THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. OUR COMMITMENT TO YOUR PRIVACY.

The HIPAA Privacy Rules require that we protect the privacy of health information that identifies a patient, or where there is reasonable basis to believe the information can be used to identify a patient. This information is called "protected health information" or "PHI". In conducting our business, we will create records regarding you and the treatment and services we provide to you. Our practice is dedicated to maintaining the privacy of your PHI. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. We realize that these laws are complicated, and this Notice of Privacy Practices ("Notice") is lengthy, but we must provide you with the following important information:

• How we may use and disclose your PHI
• Your privacy rights in your PHI
• Our obligations concerning the use and disclosure of your PHI

The terms of this Notice apply to all records containing your PHI that are created or retained by our practice. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at any time. We reserve the right to revise or amend our privacy practices and this Notice at any time, including to allow for changes in the law. Any revision or amendment to this Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

II. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU IN THE COURSE OF TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS.

1. Treatment. Our practice may use and disclose your PHI in order to treat you. We may use and disclose PHI about you to provide, coordinate, or manage your health care and related services. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. Many of the people who work for our practice -- including, but not limited to, our doctors, physician assistants, technicians and nurses -- may use or disclose your PHI in order to treat you or to assist others in your treatment. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. For example, we might use your PHI in order to write a prescription for you, schedule a diagnostic test for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. We might send a report about your care from us to a physician that we refer you to so that the other physician may treat you. Finally , we may also disclose your PHI to others who may assist in your care, such as your spouse, children or parent.

2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We may disclose your PHI to other health care providers and entities involved in your care to assist in their billing and collection efforts. We may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs or for obtaining compensation. For example, we may allow a health insurance company to review PHI for the insurance company’s activities to determine the insurance benefits to be paid for your care. We may also use your PHI to bill you directly for services and items and to collect payments owed to us.

3. Health Care Operations. We may use or disclose your PHI in our health care operations, which encompass many activities. Some examples of how your PHI may be used or disclosed in our health care operations include: reviewing and improving the quality, efficiency and cost of care provided to you; reviewing and evaluating the skills, qualifications, and performance of health care providers by providing training programs for students, trainees, health care providers, or non-health care professionals; cooperating with outside organizations that evaluate, certify or license health care providers or staff in a particular field or specialty; conducting cost-management and business planning activities for our practice; and assisting with legal compliance or legal defense activities of our practice. We may also use or disclose your PHI for the health care operations of an "organized health care arrangement" in which we participate. An example of an "organized health care arrangement" is the joint care provided by a hospital and the doctors who see patients at the hospital.

III. OTHER TYPES OF USES/DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION.

In addition to the various uses and disclosures of your PHI which routinely occur incident to treatment, payment, and health care operations activities, we are sometimes required or permitted by law to make other types of uses and disclosures of your PHI, most of which do not require your written authorization. Some uses and disclosures, for which neither an authorization, nor an opportunity to agree or object are required, are summarized in III.1. below. Other uses and disclosures, which require that you be presented an opportunity to agree or to object, but which do not require your authorization as a condition of use or disclosure, are summarized in III.2. below. Uses and disclosures which require your written authorization are addressed briefly in III.3. below. Some other relevant practices are described at III.4 below.

1. USES AND DISCLOSURES FOR WHICH AN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT IS NOT REQUIRED.

Uses and disclosures for public health activities. We may disclose your protected health information for public health activities, including: (1) the reporting of information for the purpose of preventing or controlling disease, injury, or disability; (2) the reporting of child abuse or neglect; (3) to an individual having responsibility for the purpose of activities related to the quality, safety or effectiveness of such FDA-regulated product or activity; (4) to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if we or the public health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation; or (5) an employer, about an individual who is a member of the workforce of the employer, if we provide care at the request of the employer.

Disclosures about victims of abuse, neglect or domestic violence. We may disclose your protected health information to a government authority if we reasonably believe you to be a victim of abuse, neglect, or domestic violence.

Uses and disclosures for health oversight activities. We may disclose your protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.

Disclosures for judicial and administrative proceedings. We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests, or pursuant to other legal process.

Disclosures for law enforcement purposes. (1) If you are a victim of a crime, including, but not limited to abuse, neglect, or domestic violence, we will disclose information, including PHI, to law enforcement officials, as required by law. (2) We may release your protected health information as requested by a court order or subpoena issued by a judge. (3) We may also disclose your protected health information in response to a law enforcement official's request for such information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person, provided that: (a) we may disclose only the following information: (A) Name and address; (B) Date and place of birth; (C) Social security number; (D) ABO blood type and rh factor; (E) Type of injury; (F) Date and time of treatment; (G) Date and time of death, if applicable; and (H) A description of distinguishing physical characteristics, including height, weight, gender, race, hair and eye color, presence or absence of facial hair (beard or moustache), scars, and tattoos.

Uses and disclosures about decedents. (1) We may disclose protected health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law. (2) We may disclose your protected health information to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.

Uses and disclosures for research purposes. We may use or disclose your protected health information for certain research purposes.

Uses and disclosures regarding organ and tissue donation. Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

Uses and disclosures to prevent a serious threat to health or safety. We may use or disclose your protected health information to prevent a serious threat to health or safety.

Uses and disclosures for specialized government functions. These uses and disclosures include but are not limited to: (1) We may use and disclose protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities to assure the proper execution of the military mission; (2) We may use and disclose the protected health information of individuals who are foreign military personnel to their appropriate foreign military authority for the same purposes for which uses and disclosures are permitted for Armed Forces personnel; (3) We may disclose protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities; and/or (4) We may disclose to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual protected health information about such inmate or individual.

Disclosures for workers’ compensation. We may disclose your protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs.

2. USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION, FOR WHICH YOU HAVE THE OPPORTUNITY TO AGREE OR OBJECT.

We may use and disclose PHI about you in some situations where you have the opportunity to agree or object to certain uses and disclosures of PHI about you. If you do not object, then we may make these types of uses and disclosures of PHI.

Individuals Involved in Your Care or Payment for Your Care: We may disclose PHI about you to your family member, close friend, or any other person identified by you if that information is directly relevant to the person’s involvement in your case or payment for your care. If you are present and able to consent or object (or if you are available in advance), then we may only use or disclose PHI if you do not object after you have been informed of your opportunity to object. If you are not present or you are unable to consent or object, we may exercise professional judgment in determining whether the use or disclosure of PHI is in your best interests. For example, if you are brought into this office and are unable to communicate normally with your physician for some reason, we may find it is in your best interest to give your prescription and other medical supplies to the friend or relative who brought you in for treatment.

We may also use and disclose PHI to notify such persons of your location, general condition, or death. We also may coordinate with disaster relief agencies to make this type of notification. We also may use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, x-rays, or other things that contain PHI about you.

3. USES AND/OR DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION THAT REQUIRE WRITTEN AUTHORIZATION OR CONSENT.

Other than those uses and disclosures which we may encounter in the course of treatment, payment, and health care operations and those additional uses and disclosures which we are required or permitted to make by law without your authorization or consent, we will not make other uses or disclosures of your protected health information without your written authorization. Authorizations which are required for such purposes must contain, in plain language, specific descriptions of the information you want disclosed, to whom, your authorized purposes, and the duration of such authorization. Any written authorization you give us for such purposes may be revoked by you at any time, in writing.

4. OTHER RELEVANT PRACTICES AND YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.

Appointment reminders. Our office will contact you to remind you of an appointment or procedure. The primary form of contact will be by personal phone call, although we reserve the right to contact you by other means, such as mail or email. We will leave a message on your answering machine, unless you instruct us otherwise. You must notify us in writing of your objections to be reminded of an appointment.

IV. YOUR RIGHTS REGARDING YOUR PHI.

1. Right to Receive Confidential Communications by Alternative Means. You have the right to request certain alternative means of communication. For example, if you do not want us to contact you at your home or workplace, you must provide us with an alternative means to contact you. This request for alternative communications must be in writing and we reserve the right to deny any requested alternative means to contact you and will inform you so in writing. In order to request a type of confidential communication, you must make a written request to our Privacy Officer and contact office listed at the end of this Notice. You must specify the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your protected health information. This requested restriction must be in writing and we reserve the right to deny any requested restriction and will inform you so in writing. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Officer and contact office listed at the end of this Notice. In your request, please include: (1) the information that you want to restrict; (2) how you want to restrict the information (for example, restricting use to this office, only restricting disclosure to persons outside this office, or restricting both); (3) to whom you want those restrictions to apply; and, 4) how long the restrictions shall apply.

3. Right to Inspect and Copy. You have the right to access, inspect, and obtain a copy of your protected health information, including patient medical records and billing records, but not all types of records. You must submit your request in writing to our Privacy Officer and contact office listed at the end of this Notice in order to inspect and/or obtain a copy of your PHI. Our practice will charge a fee for the costs of copying, mailing, labor and supplies associated with your request, in accordance with Florida state law. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4. Right to Amend. You may ask us to amend your protected health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer and contact office listed at the end of this Notice. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion is: (a) not part of the PHI kept by or for the practice; (b) not part of the PHI which you would be permitted to inspect and copy; or (c) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Right to Receive an Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures." This "accounting" is a list of disclosures made by us during a specified period of up to six years, other than disclosures made: for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative, or for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes) and disclosures made before April 14, 2003. The routine use of your PHI as part of patient care in our practice is not required to be documented for purposes of such disclosures, such as the doctor’s sharing of information with the physician’s assistant or technologist; or the billing department’s use of your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer and contact office listed at the end of this Notice. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a copy of this notice, visit our website at www.neurocareinstitute.com, or contact our receptionist at 407-657-7900.

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact our Privacy Officer and contact office listed below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Privacy Officer/Contact Office. For purposes of making requests for confidential communications by alternative means; to request restrictions on certain uses or disclosures of your PHI; to inspect, copy, or amend your PHI; to receive an accounting of disclosures; to file a complaint with our practice; or to ask questions about this Notice or about our health information privacy policies, please contact:

Edy Rudnick, Practice Manager/Privacy Officer
NeuroCare Institute of Central Florida, P.A.
1890 Semoran Boulevard, Suite 255
Winter Park, FL 32792
Telephone: (407) 657-7900

Effective Date: 04-14-2003