The NeuroCognitive and Behavioral Institute respects your privacy and will never sell or trade personal information provided on this Website. Maintaining your trust is important to us. We created this Privacy Policy to show our commitment to your privacy and to disclose our practices in collecting, using and disclosing your personal information in connection with this Website.
Collection of Personal Information
Except as disclosed in this Policy or as disclosed on other pages in this Website where information may be collected, we do not collect personal information about visitors to this Website.
GENERAL INFORMATION Our Website is designed to provide you with useful information about The NeuroCognitive Institute’s clinical services and information about clinical trials that we participate in.
Registration is not required in order to access the public areas of our Website. However, you may, at your option, choose to register in order to access certain resources and areas of our Website, for example, to register as a new patient to our clinical services for screening, diagnostics and treatment or register as a volunteer for any of our active clinical trials. This information is voluntary and is not required in order to visit our Website. Be assured that we will not collect personal information from individuals who choose to browse our website without registering.
MEDICAL INFORMATION As mentioned above, our Website may require you to register as a patient to our clinical services for screening, diagnostics and treatment. Be assured that the information you submit to us is safe and secure and will not be shared with others.
First and Last Name
Date of Birth
Gender
Full Address
Phone Number
Email Address
Consult Reason
Referring Provider/ Primary Care Physician Name
Primary Insurance Name and ID number
Secondary Insurance Name and ID Number
When it comes to your health information, you have certain rights
This section explains your rights and some of our responsibilities to help you.
You may:
1. 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.
2. 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, email info@neuroci.com. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
3. Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
4. 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” if it would affect your care. 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.
5. 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.
6. 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.
7. Choose someone to act for you
If you have given someone 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.
8. File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us vian email at info@neuroci.com using the information. 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 www.hhs.gov/ocr/privacy/hipaa/complaints/. 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. Share information in a disaster relief situation. Include your information in a hospital directory. Contact you for fundraising efforts.
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
In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
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 doctor treating you for an injury asks another doctor about your overall health condition.
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.
How else can we use or share your health information? 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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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
Secure Data Handling
We collect and store your personal information securely to provide you with the best possible care. Your sensitive data is encrypted and protected from unauthorized access.
Transparency and Choice
We will only collect personal information that is necessary to provide you with care. You can opt out of sharing your information at any time.
Communication Preferences
You are in full control of how we communicate with you. You can opt in or out of email, text and phone communications at any time.
Compliance
Our privacy policy complies with all relevant laws and regulations including HIPAA to ensure we protect your privacy and confidentiality to the highest standards.
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 web site.
Web logs
We maintain standard Web logs that record data about all visitors who use this Site.
These logs may contain:
i. The Internet domain from which you access this Website (e.g., google.com, bing.com etcetera);
ii. Your Internet Protocol (IP) address. Your computer is automatically assigned a number which acts as its IP address when you surf the Internet. Your IP address is either static (always stays the same) or dynamic (changes from time to time). A static IP address may be identifiable to you, while a dynamic address is usually not identifiable.
iii. The type of browser and operating system you use.
iv. The date and time you visited the Website .
v. The pages that you saw on this Website .
vi. The address of the Website you linked here from.
We use Web log information to help us design our Website, to identify popular features, and to make the Website more useful for visitors. Web logs are recorded in sequential files, and we do not normally try to identify individuals from Web logs or use Web logs to gather information about individuals. However, we may use Web logs to identify any person attempting to break into or damage our Website, and we may share Web log information with law enforcement agencies if we believe that we have evidence of a violation of computer security or related laws.
Internet Cookies We may place Internet cookies on visitors’ computer hard drives. Internet cookies save data about individuals, such as their name, user-name and the pages they visit on our Website. When a visitor with one of our cookies on his or her computer revisits our Website, we are able to recognize that computer and tailor our Website to be more helpful and efficient for that visitor. Also, cookies help us to provide streamlined services, and to document our transactions with visitors to this Website. You may have software on your computer that will allow you to decline or deactivate Internet cookies, but if you do so, some features of this Website may not work properly for you.
Our Website uses cookies for Google Analytics and Quantcast. You have the option to configure your Internet browser to notify you when you have received a cookie and provide you with the choice to accept or decline to accept the cookie. Further, you have the option to block all cookies.
Uses. We use information obtained from weblogs, cookies and visitor requests for the purposes described in this Policy. We also use personal information obtained from this Website to respond to requests, improve our services, demonstrate the quality of our services to our auditors and government agencies that have authority over us, and for the additional purposes described below.
