Information Collected About You
In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:
- Your name, address and phone number.
- Information relating to your medical history.
- Your insurance information and coverage.
- Information concerning your doctor or other medical providers.
In addition, we will gather certain medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care”, such as the referring physician, other doctors, your health plan, and family members or close friends.
- Treatment: We will use health information about you to furnish services and supplies to you. For example, we will use your medical history, such as any presence or absence of heart disease, to assess your health and perform requested ultrasound or other diagnostic services. We may contact you before the exam to remind you of your appointment or to talk with you about preparing for the exam.
- Payment: We will use and disclose health information about you to bill for our services and to collect payment from you or your insurance company. For example, we may need to give your payer information about your current medical condition so that it will pay us for the services we have furnished you. We may also need to inform your payer of the tests that you are going to receive in order to obtain prior approval or to determine whether the service is covered.
- Health Care Operations: We may use and disclose information about you for the general operation of our business. For example, we sometimes arrange for accreditation organizations, auditors or other consultants to review our practice, evaluate our operations, and tell us how to improve our services.
- Disclosures Required By Law: We may be required by federal, state or local law to disclose your medical information.
- Public Health Activities: We may disclose your medical information to report communicable diseases, defective medical devices to the FDA or work-related health issues.
- Victims of Abuse, Neglect, or Domestic Violence: We may be required to disclose your medical information if we feel that you have been abused or neglected.
- Health Oversight Activities: We may be required to disclose your medical information to Medicare or a related agency if they select your case for a medical review. We may also be required to report to government agencies responsible for licensing physicians and other health care providers.
- Coroner or Medical Examiner: We may release personal health information to a coroner or medical examiner to identify a deceased person or determine the cause of death.
- Tissue or Organ Donations: We may also release personal health information to organ procurement organizations, transplant centers, and eye tissue banks.
- Judicial and Administrative Proceedings: We may have to disclose your medical information if we receive a subpoena from a judge or administrative tribunal.
- Law Enforcement: We may have to disclose your medical information in conjunction with a criminal investigation by a federal, state or law enforcement agency.
- Serious Threats to Health or Safety: We may be required to disclose your medical information if, in our opinion, doing so will help avert a serious threat to the public.
- Research: We may use or disclose certain personal health information for research purposes where an Institutional Review Board determines that your privacy interests will be adequately protected. We may also use and disclose your protected health information to prepare or analyze a research protocol and for other research purposes.
- Military Personnel: We may disclose your medical information to the appropriate command authorities.
- National Security/Intelligence Activities: We may disclose protected health information for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.
- Worker’s Compensation: We may disclose your medical information to comply with laws regarding worker’s compensation.
We sometimes work with outside individuals and businesses that help us operate our business. We may disclose your health information to these business associates so that they can perform the tasks we hire them to do. Our business associates must guarantee us they will respect the confidentiality of your personal and identifiable health information.
We may disclose information to individuals involved in your care or in the payment for your care, but we will obtain your agreement before doing so. This includes people and organizations that are part of your “circle of care”, such as your spouse, other doctors or an aide involved in your care. Although we must be able to speak with your other doctors and health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family.
We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above. If you provide us with such permission, you may revoke that permission at any time. If you revoke your permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization. We will be unable to take back any disclosures already made based on your original permission.
- Requesting Restrictions: You have the right to ask in writing for restrictions on the ways in which we use or disclose your medical information beyond those imposed by law. We will consider your request but are not required to accept it.
- Confidential Communications: You have the right to request in writing that you receive communications containing your protected health information from us by alternative means or location. For example, you may ask that we only contact you at home or by mail. We will consider your request but are not required to accept it.
- Inspect and Copy: You may request access to inspect and copy your medical information in our records, including medical and billing records. Your request must be in writing. We will act on your request within 30 days after we get it. If we must deny your request we will send you a written denial. If this happens, you may request a review of the denial. We may charge you a fee for this service.
- Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information.
- Accounting Of Disclosures: You may request a list of uses or disclosures of your protected health information for reasons other than your treatment, payment for services furnished to you, our health care operations, or disclosures you authorized that we have made over the previous six (6) years. You may not request an accounting for dates of service prior to April 14, 2003. Your first request within a 12-month period is free, but we charge for additional lists within the same 12-month period.
- Paper Copy of This Notice: You are entitled to receive a paper copy of our Notice of Privacy Practices by using the contact information supplied on the first page.
- File a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with us using the contact information on the first page. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for complaining.
Effective Date: April 14, 2003