your rights in regards to your Protected Health Information; and to follow the privacy practices as described within this Notice while it is in effect. For purposes of this Notice, when we refer to “you” or “your,” we mean you as a patient or you as the parent or guardian of a minor patient.
NMA reserves the right to change these privacy practices and the terms of this Notice at any time, provided such applicable laws permit such changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. Any new terms will be effective for all Protected Health Information that we maintain, including Protected Health Information we create or receive before such made changes.
You may request a copy of this notice at any time. For additional information about our privacy practices, please contact us at 702-706-1507
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
The following sections describe different ways that NMA may use and disclose your Protected Health Information. Not every use or disclosure will be listed. All of the ways we are permitted to use and disclose information, however, will fall within one of the following categories. Other uses and disclosures not described in this Notice will be made only if we have your written authorization.
Treatment: We may use your Protected Health Information to provide you with treatment or services. We may also disclose such information to physicians, nurses, or other health care providers involved in your care.
Payment: We may use and disclose your Protected Health Information to obtain payment for services rendered. We may disclose your Protected Health Information to another health care provider to assist them in obtaining payment for services they have provided to you.
Health care Operations: We may use and disclose your Protected Health Information during our routine health care operations. Health care operations may include quality assessments and improvements activities, reviewing the competence or qualifications of our health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification and licensing or credentialing activities.
To Your Family & Friends: Unless you object, we may, in our professional judgment, disclose your Protected Health Information to a family member, friend or other person responsible for your care to the extent necessary to help with that person’s involvement in caring for you or paying for your care. We may also use or disclose information about you to notify a family member or other person responsible for your care of your location and general condition.
Other Permitted Uses and Disclosures: We are also permitted to use or disclose your Protected Health Information, without obtaining a written authorization from you, in the following circumstances:
When otherwise required by law.
WHEN WRITTEN AUTHORIZATION IS REQUIRED
Other than for those purposes outlined in the “Uses and Disclosures of Protected Health Information” section above, NMA will not use or disclose your Protected Health Information for any purpose unless you give us your specific written authorization to do so. Special circumstances that require an authorization include, but are not limited to, uses and disclosures of your Protected Health Information for marketing purposes that encourage you to purchase a product or service, and for sale of your Protected Health Information with some exceptions. If you provide NMA an authorization to use or disclose your Protected Health Information, you can withdraw this written authorization at any time by sending a written revocation to firstname.lastname@example.org. If you revoke your authorization, we will no longer use or disclose your Protected Health Information as previously permitted by your written authorization, except to the extent that we have already relied on your authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights with respect to the Protected Health Information that NMA maintains about you:
Right to Request Special Privacy Protections: You have the right to request restrictions on certain uses and disclosures of your Protected Health Information, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. NMA is not generally required to agree to a requested restriction. However, NMA must follow your request to restrict disclosures made for purposes of payment or health care operations where you have paid for a health care item or service entirely out of your own pocket. If we accept your request, the restrictions will not apply to any Protected Health Information disclosed prior to your request.
Right to Request Confidential Communications: You have the right to request that you receive your Protected Health Information in a specific way or at a specific location and we will accommodate reasonable requests by you. For example, you may ask that we send information to a particular e-mail account or address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
Right to Inspect and Copy: You have the right to access, inspect, and copy your medical information that we use to make decisions about your care, with limited exceptions. All requests must be submitted in advance, in writing. We will charge a reasonable, cost-based fee for copying your medical records, as allowed by state and federal law. We may deny your request to access, inspect, or copy your medical records under limited circumstances.
Right to Amend or Supplement: You have a right to request that we amend your medical record if you believe it is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your record, but will give each request careful consideration. If we deny all or part of your request for amendment, you also have the right to submit a written statement of reasonable length disagreeing with the denial and the basis of such disagreement.
Right to an Accounting of Disclosures: You have a right to receive an accounting of disclosures of your Protected Health Information made by NMA, except for disclosures made for purposes of treatment, payment, or health care operations or for certain other limited exceptions. The request must specify the time period for which you are requesting the accounting and may not be for a period of time going back more than six (6) years. The first accounting you request within a 12-month period will be free of charge. For additional accountings within that same 12-month period, you may be charged a reasonable fee.
Right to Be Notified of a Breach. We are required to notify you in writing of any breach of your unsecured Protected Health Information without unreasonable delay, but in any event, no later than 60 days after we discover the breach.
Right to a Paper Copy of the Notice: You may ask us to provide you with a paper copy of this Notice at any time.
QUESTIONS OR COMPLAINTS
If you have any questions about this Notice, please contact our [Privacy Officer] at 702-706-1507. If you believe your privacy rights have been violated, you may file a complaint with NMA or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
9811 W. Charleston Blvd
Las Vegas, NV 89117
U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll free: 1-877-696-6775
This Notice is effective October 1, 2017