Notice of Privacy Practices

Privacy Contact

Rosanna Figuereo • Fibers Neurological Institute, LLC • (786) 607-5911 • [email protected]

YOUR RIGHTS

When it comes to your health information, you have certain rights. You may: get an electronic or paper copy of your medical record and other health information we maintain about you; ask us to correct health information that you believe is incorrect or incomplete; ask us to contact you in a specific way or at a different address; ask us to limit certain uses or disclosures of your information; ask for an accounting of certain disclosures of your health information; ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically; choose a legally authorized personal representative to act for you; and file a complaint if you believe your privacy rights have been violated.

YOUR CHOICES

For certain health information, you may tell us your preferences about what we share, including sharing information with family, close friends, or others involved in your care or payment for your care; sharing information in a disaster-relief situation; and certain communications about fundraising, if applicable.

We will obtain your written permission for uses or disclosures that require authorization, including most uses of psychotherapy notes, marketing that requires authorization, and the sale of protected health information.

OUR TYPICAL USES AND DISCLOSURES

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

Run our practice. We may use and share your health information to operate our practice, improve your care, manage services, and contact you when necessary.

Bill for your services. We may use and share your health information to bill and obtain payment from health plans, automobile insurers, other payers, or other entities responsible for payment.

DETAILS ABOUT YOUR RIGHTS

Get an electronic or paper copy of your medical record. You may ask to see or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We will provide access as required by law, generally within the applicable legal time frame, and may charge only fees permitted by law.

Ask us to correct your medical record. You may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in some circumstances, but if we do, we will explain the reason in writing as required by law.

Request confidential communications. You may ask us to contact you in a specific way, such as at a particular telephone number, email address, or mailing address. We will accommodate reasonable requests.

Ask us to limit what we use or share. You may ask us not to use or share certain health information for treatment, payment, or health care operations. We generally are not required to agree, except where the law requires us to do so. If you pay for a service or health care item out-of-pocket in full, you may ask us not to share that information with your health insurer for payment or health care operations; we will honor the request unless a law requires disclosure.

Get an accounting of disclosures. You may request a list of certain disclosures of your health information made during the six years before your request. The accounting will not include disclosures for treatment, payment, health care operations, and certain other disclosures excluded by law. One accounting in a 12-month period is provided without charge; additional requests may be subject to a reasonable, cost-based fee.

Get a copy of this Notice. You may ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide a copy promptly.

Choose someone to act for you. If a person has legal authority to act as your personal representative, such as under a medical power of attorney or guardianship, that person may exercise your privacy rights. We will verify the person’s authority before acting on the request.

File a complaint. You may complain to us using the Privacy Contact information in this Notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or through the HHS Office for Civil Rights website. We will not retaliate against you for filing a complaint.

YOUR CHOICES IN MORE DETAIL

If you are able to tell us your preference, we will follow your instructions in situations where the law gives you a choice. If you cannot tell us your preference, such as when you are unconscious, we may share information when we believe it is in your best interest and as permitted by law. We may also share information when needed to lessen a serious and imminent threat to health or safety.

We will not use or disclose your information for marketing that requires authorization, sell your protected health information, or disclose most psychotherapy notes unless you give written permission or another law permits the disclosure.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may use or disclose health information when permitted or required by law, including for public health and safety activities; health research; health oversight; organ and tissue donation; coroners, medical examiners, and funeral directors; workers' compensation; lawful law-enforcement and government requests; and court, administrative, subpoena, or other legal proceedings, subject to all applicable legal conditions.

SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

If we create or maintain substance use disorder patient records protected by 42 CFR Part 2, additional confidentiality rules apply. We will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you unless you give written consent or the disclosure is authorized by a court order and subpoena as required by law. If Part 2 information would be used for fundraising, we will give you clear notice and a choice in advance.

ADDITIONAL FLORIDA PRIVACY PROTECTIONS

Florida law may provide additional protections for certain mental-health clinical records, HIV test information, and genetic testing or DNA-analysis information. We will obtain consent or authorization when required and will follow the more protective federal or Florida requirement when it applies.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information; notify you as required by law of a breach that may compromise its privacy or security; follow the duties and privacy practices in the Notice currently in effect; and provide you a copy of it. We will not use or share your information other than as described in this Notice unless you authorize us in writing or another law permits or requires it. You may revoke an authorization in writing as allowed by law.

CHANGES TO THE TERMS OF THIS NOTICE

We may change this Notice, and the changes may apply to all health information we maintain about you. The current Notice will be available upon request, in our office, and at www.neurofibers.com.

Text messages

If you check the text message box, we store your consent together with the date and time you gave it, and the mobile number you gave us. We do not share mobile numbers or text message consent with third parties for marketing.

You can withdraw your consent at any time by replying STOP (or ALTO) to any of our messages, or by calling us. Our SMS Terms explain the program in full.