Your HIPPA Rights and Responsibilities

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

At Northern California Neurosurgery Medical Group, Inc., we are committed to protecting your privacy. We comply with all federal, state, and local laws. This notice describes how we use your health information. It describes some of your rights and some of our responsibilities.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Each time you visit our offices, we record your symptoms, physical examination, test results, diagnosis, and treatment. This information enables us to: plan for your care, communicate with others who care for you, report to your insurance carrier, bill for our work, and improve the quality of our care.

YOUR RIGHTS

Although your paper chart belongs to the Medical Group, the information contained in the chart is yours. You have the right to: inspect your records, obtain a copy of your chart for a small fee, correct your records, and tell us not to release your information.

OUR RESPONSIBILITIES

We are required to: maintain the privacy of your health information; send needed health information to other medical providers, and release information to insurance companies, certain government agencies, and others. We may be required to release some information, even without your permission.

EXAMPLES OF HOW YOUR INFORMATION IS USED

Your health information will be recorded and used to plan your treatment. Reports may be sent to other doctors to help them plan your treatment. Bills will be sent to your insurance company. The information in the bills will include confidential information such as your name, address, diagnosis, and treatment. In providing your care, we may communicate with other individuals or businesses. Examples include other physicians, X-ray departments, laboratories, our transcriptionists or our record storage service. To protect your privacy, we ask our business associates to safeguard your information.

OTHER NOTICES

We may leave a message at your home, at your business, on your answering machine or on your voicemail. We may mail you a postcard or other written notices. We may need to disclose your information to your family members or other people helping with your care. In doing so, we will use our best judgment. We may disclose information to others as required by law or if subpoenaed. If you were injured on the job, we will need to disclose your health information to your workers compensation insurance company. We may, from time to time, update these policies.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have concerns or would like additional information, you may contact the practice’s Privacy Officer, Lori Laperle, at (510) 494-5700, Ext. 208.  You may also contact the CEO of Northern California Neurosurgery Medical Group, Inc., Robert Lieberson, M.D. at (510) 494-5700, Ext. 500.  Serious concerns are best handled in writing.  Send a fax to (510) 494-5710 or a letter to the attention of Ms. Laperle or Dr. Lieberson at 2400 Country Drive, Suite 100, Fremont, CA  94536.  You may also contact the Federal Office for Civil Rights at: 200 Independence Ave. S.W., Room 509F, HHH Building, Washington, D.C. 20201 or by clicking on the internet at www.hhs.gov/ocr/hipaa/.  The government web site provides an enormous amount of information about your rights and responsibilities.