THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This Company is required by law to provide you with this Notice so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as “Protected Health Information” (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please contact our Privacy Officer at (225) 590-0790.
UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION
Each time you have a diagnostic imaging exam by our Company, a record of your exam is made containing health and financial information. Typically, this record contains information about your condition, the service we provide and payment for the service. We may use and/or disclose this information to:
- communicate with other health professionals involved in your care
- document the service you receive
- educate health professionals
- provide information to public health officials
- evaluate and improve the service we provide
- obtain payment for the service we provide
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.
- For Treatment. We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to doctors or nurses. We may also disclose health information about you to people outside the Company who may be involved in your medical care after the service we provided is completed. This may include family members, doctors or visiting nurses to provide care in your home.
- For Payment. We may use and disclose health information about you so that the treatment and services you receive at our Company may be billed to you, an insurance company or a third party. For example, in order to be paid, we may need to share information with your health plan about services provided to you. We may also tell your health plan about an exam you are going to receive to obtain prior approval or to determine whether your plan will cover the exam.
- For Health Service Operations. We may use and disclose health information about you for our day-to-day health service operations. This is necessary to ensure that all patients receive quality service. For example, we may use health information for quality assessment and improvement activities and for developing and evaluating protocols. We may also combine health information about many patients to help determine what additional services we should offer, what services should be discontinued, and whether certain exams are effective. Health information about you may be used by our corporate office for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs. We may also use and disclose information for professional review, performance evaluation, and for training programs. Other aspects of health service operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and compliance programs. Your health information may be used and disclosed for the business management and general activities of the Company including resolution of internal grievances, customer service and due diligence in connection with a sale or transfer of the Company. In limited circumstances, we may disclose your health information to another entity subject to HIPAA for its own health service operations. We may remove information that identifies you so that the health information may be used to study health service and health service delivery without learning the identities of patients.
OTHER ALLOWABLE USES OF YOUR HEALTH INFORMATION
- Business Associates. There are some services provided in our Company through contracts with business associates. Examples include medical directors, outside attorneys and a scanning service we use when scanning in copies of your health record. When these services are contracted, we may disclose your health information so that they can perform the job we’ve asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.
- Individuals Involved in Your Service or Payment for Your Service. Unless you object, we may disclose health information about you to a friend or family member who is involved in your service. We may also give information to someone who helps pay for your service. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
- As Required By Law. We will disclose health information about you when required to do so by federal, state or local law.
- To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat.
- Organ and Tissue Donation. If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transplantation.
- Military and Veterans. If you are a member of the armed forces, we may disclose health information about you as required by military authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.
- Workers' Compensation. We may disclose health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Reporting Federal and state laws may require or permit the Company to disclose certain health information related to the following:
- Public Health Risks. We may disclose health information about you for public health purposes, including:
- Prevention of injury or disability
- Reporting deaths;
- Reporting abuse or neglect;
- Reporting reactions with products;
- Notifying people of recalls of products;
- Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease;
- Notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
- Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health service system, government programs, and compliance with civil rights laws.
- Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you 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.
- Public Health Risks. We may disclose health information about you for public health purposes, including:
- Law Enforcement. We may disclose health information when requested by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the Company; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
- Coroners or Medical Examiners. We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death.
- National Security and Intelligence Activities. We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or its agents health information necessary for your health and the health and safety of others.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the service that we provided to you.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Although your health record is the property of the Company, the information belongs to you. You have the following rights regarding your health information:
- Right to Inspect and Copy. With some exceptions, you have the right to review and copy your health information.
You must submit your request in writing to Randel Worthy at Alpha One Imaging. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.
- Right to Amend. If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You have this right for as long as the information is kept by or for the Company.
You must submit your request in writing to Randel Worthy. In addition, you must provide a reason for your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the health information kept by or for the Company; or
Is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures". This is a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health service operations.
You must submit your request in writing to Randel Worthy. Your request must state a time period which may not be longer than six years from the date the request is submitted and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. For example, you may request that we limit the health information we disclose to someone who is involved in your care or the payment for your service. You could ask that we not use or disclose information about a surgery you had to a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
You must submit your request in writing to Randel Worthy at Alpha One Imaging. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
- Right to Request Alternate Communications. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box.
You must submit your request in writing to Randel Worthy. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.
You may obtain a copy of this Notice at our website, www.alphaoneimaging.com.
To obtain a paper copy of this Notice, contact Randel Worthy.
CHANGES TO THIS NOTICE
We reserve the right to revise or change this Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our website. The Notice will specify the effective date on the first page, in the top right-hand corner. In addition, if material changes are made to this Notice, the Notice will contain an effective date for the revisions and copies can be obtained by contacting the Company administrator-Randel Worthy.
If you believe your privacy rights have been violated, you may file a complaint with the Company or with the Secretary of the Department of Health and Human Services. To file a complaint with the Company, contact Randel Worthy. All complaints must be submitted in writing. You will not be penalized.