Privacy Policy

NeuroClarity Center, PLLC

350 W Kensington Rd Ste 111

Mount Prospect, IL 60056

EFFECTIVE DATE OF THIS NOTICE 08/01/2025

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

Neuroclarity Center understands that health information about you and your health care is personal. Neuroclarity Center is committed to protecting health information about you. Neuroclarity Center creates a record of the care and services you received to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which Neuroclarity Center may use and disclose health information about you and your rights to the health information kept. This describes certain obligations Neuroclarity Center has regarding the use and disclosure of your health information. Neuroclarity Center is required by law to:

Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
Neuroclarity Center can change the terms of this Notice, and such changes will apply to all information in our records
The new Notice will be available upon request, in our office, and on this website.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that Neuroclarity Center uses and discloses health information. For each category of uses or disclosures. Not every use or disclosure in a category will be listed. However, all of the ways Neuroclarity Center is permitted to use and disclose information will fall within one of the categories.

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

Lawsuits and Disputes: If you are involved in a lawsuit, Neuroclarity Center may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes. Neuroclarity Center may keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:

For use in treating you.
For use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
For use in defending providers within Neuroclarity Center in legal proceedings instituted by you.
For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
Required by law and the use or disclosure is limited to the requirements of such law.
Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
Required by a coroner who is performing duties authorized by law.
Required to help avert a serious threat to the health and safety of others

2. Marketing Purposes. As a psychotherapist, Neuroclarity Center will not use or disclose your PHI for marketing purposes.

3. Sale of PHI. As a psychotherapist, Neuroclarity Center will not sell your PHI in the regular course of my business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.

2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.

3. For health oversight activities, including audits and investigations.

4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.

5. For law enforcement purposes, including reporting crimes occurring on my premises.

6. For research purposes, including studying and comparing the cognitive data of patients with identifying PHI removed from data.

7. Appointment reminders and health related benefits or services. Neuroclarity Center may use and disclose your PHI to contact you to remind you that you have an appointment. Neuroclarity Center may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

1. Disclosures to family, friends, or others. Neuroclarity Center may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. Neuroclarity Center is not required to agree to your request, and may say “no” if believed it would affect your health care.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

3. The Right to Choose How We Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone), or to send mail to a different address, and Neuroclarity Center will agree to all reasonable requests.

4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that Neuroclarity Center has about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

5. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. Neuroclarity Center may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.

6. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

Office Policies & Procedures

(Pediatric Neuropsychology Services)

1. Appointments & Scheduling

All appointments are by scheduled appointment only.
Because testing requires extensive preparation and reserved time, appointments must be confirmed in advance.
If a child is ill, please contact us as soon as possible to reschedule.

2. Cancellations & Missed Appointments

Cancellations must be made at least 48 hours in advance to avoid a cancellation fee.
Late cancellations or missed appointments may be billed, as testing slots cannot easily be filled.
Rescheduling is subject to clinician availability.

3. Fees & Payment

A detailed estimate will be provided before services begin.
A deposit or pre-authorization may be required to hold testing dates.
Payment is due according to the payment plan agreed upon.
Final reports will be released only after the balance is paid in full.

4. Insurance

Our practice is [in-network/out-of-network/self-pay].
Families are responsible for confirming insurance coverage and submitting any required paperwork.
We can provide a “superbill” with appropriate codes for potential reimbursement.

5. Testing Day Procedures

Please arrive on time to allow your child to feel comfortable and get settled.
Parents may be asked to complete questionnaires during the evaluation.
Children should bring glasses, hearing aids, AAC device, or any other items needed for optimal participation.

6. Communication & Confidentiality

Phone calls and emails are returned within 2-4 business days.
Clinical information is shared only with written consent or verbal consent that is documented in notes, except in cases of safety or as required by law.
Parents will receive a comprehensive written report and a feedback session to review results and recommendations.

7. Reports & Records

Reports are typically completed within 3–4 weeks after the feedback session.
Reports are released to families; outside providers (e.g., schools, doctors) will only receive reports with written consent.

8. Consent & Assent

Parents/legal guardians must sign consent forms before services begin.
For children 12 and older, we also request the child’s assent to participate in testing, whenever appropriate.

9. Emergencies

We are not a medical facility and cannot provide emergency care. If your child has a health condition (such as allergies, seizures, or diabetes), please bring any necessary medications or supplies and share important information with us. Parents should plan to be available during appointments in case a need arises.
If you are experiencing an emergency, please call 911 or go to the nearest emergency room.