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Privacy Policy

Notice of Privacy Practices - Pediatric Neuropsychological Services, LLC

This Notice of Privacy Practices is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act (HIPAA) for 1996.

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.

Pediatric Neuropsychological Services, LLC respects your privacy. We understand that your Personal Health Information (PHI) is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations For treatment: . Information obtained by a member of our health care team will be recorded in your medical record and used to help decide what care may be right for you. . We may also provide information to others providing you care, when applicable. This will help them stay informed about your care. For payment: . If we request payment from your health or behavioral health care plan; some health plans need information from us about your medical care. Information provided to health plans may include your diagnoses; procedures performed, or recommended care. . If you request reimbursement from your health insurance plan; some health plans need information from us about your medical care. Information provided to health plans may include your diagnoses; procedures performed, or recommended care. . If we are contracted by an outside facility, for example a school, or the state of Connecticut, some facilities need information from us about your medical care. Information provided to these facilities may include your diagnoses; procedures performed, or recommended care. . We may contact you by phone, leave messages on voice mail, send postal mail, or send email concerning payment collection issues. For health care operations: . We may use your medical records to assess quality and improve services. We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff. . We may contact you by phone, postal mail, or email to give you information about treatment alternatives or other health-related benefits and services. . We may contact you by phone, leave messages on voice mail, send postal mail, or email concerning appointments, missed appointments or to reschedule appointments. . We may use and disclose your information to conduct or arrange for services, including: Medical quality review by your health plan; Accounting, legal, risk management, and insurance services; Audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you. You have a right to: . Receive, read, and ask questions about this Notice; . Ask us to restrict certain uses and disclosures. You must deliver this request to us in writing. We are not required to grant the request, but we will comply with any request that is granted; . Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information (Notice) . Request that you be allowed to see and get a copy of your protected health information. You must make this request in writing. . Have us review a denial of access to your health information except in certain circumstances. . Ask us to change your health information. You must give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records. . When you request, we will give you a list of disclosures of your health information. We may charge a reasonable, cost-based fee. . Ask that your health information be given to you by another means. Please sign, date, and give us your request in writing. . Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. You cannot cancel an authorization if its purpose was to obtain insurance. You cannot cancel an authorization if its purpose was to obtain payment.

For help with these rights during normal business hours, please contact us at: 203-262-4482, or in writing to 7 Garage Road, Unit D, Southbury, CT 06488.

Our Responsibilities We are required to: . Keep your protected health information private . Give you this Notice . Follow the terms of this Notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may request the most recent copy of this Notice by calling and asking for it or by visiting our office to pick one up.

To Ask for Help or Complain: If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact us: 203-262-4482, or at our office at 7 Garage Road, Unit D, Southbury, CT 06488.

If you believe your privacy rights have been violated, you may discuss your concerns with us. You may also deliver a written complaint to our Office as listed above. You may also file a complaint with the U.S. Secretary of Health and Human Services.

We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, we will not retaliate against you.

Other Disclosures and Uses of Protected Health Information

Notification of Family and Others Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose health information about you to assist in disaster relief efforts.

You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it. We may use and disclose your protected health information without your authorization as follows: . To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products. . To Comply With Workers Compensation Laws if you make a workers compensation claim. . For Public Health and Safety Purposes as Allowed or Required by Law: . To prevent or reduce a serious, immediate threat to the health or safety of a person or the public. . To public health or legal authorities to protect public health and safety, . To prevent or control disease, injury, or disability . To Report Suspected Abuse or Neglect to public authorities. . To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of others. . For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime. . For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health. . For Disaster Relief Purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others. . For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site. . To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission. . In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order. . For Specialized Government Functions. For example, we may have information for national security purposes.

Other Uses and Disclosures of Protected Health Information . Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.