1203 Rivervalley Blvd, Suite-A, Lancaster, OH 43130

Phone – (740) 654-6596, FAX – (740) 653-2791

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This notice describes how health information about you maybe used and disclosed and how you may be used and disclosed and how you can get access to this information. Please review it carefully. Our website will be current at any given time.



NEEL RAYA MD Inc. is committed to providing you with high quality health care and to forming a relationship with you that is built on trust. That means respecting your privacy and confidentiality of you medical information. We protect your privacy and confidentiality rights by creating and putting into practice policies and procedures that allow access to your personal medical information only for legitimate reasons. We ensure that Protected health information is protected during its collection, use, disclosure, storage and destruction in the office of NEEL RAYA MD. We maintain protocols to ensure the confidentiality of your personal information,  Access to your information is limited to those who need it to perform their jobs for your healthcare needs. This notice is effective August 25, 2013, and applies to all protected health information as defined by federal regulations.



          Protected Health Information means all information, recorded or exchanged verbally about an identifiable individual that relates to: the individual’s health, or health care history, including genetic information and demographic about the individual or the individual’s family. What NEEL RAYA MD has learned or observed, including conduct or behavior that may be a result of illness or the effect of treatment, the provision of health care to the individual. Individuals include co-workers or families of co-workers when they are patients of NEEL RAYA MD, for healthcare provided to the individual, and includes: the Protected health identification number and any other identifying number, symbol, etc. assigned to an individual, any identifying information about the individual that is collected in the course of, and is incidental to, the provision of health care or payment for health care. By law de-identified health information which does not have specific identifiers to an individual or relative of the individual would be considered non-protected.



As we provide your health care, we are required to maintain a complete copy of your medical history, current condition, treatment plan and all treatment given, including the results of all tests, procedures and therapies. Whether this information is stored in writing, on a computer, or other means, we will keep this information in a safe and secure way that protects your privacy and confidentiality. Typically this record contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care or treatment. This information serves as means of communication among the many health professionals who contribute to your care. It is a legal document describing the care you received. This document serves as a means by which you or a third party payer can verify that services billed were actually provided. This is a source of information for the public health officials charged to improve the health of the state and nation.




(Our office will make every effort to honor reasonable restriction preferences from our patients, if it is made in writing)

·        Right to request restriction on certain uses and disclosures of your health information. (However we are not required by law to agree to a requested restriction).

·        Right to request that we communicate your health information in a certain way. You may request that we only communicate your health information privately with no other family member present. 

·        Right for a written notice of information practices

·        Right for access to read, review, and copy your health information, including your complete chart and billing records. We may need to charge you a reasonable fee to duplicate and assemble your copy.

·        Right to receive an accounting of disclosures

·        Right to ask us to update or modify your medical records if you believe your health information records are incorrect or incomplete. We will be happy to accommodate you as long as our office maintains this information. We will need the request in writing and the reason for the change. Your request may be denied if the health information record in question was not created in this office, is not part of our records or if the records containing your health information are determined to be accurate and complete.

·        Right to ask us for a description of how and where your health information was used by our office for any reason other than for treatment, payment, or health operations. Our documentation will enable us to provide information on health information usage from April 14, 2003 and forward. Please let us know in writing the time period for which you are interested. We may need to charge you a reasonable fee for this.

·        Right to timeliness of access to records.

·        Right to expect respectful care and as much information about their condition as possible.

·        Right to obtain a copy of this Notice of Privacy Practices directly from our office at any time.



Our Practice is required to:

·        Maintain the privacy of your health information.

·        Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.

·        Abide by the terms of this notice.

·        Notify you if we are unable to agree to a requested restriction, and

·        Accommodate reasonable requests you may have to communicate your health information.

·        We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will keep a posted copy of the most current notice in our office containing the effective date. You may obtain a copy of the same upon request.

·        We will not use or disclose your health information in a manner other than described in this notice without your written authorization, which you may revoke, except to the extent that action has already been taken.

·        We will  make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request. This minimum necessary requirement is not imposed in any of the following circumstances: (a) disclosure to or a request by a health care provider for treatment; (b) disclosure to an individual who is the subject of the information, or the individual’s personal representative; (c) use or disclosure made pursuant to an authorization; (d) disclosure to HHS for complaint investigation, compliance review or enforcement; (e) use or disclosure that is required by law; or (f) use or disclosure required for compliance with the HIPAA Transactions Rule or other HIPAA Administrative Simplification Rules.



Permitted Uses and Disclosures. NEEL RAYA MD INC is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) Opportunity to Agree or Object; (4) Incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6) Limited Data Set for the purposes of research, public health or health care operations.18 Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.

(1) To the Individual. NEEL RAYA MD INC may disclose protected health information to the individual who is the subject of the information.

(2) Treatment, Payment, Health Care Operations. NEEL RAYA MD INC may use and disclose protected health information for its own treatment, payment, and health care operations activities. NEEL RAYA MD INC also may disclose protected health information for the treatment activities of any health care provider, the payment activities of another covered entity and of any health care provider, or the health care operations of another covered entity involving either quality or competency assurance activities or fraud and abuse detection and compliance activities, if both covered entities have or had a relationship with the individual and the protected health information pertains to the relationship.
Treatment is the provision, coordination, or management of health care and related services for an individual by one or more health care providers, including consultation between providers regarding a patient and referral of a patient by one provider to another.
Payment encompasses activities of a health plan to obtain premiums, determine or fulfill responsibilities for coverage and provision of benefits, and furnish or obtain reimbursement for health care delivered to an individual and activities of a health care provider to obtain payment or be reimbursed for the provision of health care to an individual.
Health care operations are any of the following activities: (a) quality assessment and improvement activities, including case management and care coordination; (b) competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation; (c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; (d) specified insurance functions, such as underwriting, risk rating, and reinsuring risk; (e) business planning, development, management, and administration; and (f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the NEEL RAYA MD INC.

Most uses and disclosures of psychotherapy notes for treatment, payment, and health care operations purposes require an authorization as described below. Obtaining “consent” (written permission from individuals to use and disclose their protected health information for treatment, payment, and health care operations) is optional under the Privacy Rule for all covered entities.The content of a consent form, and the process for obtaining consent, are at the discretion of the NEEL RAYA MD INC electing to seek consent.

(3) Uses and Disclosures with Opportunity to Agree or Object. Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object. Where the individual is incapacitated, in an emergency situation, or not available, covered entities generally may make such uses and disclosures, if in the exercise of their professional judgment, the use or disclosure is determined to be in the best interests of the individual.

Facility Directories. It is a common practice in many health care facilities, such as hospitals, to maintain a directory of patient contact information. A covered health care provider may rely on an individual’s informal permission to list in its facility directory the individual’s name, general condition, religious affiliation, and location in the provider’s facility. The provider may then disclose the individual’s condition and location in the facility to anyone asking for the individual by name, and also may disclose religious affiliation to clergy. Members of the clergy are not required to ask for the individual by name when inquiring about patient religious affiliation.

For Notification and Other Purposes. NEEL RAYA MD INC also may rely on an individual’s informal permission to disclose to the individual’s family, relatives, or friends, or to other persons whom the individual identifies, protected health information directly relevant to that person’s involvement in the individual’s care or payment for care.  This provision, for example, allows a pharmacist to dispense filled prescriptions to a person acting on behalf of the patient. Similarly, a NEEL RAYA MD INC may rely on an individual’s informal permission to use or disclose protected health information for the purpose of notifying (including identifying or locating) family members, personal representatives, or others responsible for the individual’s care of the individual’s location, general condition, or death. In addition, protected health information may be disclosed for notification purposes to public or private entities authorized by law or charter to assist in disaster relief efforts.

(4) Incidental Use and Disclosure. The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. A use or disclosure of this information that occurs as a result of, or as “incident to,” an otherwise permitted use or disclosure is permitted as long as the NEEL RAYA MD INC has adopted reasonable safeguards as required by the Privacy Rule, and the information being shared was limited to the “minimum necessary,” as required by the Privacy Rule.

(5) Public Interest and Benefit Activities. The Privacy Rule permits use and disclosure of protected health information, without an individual’s authorization or permission, for 12 national priority purposes. These disclosures are permitted, although not required, by the Rule in recognition of the important uses made of health information outside of the health care context. Specific conditions or limitations apply to each public interest purpose, striking the balance between the individual privacy interest and the public interest need for this information. 

Required by Law. Covered entities may use and disclose protected health information without individual authorization as required by law (including by statute, regulation, or court orders).

Public Health Activities. Covered entities may disclose protected health information to: (1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect; (2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance; (3) individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law; and (4) employers, regarding employees, when requested by employers, for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OHSA), the Mine Safety and Health Administration (MHSA), or similar state law.

Victims of Abuse, Neglect or Domestic Violence. In certain circumstances, covered entities may disclose protected health information to appropriate government authorities regarding victims of abuse, neglect, or domestic violence.

Health Oversight Activities. Covered entities may disclose protected health information to health oversight agencies (as defined in the Rule) for purposes of legally authorized health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit programs.

Judicial and Administrative Proceedings. Covered entities may disclose protected health information in a judicial or administrative proceeding if the request for the information is through an order from a court or administrative tribunal. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or a protective order are provided.

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if  NEEL RAYA MD INC suspects that criminal activity caused the death; (5) when NEEL RAYA MD INC believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

Decedents. Covered entities may disclose protected health information to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.

Cadaveric Organ, Eye, or Tissue Donation. Covered entities may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue.

Research. “Research” is any systematic investigation designed to develop or contribute to generalizable knowledge.37 The Privacy Rule permits NEEL RAYA MD INC to use and disclose protected health information for research purposes, without an individual’s authorization, provided  NEEL RAYA MD INC obtains either: (1) documentation that an alteration or waiver of individuals’ authorization for the use or disclosure of protected health information about them for research purposes has been approved by an Institutional Review Board or Privacy Board; (2) representations from the researcher that the use or disclosure of the protected health information is solely to prepare a research protocol or for similar purpose preparatory to research, that the researcher will not remove any protected health information from NEEL RAYA MD INC, and that protected health information for which access is sought is necessary for the research; or (3) representations from the researcher that the use or disclosure sought is solely for research on the protected health information of decedents, that the protected health information sought is necessary for the research, and, at the request of NEEL RAYA MD INC, documentation of the death of the individuals about whom information is sought. NEEL RAYA MD INC also may use or disclose, without an individuals’ authorization, a limited data set of protected health information for research purposes.

Serious Threat to Health or Safety. Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.

Essential Government Functions. An authorization is not required to use or disclose protected health information for certain essential government functions. Such functions include: assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.

Workers’ Compensation. Covered entities may disclose protected health information as authorized by, and to comply with, workers’ compensation laws and other similar programs providing benefits for work-related injuries or illnesses.

(6) Limited Data Set. A limited data set is protected health information from which certain specified direct identifiers of individuals and their relatives, household members, and employers have been removed. A limited data set may be used and disclosed for research, health care operations, and public health purposes, provided the recipient enters into a data use agreement promising specified safeguards for the protected health information within the limited data set.


Individuals have the right to request that a covered entity restrict use or disclosure of protected health information for treatment, payment or health care operations, disclosure to persons involved in the individual’s health care or payment for health care, or disclosure to notify family members or others about the individual’s general condition, location, or death.61 NEEL RAYA MD INC  is under no obligation to agree to requests for restrictions. A covered entity that does agree must comply with the agreed restrictions, except for purposes of treating the individual in a medical emergency.



We will permit individuals to request an alternative means or location for receiving communications of protected health information by means other than those that we typically provide.





·        If you have questions about the privacy of your medical records, please contact Dr.Raya at 740-6546596.

·        If you believe your privacy rights have been compromised you have the right to express complaints to Dr.Raya or to the Secretary of Human and Health Services. We encourage you to express any concerns you may have regarding the privacy of your information.

·        Please let us know of your questions or complaints in writing.

Updated August 25, 2013