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.

Effective Date: October 1, 2016

Purpose:

The Health Insurance Portability and Accountability Act (“HIPAA”) and other privacy-related regulations (referred to in this Notice as “Privacy Rule”) require Neurological Monitoring Associates, L.L.C. (“NMA”) to inform its patients about the ways that NMA may use and disclose your protected health information (PHI). PHI is individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for health care. In addition, the Privacy Rule requires NMA to inform patients of your rights regarding disclosures of your health information.

State laws and certain federal laws may be more protective of certain information that the federal Privacy Rule. Many states have specific procedures for responding to discovery requests or subpoenas or for disclosing information to coroners or funeral directors. NMA will not use your information in any way that is not permitted by state law or other more restrictive federal laws. In the event there is a breach of your unsecured PHI, we are required to notify you of such and will do so.

Any questions about this Notice, NMA’s privacy practices or regarding possible violations of your privacy may be directed to NMA’s Privacy Officer. The NMA Privacy Officer can be reach at:

NMA / 333 W. Brown Deer Road #240, Milwaukee, WI 53217 / 414.351.6666

In addition to contacting NMA, any patient may also contact the federal government directly, specifically the Office of Civil Rights at the Department of Health and Human Services at the appropriate Regional Office as listed at the contact information below:

Office of Civil Rights
U.S. Department of Health and Human Services

200 Independence Avenue, S.W.
Room 509 F, HHH Building
Washington, D.C. 20201
202.619.0257
Toll Free: 1.877.696.6775
Email: OCRcomplaint@hhs.gov

How we may use and disclose your protected health information:

NMA may use and disclose PHI without your consent or authorization for treatment, payment and healthcare operations. When used for payment or operations purposes, we will limit the information used or disclosed to that which is minimally necessary to accomplish the purpose of the use or disclosure. The following categories describe different ways we may use and disclose your PHI.

  • For treatment: We may use or disclose your PHI for treatment, such as to surgeons, anesthesiologists, nurses, technologists, or other health care providers who are involved in caring for you.
  • For payment: We may use or disclose your PHI to seek or receive payment for services you receive, including payment from an insurance company or government payor. For example, NMA may disclose your health information about dates of service and type of service performed to your health insurance company in order to receive reimbursement for the services you received.
  • For healthcare operations: We may use or disclose your PHI for our operations. This is necessary to manage our programs and activities.

Uses and disclosures of your protected health information permitted without your authorization:

As permitted by HIPAA, we may use or disclose your health information from our records (even after your death) without your permission in the following circumstances.

  • As required by law: We will disclose medical information about you when required to do so by federal, state, or local law.
  • Public health: We may disclose health information about you for public health activities. These activities may include: to report abuse, neglect or domestic violence, to notify a person who may have been exposed to a disease, to prevent or control disease, injury, or disability, to report deaths, and for public health surveillance or interventions, and finally, to the U.S. Food and Drug Administration (FDA) to report adverse or product defects, to track products, to enable product recalls, or to conduct post-market surveillances as required by the FDA.
  • Serious threat to health or safety: We may use or disclose your protected health information when necessary to persons able to lessen or prevent a serious threat to you or the health and safety of the public or another person.
  • Health oversight activities: We may use or disclose protected health information about you for activities including audits, accreditations, investigations, inspections, licensure and/or disciplinary activities. These activities are necessary for the government to monitor the health care delivery system.
  • Workers’ compensation: NMA may disclose your medical records to the state workers’ compensation program to the extent authorized by state or federal laws.
  • Research: NMA at times participates in research studies for new treatments or products. In certain circumstances we may disclose your PHI in order to assist medical research.
  • Individuals involved in your care: To the person you named in your advance directive and to persons involved in your care or the payment for your care; or based on the signed authorization of the estate’s representative on behalf of a deceased patient.
  • Organ and tissue donation: We may disclose protected health information to organ procurement organizations or organ donation banks to facilitate organ and tissue donation and transplantation.
  • Lawsuits and administrative disputes: We may release protected health information in response to a court or administrative order, a subpoena, a discovery process or other lawful process.
  • Business associates and affiliates: We may disclose your PHI to our Business Associates or affiliates as allowed by HIPAA. Our business associates have written agreements with us which contain specific assurances.


Disclosures you may object to:

Unless you object, NMA may also use or disclose your medical information in the following situations:

  • We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

  • For fundraising or marketing purposes

Your authorization is required for most uses and disclosures related to psychotherapy care and services, unless required for NMA to defend itself in legal action or other proceedings brought forward. Any other uses or disclosures of your health information not addressed in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time except to the extent NMA relied on it in making an authorized use or disclosure. We request you use our Authorization for Release of Medical Information for this purpose.

Your rights regarding protected health information:

NMA maintains a separate document outlining your complete rights and responsibilities as a patient of our services. Related to medical information we maintain about you, you have the following rights:

  • You have the right to confidential communication. You may ask that we communicate with you in a certain manner or at a certain location. For example, you may ask us to send information to your work address instead of your home address. These requests do not need to be explained, however, they must be in writing, and we will not honor a request for alternative contact methods unless sufficient alternative information has been received.
  • You have the right to inspect and request your information. In most cases, you have the right to look at or receive an electronic of paper copy of your record. Excluding psychotherapy notes. This request must be completed in writing, and there may be a fee charged for the cost of processing the record.
  • You have the right to amend. If you feel that there is a mistake or missing information in your medical record, you may ask us to correct or add to the record. Your request must include the rationale for changes, and must be in writing. NMA will provide a written response to your request for an amendment and in this response will provide detailed information on how you may review the changes or appeal the denial.
  • You have the right to restrict how your PHI is used and disclosed. In writing, you must communicate what information should be limited and to whom the limits apply. We are required to comply with your request that we restrict disclosers for a health plan for purposes of payment or healthcare operations if you paid in-full, out-of-pocket for your healthcare services. We will attempt to accommodate other reasonable requests but it is important to note that that NMA is not required to agree to other requests for restrictions.
  • You have the right to know what health information we have released. You have the right to ask for a list of accounting for disclosures made of your PHI. You must request this list in writing and state the period of time this list should cover for a period of no longer than six (6) years. NMA will provide the first 12-month period free-of-charge. After this, you may be charged a fee for processing this request.
  • You have the right to receive a paper copy of this Privacy Notice at any time. Paper copies are available through any NMA staff, from NMA’s Privacy Officer, or online at www.NeuroMonAssoc.org.


Revision of the Privacy Notice

Neurological Monitoring Associates, L.L.C. reserves the right to make revisions to this privacy notice at any time. We reserve the right to make the revised or changed Notice effective for medical information it already has about you, as well as for any information it receives about you in the future. We will make the revised Notice available to you at your request.