The Clinic for Neurology, P. A.
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.
This notice takes effect on April 14,
2003 and remains in effect until we replace it.
1. OUR PLEDGE REGARDING MEDICAL INFORMATION
Protected health information is information
about you, including demographics that may identify you and
that relates to your past, present or future physical or mental
healthcare and related health care services. We are committed
to protecting your information. We create a record of the
care and services you receive at our facility. We keep this
record to provide you with quality care and to comply with
legal requirements. This notice will tell you about the ways
we may use and share medical information about you. We also
inform you of your rights and outline certain duties we have
regarding the use and disclosure of medical information.
2. OUR LEGAL DUTY
Law Requires Us to:
1. Protect your health information.
2. Give you this notice describing
our legal duties, privacy practices, and your rights regarding
your medical information.
3. Abide by the terms of privacy
practices now in effect.
We Have the Right to:
1. Change our privacy practices and
the terms of this notice at any time, provided that the
changes are permitted by law.
2. Make the changes in our privacy
practices and the new terms of our notice effective for
all medical information that we store, including information
previously created or received before the changes.
Notice of Change to Privacy Practices:
Before we make any important change
in our privacy practices, we will change this notice and
make the new notice available upon request.
3. USE AND DISCLOSURE OF YOUR MEDICAL
This section describes different ways
that we use and disclose medical information. Following are
different kinds of uses or disclosures and their meaning.
Not every use or disclosure will be listed. However, we have
listed examples of ways we are permitted to use and disclose
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 that
has already obtained your permission to have access to your
protected health information.
We would disclose your protected health information, as necessary,
to a home health agency that provides care to you. We will
also disclose protected health information to other physicians
who may be treating you when we have the necessary permission
from you to disclose your protected health information. For
example, your protected health information may be provided
to a physician to whom you have been referred to ensure that
the physician has the necessary information to diagnose or
In addition, we may disclose your protected
health information from time-to-time to another physician
or health care provider (e.g., nurses, technicians, medical
students or healthcare providers) who, at the request of your
physician, becomes involved in your care by providing assistance
with your health care diagnosis or treatment to your physician.
For example, we may disclose your protected health information
to medical school students 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 indicate
your physician. 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.
Your protected health information will
be used and disclosed, as needed, to obtain payments for health
Example: You have surgery.
We may need to give your health insurance
plan information about surgery you received, so that your
health plan will pay us or repay you for any surgery that
you paid for.
We may also tell your health plan about a treatment you are
going to receive to get approval or to determine if your plan
will pay for the treatment.
FOR HEALTH CARE OPERATIONS:
We may use and disclose your medical
information for our health care operations. This might include
measuring and improving quality, evaluating the performance
of employees, conducting training programs, and getting accreditation,
certificates, licenses and credentials we need to serve you.
We will share your protected health information with third
party "business associates" that performs various
activities (e.g., billing, transcription services) 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.
USE AND DISCLOSURES OF PROTECTED HEALTH
INFORMATION BASED UPON YOUR WRITTEN AUTHORIZATION.
ADDITIONAL USES AND DISCLOSURES:
Other uses and disclosures of protected
health information will only be made with your written authorization
unless otherwise permitted or required by law. You may revoke
this authorization in writing at any time. The exception to
this revocation is that your physician has taken an action
in reliance on the authorization. In addition to using and
disclosing your medical information for treatment, payment,
and health care operations, we may use and disclose medical
information for the following purposes.
Medical information to notify or help notify:
a family member
your personal representative
another person responsible for your care
We will share information about your location, general condition,
or death. If you are present, we will get your permission
if possible before we share, or give you the opportunity to
refuse permission. In case of emergency, and if you are not
able to give or refuse permission, we will share only the
health information that is directly necessary for your health
care, according to our professional judgment to make decisions
in your best interest about allowing someone to pick up medicine,
medicinal supplies, x-ray or medical information for you.
Research in Limited Circumstances:
We may disclose your protected health
information in limited circumstances to researchers when their
research has been approved by an institutional review board
that has reviewed the research proposal and established protocols
to ensure the privacy of your protected health information.
Coroner, Medical Examiner, Funeral
To help them carry out their duties, we may share the medical
information of a person who has died with a coroner, medical
examiner, funeral director, or an organ procurement organization.
OTHER PERMITTED AND REQUIRED DISCLOSURES
THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY
We may use and disclose your protected health information
if your physician in the practice attempts to obtain consent
from you but is unable to do so due to substantial communication
barriers and the physician determines, using professional
judgment, that you intend to consent to use or disclose under
We may use the following medical information in our facilities
directories: your name, your location in our facility, your
general medical condition. We will disclose this information
to members of the clergy or, except for religious affiliation,
to other persons. We will provide you with an opportunity
to restrict or prohibit some or all disclosures for facility
directories unless emergency circumstances prevent your opportunity
OTHER PERMITTED AND REQUIRED USES AND
DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION
OR OPPORTUNITY TO OBJECT.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose
protected health information of individuals who are Armed
Forces personnel (1) for activities deemed necessary by appropriate
military command authorities; (2) for the purpose of a determination
by the Department of Veterans Affairs of your eligibility
for benefits, or (3) to foreign military authority if you
are a member of that foreign military services. We may also
disclose your protected health information to authorized federal
officials for conducting national security and intelligence
activities, including for the provision of protective services
to the President or others legally authorized.
Government Functions (Specialized):
Subject to certain requirements, we may disclose or use health
information for medical suitability determinations for the
Department of State, for correctional institutions and other
law enforcement custodial situations, and for government programs
providing public benefits.
Court Orders and Judicial and Administrative
We may disclose medical information in response to a court
or administrative order, subpoena, discovery request, or other
lawful process, under certain circumstances. Under limited
circumstances, such as a court order, warrant, or grand jury
subpoena, we may share your medical information with law enforcement
officials. We may share limited information with a law enforcement
official concerning the medical information of a suspect,
fugitive, material witness, crime victim or missing person.
We may share the medical information of an inmate or other
person in lawful custody with a law enforcement official or
correctional institution under certain circumstances.
As required by law, we may disclose your medical information
to public health or legal authorities charged with preventing
or controlling disease, injury or disability, including child
abuse or neglect. We may also disclose your medical information
to persons subject to jurisdiction of the Food and Drug Administration
for purposes of reporting adverse events associated with product
defects or problems, to enable product recalls, repairs or
replacements, to track products, or to conduct activities
required by the Food and Drug Administration.
We may when authorized by law to do so, notify a person who
may have been exposed to a communicable disease or otherwise
be at risk of contracting or spreading a disease or condition.
Victims of Abuse, Neglect, or Domestic
We may disclose your protected health information to a public
health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your
protected health information if we believe that you have been
a victim of abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. In
this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Your protected health information may be disclosed by us as
authorized to comply with workers' compensation laws and other
similar legally-established programs.
Health Oversight Activities:
We may disclose medical information to an agency providing
health oversight for oversight activities authorized by law,
including audits, civil, administrative, or criminal investigations
or proceedings, inspections, licensure disciplinary actions,
or other authorized activities.
Under certain circumstances, we may disclose health information
to law enforcement officials. These circumstances include
reporting required by certain laws (such as the reporting
of certain types of wounds), pursuant to certain subpoenas
or court orders, reporting limited information concerning
identification and location at the request of a law enforcement
official, reports regarding suspected victims of crimes at
the request of a law enforcement official, reporting death,
crimes on our premises, and crimes in emergencies.
We may use or disclose your protected health information if
you are an inmate of a correctional facility and your physician
created or received your protected health information in the
course of providing care to you.
Appointment Reminders: We may use your medical information
to contact you to provide appointment reminders.
We may use or disclose your medical information to a public
or private entity authorized by law or by its charter to assist
in disaster relief efforts.
Marketing Health Related Services:
We may use your medical information to contact you with information
about health-related benefits and services or about treatment
alternatives that may be of interest to you. We may disclose
your medical information to a business associate to assist
us in these activities.
We may use your medical information to contact you for fundraising
purposes. We will limit our use and disclosure to your demographic
information and the dates of your health care. We may disclose
this information to a business associate or foundation to
assist us in fundraising activities. We will provide you with
any fundraising materials and a description of how you may
opt out of receiving future fundraising communications.
4. YOUR PATIENT RIGHTS
You Have a Right to:
1. Inspect or get copies of your
medical information. You may request that we provide copies
in a format other than photocopies. We will use the format
you request unless it is not practical for us to do so.
You must make your request in writing. You may get the form
to request access by contacting the practice administrator
listed at the end of this notice. You may also request access
by sending a letter to the contact person listed at the
end of this notice.
If you request copies, we will charge
you for each page, and postage if you want the copies mailed
to you. Contact us for a full explanation of our fee structure.
2. 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 of
Privacy Practices. It excludes disclosures we may have made
to you, to family members or friends involved in your care,
or for notification purposes. 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.
3. Request that we place additional
restrictions on our use or disclosure of your medical information.
We are not required to agree to these additional restrictions,
but if we do, we will abide by our agreement (except in
the case of an emergency).
4. Request to receive confidential
communications from us by alternative means or to alternative
locations. Your request must be made in writing to the contact
person listed at the end of this notice.
5. Request that we amend your protected
health information. In certain cases we may deny your request
if we did not create the information you want changed or
for certain other reasons. If we deny your request, we will
provide you a written explanation. You may respond with
a statement of disagreement that will be added to the information
you wanted changed. If we accept your request to change
the information, we will make reasonable efforts to tell
others, including people you name, of the change and to
include the changes in any future sharing of that information.
6. You have a right to refuse a copy
of the Notice of Privacy Practices. Your treatment will
not be conditioned on your refusal unless it is for the
purpose of creating health information or research related
QUESTIONS AND COMPLAINTS
IF YOU HAVE ANY QUESTIONS ABOUT THIS
NOTICE, PLEASE CONTACT OUR OFFICE.
The Clinic for Neurology, P.A.
185 Chateau Dr SW
Huntsville, AL 35801
If you believe that your privacy rights
have been violated, contact the practice administrator named
above. You may also submit a written complaint to the U.S.
Department of Health and Human Services:
Office for Civil Rights
US Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
We will not retaliate in any way if
you choose to file a complaint.