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.

Neurospine Surgical Consultants is required by law to protect the privacy of your health information, give you this notice of our legal duties and privacy practices, notify you if a breach affects your unsecured health information, and follow the terms of the notice currently in effect.

How we may use and share your health information

Treatment. We use and share your information with doctors, nurses, and other providers involved in your care. Example: sharing your MRI results with your primary care doctor, Windhaven Medical Imaging, or Windhaven Ambulatory Surgery Center.

Payment. We use and share your information to bill and get paid by health plans or other payers. Example: giving your insurance company information about a procedure so it will pay for it.

Health care operations. We use and share your information to run our practice, improve care, train staff, and contact you when needed. Example: reviewing records to evaluate the quality of care.

Appointment reminders and health-related services. We may contact you to remind you of appointments or tell you about treatment options.

Family and friends. We may share information with a family member, friend, or other person involved in your care or payment, unless you object. If you cannot respond, for example in an emergency, we may share information if we believe it is in your best interest.

Electronic disclosure. Your health information may be disclosed electronically, for example through our electronic health record system and secure exchanges with other providers and health plans.

Other uses and disclosures allowed or required by law

We may share your information without your written permission in these situations, as allowed by law:

• When required by federal, state, or local law
• For public health activities, such as preventing disease, reporting adverse reactions to medicines, or reporting suspected abuse or neglect
• For health oversight activities, such as audits, investigations, and licensing
• In response to a court or administrative order, subpoena, or other lawful process
• For certain law enforcement purposes
• To coroners, medical examiners, and funeral directors
• For organ, eye, or tissue donation
• For research approved through a process that protects your privacy
• To prevent a serious threat to health or safety
• For specialized government functions, such as military and national security
• For workers' compensation claims
• To a correctional institution or law enforcement official if you are in custody

Uses that require your written permission

We will not do the following without your written authorization: use or share psychotherapy notes, use your information for marketing, or sell your information. Any other use not described in this notice also requires your authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

• Get a copy of your records. You can ask to see or get a paper or electronic copy of your medical and billing records. We will respond within 30 days and may charge a reasonable, cost-based fee.
• Ask us to correct your records. You can ask us to correct information you think is incorrect or incomplete. We may say no, but we will explain why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way or at a different address. We will agree to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain information. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share that information with your health plan, and we will agree unless a law requires us to share it.
• Get a list of those we've shared information with. You can ask for a list of the times we've shared your information in the six years before your request, with whom, and why, excluding treatment, payment, operations, and certain other disclosures. One list per year is free.
• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights.

Complaints

If you believe your privacy rights have been violated, you can file a complaint with us by contacting our Privacy Officer below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail at 200 Independence Avenue SW, Washington, DC 20201, by phone at 1-877-696-6775, or online at www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

Changes to this notice

We may change this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office, and on our website.

Contact

Privacy Officer, Neurospine Surgical Consultants

6160 Windhaven Parkway, Suite 200, Plano, TX 75093

Phone: (972) 378-6908. Email: [email protected]