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, your other
doctors, your health plan, and close friends or family members.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health
information about you in different ways. All of the ways
in which we may use and disclose information will fall within
one of the following categories, but not every use or disclosure
in a category will be listed.
For Treatment. We will use health information about you to furnish services
and supplies to you, in accordance with our policies and procedures. 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.
For 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 a payer information about your current medical condition
so that it will pay us for the ultrasound examinations or
other services that 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.
For 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.
Public Policy Uses
and Disclosures. There are a number
of public policy reasons why we may disclose information
about you.
We may disclose health information about you when we are
required to do so by federal, state, or local law.
We may disclose protected health information about you
in connection with certain public health reporting activities.
For instance, we may disclose such information to a public
health authority authorized to collect or receive PHI for
the purpose of preventing or controlling disease, injury
or disability, or at the direction of a public health authority,
to an official of a foreign government agency that is acting
in collaboration with a public health authority. Public health
authorities include state health departments, the Center
for Disease Control, the Food and Drug Administration, the
Occupational Safety and Health Administration and the Environmental
Protection Agency, to name a few.
We are also permitted to
disclose protected health information to a public health
authority or other
government authority
authorized by law to receive reports of child abuse or
neglect. Additionally we may disclose protected health information
to a person subject to the Food and Drug Administration’s
power for the following activities: to report adverse events,
product defects or problems, or biological product deviations,
to track products, to enable product recalls, repairs or
replacements, or to conduct post marketing surveillance.
We may disclose your protected health information in situations
of domestic abuse or elder abuse.
We may disclose protected health information in connection
with certain health oversight activities of licensing and
other agencies. Health oversight activities include audit,
investigation, inspection, licensure or disciplinary actions,
and civil, criminal, or administrative proceedings or actions
or any other activity necessary for the oversight of 1) the
health care system, 2) governmental benefit programs for
which health information is relevant to determining beneficiary
eligibility, 3) entities subject to governmental regulatory
programs for which health information is necessary for determining
compliance with program standards, or 4) entities subject
to civil rights laws for which health information is necessary
for determining compliance.
We may disclose information in response to a warrant, subpoena,
or other order of a court or administrative hearing body,
and in connection with certain government
investigations and law enforcement activities.
We may release personal
health information to a coroner or medical examiner to
identify a deceased person or determine
the cause of death. We also may release personal health information
to organ procurement organizations, transplant centers, and
eye or tissue banks.
We
may release your personal health information to workers’ compensation
or similar programs.
Information about you also
will be disclosed when necessary to prevent a serious threat
to your health and safety or the health and safety of others.
We may use or disclose certain personal health information
about your condition and treatment for research purposes
where an Institutional Review Board or a similar body referred
to as a Privacy Board determines that your privacy interests
will be adequately protected in the study. We may also use
and disclose your protected health information to prepare
or analyze a research protocol and for other research purposes.
If you are a member of the Armed Forces, we may release
personal health information about you as required by military
command authorities. We also may release personal health
information about foreign military personnel to the appropriate
foreign military authority.
We may disclose your protected health information for legal
or administrative proceedings that involve you. We may release
such information upon order of a court or administrative
tribunal. We may also release protected health information
in the absence of such an order and in response to a discovery
or other lawful request, if efforts have been made to notify
you or secure a protective order.
If you are an inmate, we may release protected health information
about you to a correctional institution where you are incarcerated
or to law enforcement officials.
Finally, 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.
Our Business Associates. We sometimes work with outside
individuals and businesses who help us operate our business
successfully. We may disclose your health information to
these business associates so that they can perform the tasks
that we hire them to do. Our business associates must guarantee
to us that they will respect the confidentiality of your
personal and identifiable health information.
Individuals Involved
in Your Care or Payment for Your Care. 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, your other doctors, or an aide who may
be providing services to you. Although we must be able to
speak with your other physicians or health care providers,
you can let us know if we should not speak with other individuals,
such as your spouse or family.
Appointment Reminders. We may use and disclose medical
information to contact you as a reminder that you have an
appointment or that you should schedule an appointment.
Treatment Alternatives. We may use and disclose your personal
health information in order to tell you about or recommend
possible treatment options, alternatives or health-related
services that may be of interest to you.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
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, in writing,
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 upon your
original permission.
INDIVIDUAL RIGHTS
You have the right to ask for restrictions on the ways in
which we use and disclose your medical information beyond
those imposed by law. We will consider your request, but
we are not required, to accept it.
You have the right to request
that you receive communications containing your protected
health information from us by alternative
means or at alternative locations. For example, you may
ask that we only contact you at home or by mail.
Except under certain circumstances,
you have the right to inspect and copy medical and billing
records about you.
If
you ask for copies of this information, we may charge
you a fee for copying and mailing.
If you believe that information
in your records is incorrect or incomplete, you have the
right to ask us to correct
the existing information or correct the missing information.
Under certain circumstances, we may deny your request.
You have a right to ask
for a list of certain disclosures of your medical information
that we have made. If you
ask for this information from us more than once every
twelve
months, we may charge you a fee.
You have the right to a
copy of this Notice in paper form. You may ask us for a
copy at any time.
You may also obtain a copy
of this form at our web site www.radconlr.com.
To exercise any of your
rights, please contact us in writing at
