NOTICE OF PRIVACY PRACTICES for WESTERN NEUROLOGICAL ASSOCIATES, PC.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

EFFECTIVE APRIL14, 2003

Privacy Promise

WNA understands that your health information is personal. Protecting your health information is important.  We follow strict federal and state laws that require us to maintain the confidentiality of your health information.

Understanding your Health Record Information

Each time you visit Western Neurological Associates, we make a record of your visit.  Typically, this record contains your health history, current symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment and is used as:

• Basis for planning your care and treatment.
• Means of communicating among health professionals who contribute to your care.
• Legal documentation describing the care that you received.
• Means by which you or a third-party payer can verify that the services billed were actually provided.
• Tool in educating health professionals.
• Source of information for public health officials charged with improving the health of the nation.
• Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Your Rights Under the Federal Privacy Statement

Although your health records are the physical property of WNA, or the facility that compiled it, the information belongs to you.  You have the right to:

• Obtain a paper copy of this notice of privacy practices upon request.
• Inspect and obtain a copy of your health record upon written request.*
• Request correction or additions to your health information.*
• Request restrictions on how we use and share your information. (We will consider all requests for restrictions carefully but are not required to agree to any restriction.)
• Request an accounting of certain disclosures of your health information made by us.  The accounting does not include disclosures made for treatment, payment, and health care operations, and some disclosures required by law.  Your request must state the period of time desired for the accounting, which must be within the six years prior to your request and excludes dates prior to April 14, 2003.  The first accounting is free but a fee will apply if more than one request is made in a 12-month period.
• Request that we use a specific telephone number or address to communicate with you.*
• Revoke your authorizations to use or disclose health information except to the extent that action has been taken.

Requests marked with an asterisk (*) must be made in writing.  Contact the Privacy Office for the appropriate form for your request.

Our Responsibilities Under the Federal Privacy Standard

WNA is required by law to:
Maintain the privacy of your health information.
Provide this notice that describes the ways we may use and share your information.
Follow the terms of the notice currently in effect.

We reserve the right to make changes to this notice and any time and make the new privacy practices effective for all information we maintain.  Current notices will be posted in all offices of WNA.  You may also request a copy from the WNA Privacy Office.

How to Get More Information or to Report a Problem

If you have questions and/or would like additional information, you may contact the
Privacy Official
Western Neurological Associates
1151 East 3900 South Suite B150
Salt Lake City, UT 84124
Ph. 801-262-3441

If you believe that your privacy rights have been violated, you can file a complaint with the WNA privacy officer or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment, and Health Operations:

We will use your health information for treatment.

Example: A physician, or member of your health care team, will record information in your record to diagnose your condition and determine the best course of treatment for you.  The primary caregiver will give treatment orders and document what he or she expects other members of the health care team to do to treat you.  Those other members will then document the actions they took and their observations.  The primary caregiver will know how you are responding to treatment.  We will also provide your physician, other health care professionals, or a subsequent health care provider copies of your records to assist them in treating you once we are no longer treating you.

We will use your health information for payment.

Example: We may send a bill to you or a third-party payer, such as a health insurer.  The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received, and supplies used.

We will use your health information for health operations.

Example: Members of the medical staff, the risk or quality improvement manager, may use information in your health records to asses the care and outcomes in your cases and the competence of the care givers.

Other Services We Provide

We may use you health information to:

• Recommend treatment alternatives
• Tell you about health services and products that may benefit you.
• Share information with family or friends involved in your care or payment for your care.
• Remind you of an appointment by phone (optional, notify the scheduler if you do not wish to be reminded).
• Share information with third parties who assist us in the treatment, payment, and health care operations.

Our business associates must follow our privacy practices.

Sharing Your Health Information

There are limited situations when we are permitted or required to disclose health information without your signed authorization.  These situations are:

• For public health purposes such as reporting communicable diseases, work-related illnesses, or other diseases and injuries permitted by law.
• Reporting deaths, reactions to drugs, and problems with medical devices.
• To protect victims of abuse, neglect, or domestic violence.
• For health oversight activities such as investigations, audits, and inspections.
• For lawsuits and similar proceedings.When requested or required by law or court order.
• For worker’s compensations or similar programs if you are injured at work.

All other uses and disclosures not described in this notice, require your signed authorization.
You may revoke your authorization at any time with a written statement.