About This Joint Notice 

The entities listed above are affiliated and may share your health information with one another for treatment, payment, and health care operations as permitted by the Health Insurance Portability and Accountability Act (HIPAA). This joint notice satisfies each entity’s obligation to provide you with a notice of its privacy practices. Each entity agrees to abide by the terms of this notice. 

Your Rights 

When it comes to your health information, you have the following rights: 

Get an electronic or paper copy of your medical record 

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. 

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. 

• We may say “no” to your request, but we’ll tell you why in writing within 60 days. 

Request confidential communication 

• You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address. 

• We will say “yes” to all reasonable requests. 

Ask us to limit what we use or share 

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no,” for example, if it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment. 

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. 

Get a list of those with whom we’ve shared information 

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. 

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 

Get a copy of this privacy notice 

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

Choose someone to act for you 

If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. 

We will make sure the person has this authority and can act for you before we take any action. 

File a complaint if you feel your rights are violated 

• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice. 

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov. 

• We will not retaliate against you for filing a complaint. 

Your Choices 

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. 

In these cases, you have both the right and choice to tell us to: 

• Share information with your family, close friends, or others involved in your care or payment for your care 

• Share information in a disaster relief situation 

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. 

In these cases we never share your information unless you give us written permission: 

• Marketing purposes 

• Sale of your information 

• Most sharing of psychotherapy notes 

Fundraising: 

We may contact you for fundraising efforts, but you can tell us not to contact you again. 

Our Uses and Disclosures 

We typically use or share your health information in the following ways. 

Treat you 

We can use your health information and share it with other professionals who are treating you. 

Example: A surgeon requests our interpretation of intraoperative neurophysiological monitoring data to guide decisions during your procedure. 

Run our organization 

We can use and share your health information to run our practice, improve your care, and contact you when necessary. 

Example: We use health information about you to manage your treatment and services. 

Bill for your services 

We can use and share your health information to bill and get payment from health plans or other entities. 

Example: We give information about you to your health insurance plan so it will pay for your services. 

We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. 

Help with public health and safety issues 

We can share health information about you for certain situations such as: 

• Preventing disease 

• Helping with product recalls 

• Reporting adverse reactions to medications 

• Reporting suspected abuse, neglect, or domestic violence 

• Preventing or reducing a serious threat to anyone’s health or safety 

Do research 

We can use or share your information for health research. 

Comply with the law 

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. 

Respond to organ and tissue donation requests 

We can share health information about you with organ procurement organizations. 

Work with a medical examiner or funeral director 

We can share health information with a coroner, medical examiner, or funeral director when an individual dies. 

Address workers’ compensation, law enforcement, and other government requests 

We can use or share health information about you: 

• For workers’ compensation claims 

• For law enforcement purposes or with a law enforcement official 

• With health oversight agencies for activities authorized by law 

• For special government functions such as military, national security, and presidential protective services 

Respond to lawsuits and legal actions 

We can share health information about you in response to a court or administrative order, or in response to a subpoena. 

Our Responsibilities 

• We are required by law to maintain the privacy and security of your protected health information. 

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. 

• We must follow the duties and privacy practices described in this notice and give you a copy of it. 

• We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html 

Changes to the Terms of this Notice 

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website. 

Contact Information 

If you have questions about this notice or wish to exercise any of your rights, please contact: 

Carly DeGasperis, Privacy Officer 

700 US-46 East, Suite 420 

Fairfield, NJ 07004 

Phone: 973-882-3450 

Email: carly.degasperis@accurateiom.com 

ADDENDUM A 

State-Specific Privacy Rights — Neurophysiologic Interpretive Medicine PLLC 

This addendum applies to patients receiving services from Neurophysiologic Interpretive Medicine PLLC in New York. Where New York law provides greater protections than HIPAA, New York law controls. 

New York 

Patient Access to Medical Records (N.Y. Public Health Law §18) 

Under New York law, you have the right to inspect and obtain copies of your medical records. Requests are generally fulfilled within 10 days (paper) or 5 days (electronic). A reasonable fee may be charged. If access is denied, you have the right to request a review of that decision by a designated reviewing physician.