Notice of Privacy Practices for Neurological Care

[Practice Name] Neurology

Effective Date: [Date]

Our Commitment to Your Privacy

We understand that neurological health information is personal. We are committed to protecting your medical information and following all laws regarding the use of your health information.

Your Health Information Rights

You have the right to:

• Request restrictions on certain uses of your medical information
• Receive confidential communications
• Inspect and receive a copy of your medical record
• Request amendments to your medical information
• Receive an accounting of disclosures of your health information
• Obtain a paper copy of this notice

How We May Use and Disclose Your Information

Treatment

• Sharing information with other healthcare providers
• Coordinating care with specialists
• Managing neurological medications and treatments

Payment

• Billing and collection activities
• Insurance verification
• Claims management

Healthcare Operations

• Quality assessment
• Staff training
• Licensing activities

Special Circumstances

We may disclose your information without authorization for:

• Public health activities
• Health oversight activities
• Law enforcement purposes
• Research studies (with proper approval)
• Emergency situations

Your Authorization

Other uses and disclosures of medical information not covered by this notice require your written authorization.

Changes to This Notice

We reserve the right to change this notice. The revised notice will be posted in our office and on our website.

Contact Information

Privacy Officer: [Name] Phone: [Phone Number] Address: [Address]

Acknowledgment

I acknowledge receipt of this Notice of Privacy Practices:

Signature: _________________ Date: _____________________