HIPAA Notice of Privacy Practices

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health services.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment

Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

Other Uses and Disclosures

We may use or disclose your protected health information for the following purposes without your authorization in accordance with applicable law. These purposes include: Public Health, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements; Legal Proceedings, Law Enforcement, Funeral Directors, Organ Donation, Research, Criminal Activity, Military Activity and National Security, Worker's Compensation, Inmates, and other uses and disclosures to the extent permitted or required under applicable law.

Under the law, we must make certain disclosures to you and are required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500. Certain permitted uses and disclosures require your prior authorization or your opportunity to object. In such instances, we will only use or disclose your protected health information after receiving your authorization or providing you with the opportunity to object.

In addition, we may disclose your protected health information to certain of our service providers in accordance with applicable law and pursuant to HIPAA business associate agreements, which require them to maintain appropriate privacy and security safeguards.

Your Rights as a Patient

Following is a statement of your rights with respect to your protected health information.

• Right to Inspect and Copy: You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected information that is subject to law that prohibits access to protected health information.
• Right to Request Restrictions: You have the right to request a restriction of your protected health information. This means you may ask us to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes.
• Right to Confidential Communications: You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
• Right to Paper Copy: You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively (i.e., electronically).
• Right to Amend: You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
• Right to Accounting: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.

Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

Contact Us

If you have any questions or objections to this form, please contact us at:

Greenlight Neurology
4500 9th Ave NE, Ste 300
Seattle, WA 98105
Email: contact@greenlightneurology.com

This notice was published and becomes effective on/or before July 14, 2025.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.