NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Effective July 1, 2023
A. REQUIREMENTS UNDER HIPAA: 
Charlottesville Neurology & Sleep Medicine is required to:

• Maintain the privacy of your protected health information (‘PHI’), to the extent required by state and federal law. PHI is information about you that may be used to identify you (such as your name, social security number or address), and that relates to (a) your past, present or future physical or mental health or condition, (b) the provision of health care to you, or (c) your past, present, or future payment for the provision of health care. In conducting its business, Charlottesville Neurology & Sleep Medicine will receive and create records containing your PHI.
  
• Give you this Notice explaining our legal duties and privacy practices with respect to medical information about you.
  
• Charlottesville Neurology & Sleep Medicine is required to notify affected individuals following a breach of unsecured medical information under federal law.
  
• Charlottesville Neurology & Sleep Medicine is required by law to maintain the privacy of your PHI and to provide you with notice of its legal duties and privacy practices with respect to your PHI. Additionally, Charlottesville Neurology & Sleep Medicine must abide by the terms of this Notice while it is in effect. This current Notice takes effect on July 1, 2023, and will remain in effect until Charlottesville Neurology & Sleep Medicine replaces it. Charlottesville Neurology & Sleep Medicine reserves the right to change the terms of this Notice at any time, as long as the changes are in compliance with applicable law. If Charlottesville Neurology & Sleep Medicine changes the terms of this Notice, the new terms will apply to all PHI that it maintains, including PHI that was created or received before such changes were made. If Charlottesville Neurology & Sleep Medicine changes this Notice, it will post the new Notice on its Web site and will make the new Notice available upon request.
  

B. USES AND DISCLOSURES OF PHI
The following categories describe the different reasons that we typically use and disclose medical information. These categories are intended to be general descriptions only, and not a list of every instance in which we may use or disclose your medical information. Please understand that for these categories, the law generally does not require us to get your authorization in order for us to use or disclose your medical information. Charlottesville Neurology & Sleep Medicine may use and disclose your PHI in the following ways:

• Treatment, Payment and Health Care Operations. Charlottesville Neurology & Sleep Medicine is permitted to use and disclose your PHI for purposes of (a) treatment, (b) payment and (c) health care operations. For example:
  
  • Treatment. Charlottesville Neurology & Sleep Medicine may disclose your PHI to another physician or health care provider for purposes of a consult or in connection with the provision of follow-up treatment.
    
  • Payment. Charlottesville Neurology & Sleep Medicine may use and disclose your PHI to your health insurer or health plan in connection with the processing and payment of claims and other charges.
    
  • Health Care Operations. Charlottesville Neurology & Sleep Medicine may use and disclose your PHI in connection with its health care operations, such as providing customer services and conducting quality review assessments. Charlottesville Neurology & Sleep Medicine may engage third parties to provide various services for Charlottesville Neurology & Sleep Medicine. If any such third party must have access to your PHI in order to perform its services, Charlottesville Neurology & Sleep Medicine will require that third party to enter a business associate agreement that binds the third party to the use and disclosure restrictions outlined in this Notice.
    
• Appointment Reminders and Health Related Benefits and Services. We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health- related benefits or services that we believe may be of interest to you.
  
• Healthcare Operations and Continuity of Care. In the event that you or a third party chooses to discontinue payment for services that Charlottesville Neurology & Sleep Medicine provides or arranges for you, Charlottesville Neurology & Sleep Medicine may reach out to you to offer ongoing healthcare services to you under new payment arrangements, at your choosing.
  
• Authorization. Charlottesville Neurology & Sleep Medicine is permitted to use and disclose your PHI upon your written authorization, to the extent such use or disclosure is consistent with your authorization. You may revoke any such authorization at any time.
  
• As Required by Law. Charlottesville Neurology & Sleep Medicine may use and disclose your PHI to the extent required by federal, state, or local law or regulations.
  

C. SPECIAL CIRCUMSTANCES
The following categories describe unique circumstances in which Charlottesville Neurology & Sleep Medicine may use or disclose your PHI:  Public Health Activities, Worker’s Compensation, Health Oversight Activities, Judicial and Administrative proceedings, Law Enforcement, Decedents, Research, Threat to Health & Safety, Specialized Government Functions.
 
 
D. YOUR RIGHTS REGARDING YOUR PHI
Federal and state laws provide you with certain rights regarding the medical information we have about you. You have the following rights regarding the PHI maintained by Charlottesville Neurology & Sleep Medicine:

• Inspection and Copies. You have the right to inspect and copy your PHI. You must submit your request in writing to Charlottesville Neurology & Sleep Medicine. Charlottesville Neurology & Sleep Medicine may impose a reasonable fee for the costs of copying, mailing, labor and supplies associated with your request. Charlottesville Neurology & Sleep Medicine may deny your request to inspect and/or copy your PHI in certain limited circumstances. If that occurs, Charlottesville Neurology & Sleep Medicine will inform you of the reason for the denial, and you may request a review of the denial. Unless such is unreasonable or unfeasible, you may request copies of your PHI from Charlottesville Neurology & Sleep Medicine in an electronic format.
  
• Amendment. You have a right to request that Charlottesville Neurology & Sleep Medicine amend your PHI if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is maintained by Charlottesville Neurology & Sleep Medicine. You must submit your request in writing to Charlottesville Neurology & Sleep Medicine and provide a reason to support the requested amendment. Charlottesville Neurology & Sleep Medicine may, under certain circumstances, deny your request by sending you a written notice of denial. If Charlottesville Neurology & Sleep Medicine denies your request, you will be permitted to submit a statement of disagreement for inclusion in your records.
  
• Accounting of Disclosures. You have a right to receive an accounting of all disclosures Charlottesville Neurology & Sleep Medicine has made of your PHI. However, that right does not include disclosures made for treatment, payment or health care operations, disclosures made to you about your treatment, disclosures made pursuant to an authorization, and certain other disclosures. You must submit your request in writing to Charlottesville Neurology & Sleep Medicine and you must specify the time period involved (which must be for a period of time less than six years from the date of the disclosure). Your first accounting will be free of charge. However, Charlottesville Neurology & Sleep Medicine may charge you for the costs involved in fulfilling any additional request made within a period of 12 months. Charlottesville Neurology & Sleep Medicine will inform you of such costs in advance, so that you may withdraw or modify your request to save costs.
  
• Restrictions. You have the right to request restrictions on certain uses and disclosures of PHI for treatment, payment or health care operations. You also have the right to request that Charlottesville Neurology & Sleep Medicine restrict its disclosures of PHI to only certain individuals involved in your care or the payment of your care. You must submit your request in writing to Charlottesville Neurology & Sleep Medicine. Charlottesville Neurology & Sleep Medicine is not required to comply with your request. However, if Charlottesville Neurology & Sleep Medicine agrees to comply with your request, it will be bound by such agreement, except when otherwise required by law or in the event of an emergency.
  
• Confidential Communication. You have the right to receive confidential communications of your PHI. You may request that Charlottesville Neurology & Sleep Medicine communicate with you through alternate means or at an alternate location, and Charlottesville Neurology & Sleep Medicine will accommodate your reasonable requests. You must submit your request in writing to Charlottesville Neurology & Sleep Medicine.
  
• Breach Notification. You have the right to be notified in the event that Charlottesville Neurology & Sleep Medicine (or a Charlottesville Neurology & Sleep Medicine Business Associate) discovers a breach of unsecured PHI.
  
• Changes To This Notice. We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well, as any information we receive in the future. We will post a copy of the current notice, along with an announcement that changes have been made, as applicable, on our website. When changes have been made to the Notice, you may obtain a revised copy by sending a letter to Charlottesville Neurology & Sleep Medicine’s Privacy Officer at the address or contact information listed below.
  
• Complaint. If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with Charlottesville Neurology & Sleep Medicine’s Privacy Officer at the address or contact information listed in below. To file a complaint with Charlottesville Neurology & Sleep Medicine, you may either call or send a written letter. Charlottesville Neurology & Sleep Medicine will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services. In addition, if you have any questions about this Notice, please contact the Charlottesville Neurology & Sleep Medicine HIPAA Privacy Officer at the address or phone number listed below.
  

Charlottesville Neurology & Sleep Medicine
Attn: Marissa Kile
1410 Rolkin Ct, Suite 101
Charlottesville, VA 22911
Further Information. If you would like more information about your privacy rights, please contact Charlottesville Neurology & Sleep Medicine’s Privacy Officer as indicated above. To the extent you are required to send a written request to Charlottesville Neurology & Sleep Medicine to exercise any right described in this Notice, you must submit your request to Charlottesville Neurology & Sleep Medicine’s office manager to the mailing address above.