Notice of Privacy Practices as required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Effective Date of this Notice: April 2008
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY
At Neuropsychologic Associates, PLLC we are committed to treating and using protected health information about you responsibly. This notice of Health Information Practices describes how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 1, 2008 and applies to all protected health information as defined by federal regulations.
Patient Health Information Rights: Although your health record is the physical property of Neuropsychologic Associates, PLLC, the information belongs to you. You have the right to:
Neuropsychologic Associates, PLLC is required to:
Uses and Disclosures of Protected Health Information (PHI): The practice reasonably ensures that the PHI it requests, uses and discloses for any purpose is the minimum amount of PHI necessary for that purpose. The practice allows individuals to act as personal representatives of patients with the patient's written consent. The two general exceptions to allowing individuals to act as personal representative relate to unemancipated minors and abuse, neglect, or endangerment situations.
Uses and Disclosures: Treatment, Payment and Health Care Operations: The practice uses and discloses protected health information for payment, treatment, and health care operations. Treatment includes those activities related to providing services to the patient, including releasing information to other health care providers involved in the patient's care. Payment relates to all activities associated with getting reimbursed for services provided, including submission of claims to insurance companies and any additional information requested by the insurance company so they can determine if they should pay the claim. Health care operations include a number of areas, such as communicating with hospitals and diagnostic agencies. The practice discloses protected health information to those involved in a patient's care when the patient approves, or when that patient is not present or not able to approve, when such disclosure is deemed appropriate in the professional judgment of the practice. There are instances where protected health information may be released without the patient's consent, as when it is required by the law. In those instances, the disclosure is limited to the information directly requested and relevant. Examples of those situations would be the following:
Judicial and Administrative Proceedings: In general, the practice discloses information for judicial administrative proceedings in response to an order of a court or an administrative tribunal, a subpoena, discovery request or other lawful process, not accompanied by a court order or an ordered administrative tribunal.
Law Enforcement: The practice discloses PHI for law enforcement purposes to law enforcement officials.
Avert A Serious Threat of Health or Safety: The practice uses and discloses protected health information to public health and other authorities as required by law to avert a serious threat to health or safety.
Specialized Government Functions: The practice uses and discloses protected health information for military and veterans activities, national security and intelligence activities, and other activities as required by law.
Health Oversight Activities: The information, as required by law, may be used and released for audits, investigations, licensure issues and other health oversight activities, including but limited to hospital peer review, managed care peer review or Medicare and Medicaid peer review.
Emergency Situations: The practice uses and discloses protected health information as appropriate to provide treatment in emergency situations.
Marketing Purposes: The practice does not use or disclose any protected health information for marketing purposes. The practice does engage in communications about products and services that encourages recipients of the communication to purchase or use the product or service for treatment, to direct or recommend alternative treatments, therapies, health care providers or setting to care to the individual. These activities are not considered marketing. In addition, the practice will contact the individual with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
Research: The practice may be involved in research activities. If you are asked to participate in a research program, specific information regarding disclosure of PHI will be reviewed at that time. The practice does not use or disclose protected health information to an employer or health plan sponsor, for underwriting and related purposes, for facility directories, to brokers and agents, or for fundraising. If an individual wants the practice to release his or her protected health information to the above, then the patient will need to contact the practice and complete an appropriate written authorization.
Individual Rights Regarding Protected Health Information
Accounting for Disclosures of Protected Health Information: The practice tracks all disclosures of a patient's protected health information that occurs for other than the purposes of treatment, payment, and health care operations, that are not made to the individual or to a person involved in the patient's care, that are not made as a result of a patient authorization, and that are not made for national security or intelligence purposes or to correctional institutions or law enforcement officials. The practice allows an individual to request one accounting within a 12-month period free of charge. The practice charges a reasonable fee for more frequent accounting requests. The charge will be $20.00. An individual can request an accounting of disclosures for a period of up to six years prior to the date of the request. Requests for a shorter accounting period will be accepted. However, patients may only request an accounting of disclosures made on or after April 01, 2008. The practice responds to all requests for an accounting of disclosures within 60 days of receipt of the requests. If the practice intends to provide the accounting for disclosures and cannot do so within the 60 days, the practice informs the requestor of such and provides a reason for the delay and the date the request to be fulfilled. Only one 30-day extension is permitted. A request for an accounting for disclosures must be made in writing and mailed or sent to the practice. It should be marked "Attention: Privacy Officer."
Inspect and Copy Protected Health Information: The practice allows individuals to inspect and copy their protected health information, documents all requests, responds to those requests in a timely fashion, informs individuals of the appeal rights when a request is rejected in whole or in part, and charges a reasonable fee for the copying of records. The practice reviews the request and acts on a request for access generally within 30 days. The practice may have a single extension of 30 days if needed. Each request will be accepted or denied and the requestor notified in writing. If a request is denied, the requestor is informed if the denial is "reviewable" or not. The requestor has the right to have any denial reviewed by a licenses health care professional who is designated by the practice as a reviewing official and who did not participate in the original decision to deny. The practice informs the requestor of the decision of the reviewing official and adheres to the decision. The practice charges fees in accordance with New York law limitations for record copying.
The charges are the following:
$20.00 handling fee
$0.75 pages 1-25
$0.50 pages 26-50
$0.25 pages 51 to end
Requests for the inspection and copying of records must be sent to the practice in writing. It should be marked "Attention: Privacy Officer."
Request Amendment to Protected Health Information: The practice allows an individual to request that the practice amend the protected health information maintained in the patient's medical record or the patient's billing record. The practice documents all requests, responds to those requests in a timely fashion, and informs individuals of their appeal rights when a request is denied in whole or in part. Generally the practice will act on a request for amendment no later than 60 days after receipt of such a request. If the practice cannot act on the amendment within 60 days, the practice extends the time for such action by 30 days and, within the 60-day time limit, provides the requestor with a written statement of the reasons for the delay and the date by which the practice will complete action on the request. Only one extension is allowed. If the practice denies the request, the practice provides the requestor with a written denial in a timely fashion. The practice allows a requestor to submit a written statement disagreeing with the denial of all or part of the initial request. The statement must include the basis the disagreement. The practice limits the length of disagreement to one page.
The practice accepts requests to amend the PHI maintained by the practice. The requests must be in writing and should be marked "Attention: Privacy Officer."
Request Confidential Communications: The practice accommodates all reasonable requests to keep communications confidential. The practice determines the reasonableness based on the administrative difficulty of complying with the request. A request for confidential communications, must specify an alternative address or other method of contact, and must provide information about how payment will be handled. The request must be sent to the practice in writing and should be marked "Attention: Privacy Officer." The practice accommodates all reasonable requests. The reasonableness of a request is determined solely on the basis of the administrative difficulty of complying with the request. The practice will reject a request due to administrative difficulty, if no independently verifiable method of communication such as a mailing address or published telephone number is provided for communications, including billing; or if the requestor has not provided information as to how payment will be handled. The practice will not refuse a request if the requestor indicates that the communication will case endangerment; or based on any perception of the merits the requestor's request.
Request Restriction of Disclosures: The practice accepts all requests for restriction of disclosures of protected health information. The practice does not agree to any restrictions in the use or disclosure of protected health information. All requests for restrictions of disclosures of protected health information must be in writing and should be marked "Attention: Privacy Officer." The privacy officer notifies the requestor in writing that the practice does not accept restriction of disclosure.
The practice obtains a written authorization from a patient or the patient's representative for the use or disclosure of protected health information for other than treatment, payment, or health care operations; however, the practice will not get an authorization for the use or disclosure or protected health information specifically allowed under the Privacy Rule in the absence of an authorization. The practice will provide a patient upon request a copy of any authorization initiated by the practice (as opposed to requested by the patient) and signed by the patient.
Please contact us for more information:
Neuropsychologic Associates, PLLC
500 West Main Street, Suite 208
Babylon, New York 11702
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
98 Park Avenue
Babylon NY 11702
VIEW MAP >>
Lynbrook, NY 11563
VIEW MAP >>