Effective Date: July 28, 2010

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 notice is being provided to you because your physician _______________ (“Physician”) is utilizing an EEG technologist supplied to your Physician by Neurotech LLC (“Neurotech”). The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires that Neurotech take certain steps to maintain the privacy of certain information about you, called “protected health information” (“PHI”). PHI is health related information that identifies you. This notice describes how your PHI is used by Neurotech, and the rights you have under the law. Neurotech may hire another individual or organization, called a Business Associate, to provide administrative services to Neurotech. If this is the case, Neurotech will require that the Business Associate comply with an agreement that requires the Business Associate to also protect your PHI.

USES AND DISCLOSURES OF YOUR PHI

A.) Uses And Disclosures For Treatment Purposes
HIPAA allows for the use of your PHI for treatment purposes. Neurotech will use health information about you in operating the EEG equipment for your EEG testing. Neurotech may disclose health information about you to your Physician.

B.) Other Uses And Disclosures, Which Are Allowed By HIPAA
HIPAA allows Neurotech to use and disclose your PHI for a number of other reasons. It is important that you are informed of other possible uses and disclosures, even though they may never apply to Neurotech’s use of your PHI.

C.) Uses And Disclosures That Require Your Written Authorization.
Neurotech will not use or disclose PHI for reasons other than those defined in sections A and B unless the individual who is the subject of the information provides a valid written authorization to do so. Individuals have a right to revoke an authorization at any time by contacting the Neurotech office listed at the end of this notice.

D. Uses And Disclosures That Require You To Be Given An Opportunity To Agree Or Disagree
Neurotech will disclose your PHI to family members, other relatives and friends when you are present and have either verbally agreed to the disclosure, or have been given an opportunity to object, and the information is directly relevant to the family or friend’s involvement with your care or payment for that care.

RIGHTS OF INDIVIDUALS

Right To Request Restrictions On PHI
Uses And Disclosures You may request that Neurotech restrict certain uses and disclosures of your PHI. Neurotech will attempt to honor reasonable requests, but HIPAA does not require us to agree to these restrictions.

Right To Request Confidential Communications You may also request that Neurotech send communications to you by alternative means or at alternate locations. For example, if you feel you would be harmed if we sent information to your current mailing address, you could request that we send information to another address. You may be required to make certain requests in writing. Requests for restrictions or confidential communications should be made to the Neurotech office listed at the end of this notice.

Rights To Inspect And Copy PHI You have a right to inspect and obtain a copy of your PHI contained in what is called the “designated record set.” “Designated Record Set” includes any of your PHI records maintained by Neurotech. Neurotech is allowed to charge a reasonable fee to supply this information. You must request access or copies of records in writing. Requests should be made to the Neurotech office listed at the end of this notice.

2 The requested information will be provided within 30 days of your written request if the information is maintained on site or within 60 days if the information is maintained offsite. A single 30-day extension is allowed if Neurotech is unable to comply with the deadline. In certain cases we are allowed to deny your request. If access is denied, you will be provided with a written denial setting forth the basis for the denial, and a description of how you may appeal the denial.

Right To Amend PHI
You have the right to request that Neurotech amend your PHI or a record about you in a designated record set for as long as the PHI is maintained in the designated record set.

Neurotech has 60 days after your written request to act on the request. A single 30-day extension is allowed if Neurotech is unable to comply with the deadline. If the request is denied in whole or in part, Neurotech must provide you with a written denial that explains the basis for the denial.

Requests for amendment of PHI in a designated record set should be made to the Neurotech office listed at the end of this notice.

The Right To Receive An Accounting Of PHI Disclosures
At your request, Neurotech will also provide you with an accounting of certain disclosures of your PHI by Neurotech during the six years prior to the date of your request. Such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) for reasons involving national security to corrections or law enforcement personnel; (4) prior to the compliance date; or (5) disclosures made subject to a valid authorization provided by you.

If the accounting cannot be provided within 60 days, an additional 30 days is allowed if you are given a written statement of the reasons for the delay and the date by which the accounting will be provided. If you request more than one accounting within a 12-month period, Neurotech will charge a reasonable, cost-based fee for each subsequent accounting.

Personal Representatives
You may exercise your rights through a personal representative. Your personal representative may be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you.

Neurotech retains discretion to deny access to your PHI to a personal representative in order to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minors.

Neurotech’s Duties
Neurotech is required by law to maintain the privacy of PHI and to provide individuals with notice of its legal duties and privacy practices. Neurotech is also required to abide by the terms of this notice.

If Neurotech’s privacy practices are changed, a revised version of this notice will be mailed to individuals for whom Neurotech still maintains PHI within 60 days of the effective date of any material change to the uses and disclosures, the individual’s rights, the duties of Neurotech or other privacy practices stated in the notice.

Contact Information And Your Right To File A Complaint
If you believe your privacy rights have been violated, you may complain by contacting the Neurotech office listed at the end of this notice. Neurotech will not retaliate against you for filing a complaint.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, at the regional office that handles your area. You can get information on DHHS regional offices and how to file a complaint at http://www.hhs.gov/ocr/privacyhowtofile.htm or by calling 1-800-368-1019.

We reserve the right to change the terms of this notice and our privacy policies at any time. For questions regarding this notice or to request a copy of this notice contact:

Neurotech Contact:
Keith Morgan,
Manager Neurotech LLC
15285 Watertown Plank Rd, Suite 2
Elm Grove, WI 53122