NEUROCORE NOTICE OF PRIVACY PRACTICES

Protecting your information is a top priority for Neurocore, LLC (“we” or “us”). We will never sell or rent any information you share with us. Neurocore agrees to maintain any and all information gathered from you in accordance with all federal, state, and local laws, rules and regulations.

Some of our services may involve the collection of your health information. This notice describes how health information we collect about you may be used and disclosed by us and how you can get access to this information. Please review it carefully.

Our Responsibilities.
• We will follow the duties and practices described in this notice and give you a copy of it.
• We will maintain the privacy and security of your personal information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. Notice to you will be consistent with the guidelines for where you live, and may be via first class mail, email, or another method.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Your Rights.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Please ask us how to exercise any of your rights below using the contact information at the end of this notice.

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.
• 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.

Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

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.

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.

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.

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.

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.

File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
• 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.

You have both the right and choice to tell us whether to share information with your family, close friends, or others involved in your care.

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

If we engage in any fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures.
We typically use or share your health information in the following ways:

To treat you. We can use your health information and share it with other professionals who are treating you.

To run our organization. We can use and share your health information to run our business, improve your care, and contact you when necessary.

To bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.

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.

To help with public health and safety issues. We can share health information about you for certain situations such as:
• Helping with product recalls
• Reporting adverse treatment results
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

To do research. We can use or share your information for health research.

To 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.

To address law enforcement, and other government requests. We can use or share health information about you:
• For law enforcement purposes or with a law enforcement official when required by law
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services when required by law

To 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.

Third Party Service Providers.
We use third party companies and individuals to help us provide our services to you and to provide auditing, legal, operational and other services for us. The services that we contract for include, but are not limited to, customer service, technical maintenance and monitoring, web management and communication, database management, billing and payment processing, and reporting and analytics. We will share with these third parties only the minimum necessary information to perform their task for us and only after entering into an appropriate confidentiality agreement.

Special Requirements for Mental Health Records
Certain health information receives special privacy protection, such as psychotherapy notes and services for mental health and developmental disabilities. We will not use or disclose this highly confidential information about you without your prior written consent except to provide our services and as permitted or required by applicable law, such as in the following circumstances:
• For use by the case worker for your treatment
• For training our staff
• If the law requires us to disclose the information
• In response to health oversight activities
• To appropriate authorities to avoid a serious and imminent threat to health or safety
• To defend ourselves if you sue us

Additional Restrictions.
In addition to all of the use and disclosure restrictions above, when state laws imposes additional restrictions on our ability to use or disclose your information, we will comply with those laws.

Your Consent.
When we rely on your consent to share your health information, you have a right to withhold or withdraw this consent at any time by contacting us as detailed below. This will not affect your right to receive future services. If you withdraw your consent, this will only apply to disclosures going forward; it will not apply to disclosures we have made in the past. Additionally, withholding or withdrawing your consent will not affect any disclosures that we are permitted to make under federal or state law.

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.

Additional Information.
For more information about your rights and our responsibilities related to your health information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html. For information about how we collect, use and disclose your non-health information, see: www.neurocorecenters.com/website-privacy-policy.

Contact Us.
Neurocore, LLC
201 Monroe Ave. NW Ste. 300, Grand Rapids, MI 49503

Policy effective date: December 18, 2019