Notice of Privacy Practices

Neurosciences Ltd. & Norman V. Kohn, MD

Notice of Privacy Practices for Protected Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This practice creates a medical record of your health information, also called “protected health information” or “PHI,” for the purposes of treating you, receiving payment for our work, and complying with certain policies and laws. We are required by law to provide you with this Notice of our legal duties and privacy practices. We are required by federal and state law to maintain the privacy of your PHI. We are also required by law to notify you if you are affected by a breach of your unsecured PHI.

We may use and disclose your PHI as required or authorized by law. For example, we may use or disclose your PHI for the following purposes:


Payment: When an outside agency or company is paying for your treatment,

Health Care Operations:

Public Health:

Law Enforcement:

Illinois law: Illinois law has certain requirements that govern the use or disclosure of your PHI. Your explicit authorization is required for most disclosures about mental health treatment. Illinois law limits disclosure of personal psychotherapy notes.

Your Rights: You have certain rights under federal and state laws relating to your PHI. You have the right to:

Complaints: If you feel that your privacy rights have been violated, you may file a complaint with us in writing. We will not retaliate against you for filing a complaint. You may also file a complaint with the Secretary of Health and Human Services in Washington, DC if you feel your privacy rights have been violated.

Authorizations: We are required to obtain your written Authorization when we use or disclose your PHI in ways not described in this Notice. You may revoke your Authorization at any time in writing, except to the extent that we have already acted on your Authorization.

We are required to abide with terms of the Notice currently in effect, however, we may change this Notice. If we materially change this Notice, you can get a revised Notice at or at our office. Changes to the Notice are applicable to PHI already in our possession.

EFFECTIVE DATE: November 10, 2014