Notice of Privacy Practices for Neurosurgical Care

[Practice Name] Neurosurgical Services

Effective Date: [Date]

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Commitment to Your Privacy

Our neurosurgical practice is dedicated to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the confidentiality of your health information and provide you with this notice of our legal duties and privacy practices.

How We May Use and Disclose Your Information

Treatment

• Sharing information with other healthcare providers involved in your care
• Coordinating surgical procedures and post-operative care
• Managing neurological medications and treatments

Payment

• Verifying insurance coverage
• Processing claims and collecting payments
• Obtaining pre-authorization for neurosurgical procedures

Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training neurosurgical residents and staff
• Compliance and licensing activities

Your Health Information Rights

1. Right to Inspect and Copy
2. Right to Amend
3. Right to an Accounting of Disclosures
4. Right to Request Restrictions
5. Right to Confidential Communications
6. Right to a Paper Copy of This Notice

Special Situations

Research

We may use your information for neurosurgical research purposes, subject to appropriate oversight and patient protections.

Public Health Risks

We may disclose your information to prevent or control disease, injury, or disability.

Changes to This Notice

We reserve the right to change this notice. Any revised notice will be effective for medical information we already have about you as well as any information we receive in the future.

Contact Information

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

Acknowledgment

I acknowledge that I have received a copy of this Notice of Privacy Practices.

Patient Signature

Date