TO OUR PATIENTS: This NOTICE describes how your Health Information
(as a patient in this Practice) may be used and disclosed and how you can
gain access to your Health Information. This "NOTICE" requirement was
created by the Privacy regulations initiated as a result of the Health
Insurance Portability and Accountability Act (HIPPA) of 1996. Please
review it carefully.
Neurosurgical Consultants, P.A. (hereinafter referred to as "the Practice")
acknowledges that privacy is one of its highest priorities. Protecting your
privacy and your medical information is at the core of our business. We
recognize our obligation to keep your information secure and confidential
whether on paper or the Internet. The Federal Laws governing these matters
are complicated; however, the Law does require that we provide you with this
Keeping the medical and health information we have about you secure is one
of our most important responsibilities. We value your trust and will handle
your information with care. Our employees access information about you only
when necessary to provide treatment, verify eligibility, obtain
authorization, process claims and otherwise meet your needs. We may also
access information about you when considering a request from you or when
exercising our rights under the law or any agreement with you.
We safeguard information during all business practices according to
established security standards and procedures, and we continually assess
new technology for protecting information. Our employees are trained to
understand and comply with these information principles.
In the course of doing business, we collect and use various types of
information, like name address and claims information. We use this
information to provide service to you, to process your claims and bring you
health information that might be of interest to you. We limit who receives
information and what type of information is shared.
Keeping your information accurate and up-to-date is very important. If you
believe the health information we have about you is incomplete, inaccurate
or not current, please call or write us at the telephone numbers or
addresses below. We will take appropriate action to correct any erroneous
information as quickly as possible through a standard set of practices and
We share information within our Practice to deliver the health care services
and related information and education programs that are part of your overall
We share critically important health information with the other Physicians,
Surgeons, Nurses and Technicians who are part of the Healthcare Team
providing you with our services. We share this information with your
Personal and Referring Physician in order to assure a continuity of care.
To help us offer you our services, we may share information with companies
that work with us, such as claim processing and mailing companies and
companies that deliver health education and information directly to you.
These companies act on our behalf and are obligated contractually to keep
the information that we provide them confidential.
The Practice DOES NOT SHARE any customer information with third-party
marketers who offer their products and services to our patients.
Patient-specific personally identifiable data is released only when required
to provide a service for you and only to those with need to know, or with
your consent. Data is released with the condition that the person receiving
the data will not release it further, unless you give permission.
The following special circumstances may require us to use or disclose your
*If we receive a subpoena or similar legal process demanding
release of any information about you, we will attempt to notify you (unless
we are prohibited from doing so). Except as required by law or as described
above, we do not share information with other parties, including government
- To Public Health authorities and Health Oversight Agencies
that are authorized by law to collect this information.
- Certain legal proceedings* in response to a Court
or Administrative Order (subpoena).
- When necessary to reduce or prevent a serious threat to your
health and safety or the health and safety of another individual
or the Public. We will only make disclosures to a person or
organization able to prevent the threat.
- If you are a member of the U.S. or Foreign Military Forces
(including Veterans) ONLY when required by the appropriate
- To U.S. Federal Officials for national security or U.S.
domestic intelligence activities authorized by law.
- To Correctional Institutions or Law Enforcement Officials for
individuals who are under the custody of Law Enforcement Officials
- For Worker's Compensation and similar programs.
If you have any questions regarding this NOTICE or relating to our health
information privacy policies, please contact the NEUROSURGICAL
CONSULTANTS, P.A. Practice Administrator at 972.566.6444 for further
- Communications. You can request that our Practice
communicate with you about your health and related issues in a
particular manner or at a certain location. As an example, you may
ask that we contact you at home rather than at your place of
business. We will accommodate reasonable requests.
- Confidential Channel Communications. You may request
that we disclose your health information with certain family members
or other individuals. You may also request a restriction in our use
or disclosure of your health information for treatment, payment or
other healthcare operations.
- Restriction of Information. You have the right to
request that we restrict our disclosure of your health information
to only certain individuals involved in your care or payment for
your care, such as family members and friends. We are not obligated
to agree to your request; however, if we do agree, we are bound by
our agreement except when otherwise required by law, in emergencies
or when the information is necessary to treat you.
- Inspection of Records. You have the right to inspect
and obtain a copy of your health information that may be used to
make decisions about you, including patient medical records and
billing records (except for psychotherapy notes.) You must submit
your request in writing to NEUROSURGICAL CONSULTANTS, P.A.
- Amending Health Records. You may ask us to amend your
health information if you believe it is incorrect or incomplete and
as long as the information is kept by and/or for our Practice. To
request an amendment, your request must be in writing and submitted
to NEUROSURGICAL CONSULTANTS, P.A. You must provide us with a valid
reason that your request for this amendment.
- Right to a Copy of This Notice. You are entitled to
receive a copy of this Notice of Privacy Practices and may ask us to
provide you with a copy at any time. Please contact our Front Desk
Staff to obtain a copy of this Notice.
- Right to File a Complaint. If you believe that your
Privacy Rights have been violated, you may file a complaint with
our Practice or with the
Secretary of Health and Human Services.
To file a complaint with our Practice, please contact our Practice
Administrator at 972.566.6444 for further information. All
complaints must be submitted in writing. You will not be penalized
for filing a complaint.
- Right to Provide Authorization. Our Practice will obtain
your written authorization for uses and disclosures that are not
identified by this Notice.
NEUROSURGICAL CONSULTANTS, PA is privileged to have the opportunity to
provide Neurosurgical treatment to many patients. Our Staff works
diligently to accommodate the needs of these patients and to schedule their
surgical procedures in a timely manner. This requires careful planning and
coordination among our Office, the Hospital facilities, the Operating Room
personnel and specialized surgical and technical equipment in addition to
other Medical Specialists who will be involved in your care (such as the
Anaesthesiologist, Assistant Neurological Surgeon, etc.)
For INTERNATIONAL PATIENTS,
a deposit (payable by Certified Check, Wire Transfer* or Major
Credit Card) will be required to secure a surgical date and final payments
will be collected at the pre-operative visit.
For DOMESTIC PATIENTS,
a deposit (payable by Certified Check, Wire Transfer* or Major
Credit Card) to cover your insurance company's "Deductible" portion will be
required to secure a surgical date. In cases where there has been a
NEGOTIATED SURGICAL FEE, a deposit is required to secure a scheduled surgery
date with final payment collected at the pre-operative visit.
The Cancellation of a Scheduled Procedure results in the failure to
serve other needy patients as well as the disruption of the schedules for
the Operating room and other Healthcare Professionals.
We, therefore, respectfully request your understanding and cooperation
with our Cancellation Policy.
* Cancellation within 7 Days prior to your procedure date will
result in a 50% loss of the deposit. Cancellations made because of a death
or illness in the family will be exempt from this policy, and a full refund
will be made.
(*Wire Transfer payments must be received 72 hours prior to
scheduling or performing a procedure.)
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This page last edited on 2/14