Following is a statement of your rights under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required to follow the terms of this notice. We reserve the right to change the terms of our notice at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location within the practice and, if such is maintained by the practice, on its website.

You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified within this Notice. For example, we would need your written authorization to disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization at any time in writing, except to the extent that your healthcare provider or our practice has taken an action in reliance on the use or disclosure indication in the authorization.

You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone) and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.

You have the right to inspect and copy your PHI – This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.

You have the right to request a restriction of your PHI – This means you may ask us in writing not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request in writing that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.   You may have the right to request an amendment to your protected health information – This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request for an amendment.

You have the right to request a disclosure accountability – This means that you may request a listing of disclosures that we have made of your PHI to entities or persons outside of our office.

You have the right to receive a privacy breach notice – You have the right to receive written notification if the practice discovers a breach of your unsecured PHI and determines through a risk assessment that notification is required.

If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided at right, under Privacy Complaints.

Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive but to describe possible types of uses and disclosures.

Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may involved in your care and treatment.

Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office, for fund-raising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.

Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that you health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits.

Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.

Health Information Organization – The practice may elect to use a health information organization, or other such organization, to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person that you identify your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for you care of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.

Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirement of the Privacy Rule.

You have the right to complain to us or directly to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying the Privacy Manager at 1-888-234-3255 or at:

privacy@cdi.comWe will not retaliate against you for filing a complaint.

Effective Date: 08/21/2013
Publication Date: 08/21/2013

The goal of Computational Diagnostics Inc. (CDI), and its affiliate Clinical Neurophysiological Services, LLC (CNS), is to provide excellent health care to all patients.

All patients have the right to the following:

Access: The right to receive care without discrimination due to age, ancestry, color, culture, disability (physical or intellectual), ethnicity, gender, gender identity or expression, genetic information, language, military/veteran status, national origin, race, religious creed, sexual orientation and preference, AIDS or HIV status, socioeconomic status, or source of payment for patient care.

Respect and Dignity: The right to receive considerate, respectful care given by competent personnel, which optimizes patients comfort and dignity.

Communication: The right to –

• Know the name of the provider who has primary responsibility for care, and the identity and function of all individuals providing care, treatment and services.

• Be communicated with in a manner that is clear, concise and understandable. Information provided shall be appropriate to the age and cognition of the patient.

Quality Care Delivery: The right to –

• Receive high quality care based on professional standards that are continually maintained and reviewed.

• Expect good management techniques to be implemented to effectively use the patient’s time and to avoid the personal discomfort of the patient.

• Be free from all forms of mental, physical, sexual, and verbal abuse, neglect and exploitation.

Participation in Care: The right to –

• Participate with the providers in the development, implementation and revision of the patient plan of care.

• Receive information about current health status, outcomes, and recovery.

• Be informed about proposed care options including the risks and benefits, other care options, what could happen without care, and the expected outcome(s) of any medical care provided, including any outcomes that were not expected.

• Participate in the consideration of ethical issues concerning care.

Consent: The right to –

• Refuse any care, therapy, drug, treatment or procedure that a provider is recommending. The provider will discuss the medical consequences of such refusal. There are times when care must be provided by law or regulation.

• Give consent prior to the start of any experimental, research, donor program or educational activities in which the patient may be asked to participate. The patient or the patient’s legal representative may, at any time, refuse to continue in any such study/program to which informed consent has previously been given. Refusal to participate or discontinuation of participation will not compromise the patient’s right to access care, treatment or services.

Personal Privacy: The right to be interviewed, examined, treated and have care discussed in places designed to protect privacy.

Medical Record: The right to access all information contained in the patient’s medical record, unless access is restricted by the attending provider for medical reasons.

Financial Charges: The right to examine and receive a detailed explanation of the bill for services.

Complaint/Grievance: The right to –

• Receive information about how to get assistance with concerns, problems, or complaints about the quality of care and services received, and to initiate a formal grievance process with CDI/CNS or with state regulatory agencies without being subject to coercion, discrimination, reprisal or unreasonable interruption of care, treatment or services.

• Report PA Department of Health or Civil Rights complaints/grievances directly to: The Pennsylvania Department of Health, Division of Acute & Ambulatory Care, Room 532 Health & Welfare Building, 625 Forster Street, Harrisburg, PA 17120-0701. Phone: (717) 783-8980. Fax: (717) 705-6663. Complaint Hotline: 1-800-254-5164. Click here to make a report.
  

• Report complaints/grievances directly to The Joint Commission, a hospital accreditation organization, at: The Office of Quality and Patient Safety (OQPS)The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. Patient Safety Event Phone Line: 1 800-994-6610, Email: www.jointcommission.org, using the “Report a Patient Safety Event” link in the “Action Center” on the home page of the website. Fax: 1 630-792-5636 or Patients enrolled in Medicare or Medicare insurance products may contact Livanta, 1 866-815-5440.