Neurosurgical Medical Clinic, Inc.

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.

 Uses and Disclosures: We will use and disclose elements of your protected health information (PHI) in the following ways:

                Without your signed authorization

·        Treatment  - We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, medical students or other people who are taking care of you.

·        Payment – We may use and disclose you medical information for payment purposes.

·        Health care operations – We may use and disclose your medical information for our health care operations.  This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

·        When release is required by law, including in judicial settings and to health oversight regulatory agencies and law enforcement.

·        In emergency situations or to avert serious health/safety situations.

·        To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.

·        To organ, tissue and other donations organization, upon or proximate to your death, if we have no indication on hand about your donation preferences (or a positive indication).

Special cases

·        To contact you about appointment reminders, treatment alternatives and other health related benefits and services.

·        In fundraising for ourselves

·        To the sponsor of your health plan

Other

·        All other uses and disclosure by us will require us to obtain from you a written authorization in addition to any other permission you will provide us.  

Your rights: You have the following rights concerning your PHI:

Restrictions: To request restricted access to all or part of your PHI. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).  To do this, please describe in writing the restriction you are requesting and forward it to the contact indicated at the end of this notice.

Confidential communications: To receive correspondence of confidential information by alternate means or location.  To do this a request must be done in writing to the contact indicated at the end of this notice.

Access: To inspect or receive copies of your protected health information. To do this, forward such request in writing to the contact indicated at the end of this notice.

Amendments: To request changes be made to your PHI. To do this forward you request in writing to the contact indicated at the end of this notice. We are not required to grant your request.

Accounting: To receive an accounting of the disclosures by us of your PHI in the six years prior to your request. To do this, forward such request in writing to the contact indicated at the end of this notice.

 This notice: To get updates or reissue of this notice, at your request.

Complaints: To complain to us or the U.S. Dept. of Health & Human Services if your feel your privacy rights have been violated. To register a complaint with us, please request and complete our complaint form. The law forbids us from taking retaliatory action against you if you complain.

 Our duties: We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.

 Privacy contact: For more information about our privacy practices, please contact:

Neurosurgical Medical Clinic, Inc.

Georgia Jackson, Office Administrator

501 Washington Street, Ste. 700

San Diego , CA 92103

(619)297-4481

Effective date: This notice is effective 4/01/03 .