Eastern Shore Neurology
Is a HIPAA compliant company….

1. You have the right to request that we restrict the method which we use or disclose your healthcare information for the purpose to your treatment, payment, or healthcare operations. We have the right to comply with your request.

2. Once you become aware of this notice, you expressly acknowledge our use and disclosure of your healthcare information for the purpose of your treatments, payments or healthcare operations.

3. We will keep and record information about your medical condition. We may use this information for disclosure to others as follows:

• We may use or disclose your healthcare information in order to treat you. For example, we may advise healthcare providers (which we are transferring you to) of your medical condition.

• We may also disclose your condition to family or caregivers who are involved in your medical care.

• We may disclose your health care information in order to receive payments for services we may have provided you. For example, we may disclose your condition in order for your insurance company to understand why you have received treatments, so that they will pay your claim. We may also disclose your information to our billing department in order to seek payment for our services.

• We may use or disclose your healthcare information for our operations. For example, we may review your information in order to evaluate your treatment and our services, in order to ensure that our care for you now and in the future is the best that it could be.

• We may use your healthcare information to contact you in the future.

• We may also disclose your information as required by any city, state, and/or federal laws.



KNOW YOUR RIGHTS

You may have the following rights regarding your healthcare information:

1. The right to inspect and copy your information: you may review and copy your medical records and information. You should make such a request to us in writing and submit it to our office.

2. The right to amend: you may ask that we amend your healthcare information if you believe that your information is incomplete or inaccurate. A request for an amendment should be made in writing and should submitted to our office, indicating your reason of the amendment. We may deny your request if it is not written and/or if you fail to state the reason for your proposed amendment.

We may still deny your request if you ask us to amend information that is not a part of the data that we normally keep, was not created by us (unless the entity responsible is no longer available), is not part of the information available for you to inspect and copy, or just is inaccurate.

3. The right to know about disclosure: you have the right to request an accounting to whom we have disclosed your information. The request should be made in writing and submitted to our office. You must state the period for your request, which cannot be longer than 6 years.

4. The right to request restrictions: you may request that we communicate with you in a certain format or at a specific location. You must request such confidential communication or specific type or place communication in writing submitted to our office. No reason for this request is necessary, we will honor all reasonable requests.

5. Right to receive a copy of this notice: you may request to receive a copy of this notice by contacting our staff (or by visiting our website).

PLEASE NOTE: PERIODICALLY; WE MAY CHANGE OUR POLICIES AND PROCEDURES AS NECESSARY AND APPROPRIATE TO COMPLY WITH CHANGES IN THE LAW, INCLUDING THE STANDARDS, REQUIREMENTS, AND IMPLEMENTATION SPECIFICATIONS.

When we change a privacy practice that is stated in this notice and/or make corresponding changes in our policies and procedures, we may make such changes effective for the protected healthcare information that we have created or have received prior to the effective date of the notice revision. We reserve the right here under which states a privacy practice that is stated in this notice, so that new practices can have retroactive effect to the extent allowed by the law.

Additionally, we retain the right to alter, amend, or change this notice at any time.

Any revision may be effective on any information that we may already have about you, and/or

any information we may obtain about you in the future. A copy of our most current notice will be on display at our office (as well as on our website).

Complaints regarding the use of our healthcare information should be made to us directly to our office address, ATTNTION: OFFICE MANAGER.

All complaints must be submitted in writing. There is no cost or penalty for you to file a complaint.

Should you have any questions about this policy, please never hesitate to ask our friendly staff.