NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
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.
Our office is permitted
by federal privacy laws to make uses and disclosures of your health information
for purposes of treatment, payment and health care operations. Protected
health information is the information we create and obtain I providing our
services to you. Such information may include documenting your symptoms,
examination and test results, diagnoses, treatment and applying for future care
or treatment. It also includes billing documents for those services.
Example of uses of your health information for treatment purposes are:
·
During the course
of your treatment, the radiologist determines he will need to consult with your
primary physician in the area. He will share the diagnostic information
with your physician.
Example of use of your health information for payment purposes:
·
We submit requests
for payment to your health insurance company. The health insurance
company or business associate helping us to obtain payment requests information
from us regarding your medical care given. We will provide information to
them about you and the care given.
Example of use of your
information for Health Care Operations:
·
We may obtain
services from business associates such as quality assessment, quality
improvement, outcome evaluation, protocol and clinical guidelines development, training
programs, credentialing, medical review, legal services, and insurance.
We will s hare information about you with such business associates as necessary
to obtain these services.
.
The health and billing records we maintain are the physical property of Premier Diagnostic Imaging, LLC. You have the following rights with respect to your Protected Health Information.
1.
Request a
restriction on certain uses and disclosures of your health information by
delivering the request in writing to our office – we are not required to grant
the request but we will comply with any request granted;
2.
Obtain a paper
copy of Privacy practices for Protected Health Information (“Notice”) by making
a request at our office.
3.
Right to
inspect and copy your health record and billing record – you may exercise this
right by delivering the request in writing to our office using the form we
provide to you upon request; appeal a denial of access to your protected health
information except in certain circumstances;
4.
Right to
request that your health care record be amended to correct incomplete or
incorrect information by delivering a written request to our office using the
form we provide to you upon request. (The physician or other health
care provider is not required to make such amendments); you may file a
statement of disagreement if your amendment is denied, and require that the
request for amendment and any denial be attached in all future disclosures of
your protected health information.
5.
Right to
receive an accounting of disclosures of your health information as required to
be maintained by law by delivering a written request to our office using the
form we provide to you upon request. An accounting will not include internal
uses of information for treatment, payment or operations, disclosures made to
you or made at our request or disclosures made to family members in the course
of providing care;
6.
Right to
confidential communication by requesting that communication of your health
information be made by alternative means or at an alternative location by
delivering the request in writing to our office using the form we give you upon
request; and,
If you want to exercise any of
the above rights, please contact Rose Haney at Premier Diagnostic Imaging at
931-528-1800, in person or in writing, during normal business hours. She will
provide you with assistance on the steps to take to exercise your rights.
The office is required to:
·
Maintain the
privacy of your health information as required by law;
·
Provide you with a
notice as to our duties and privacy practices as to the information we collect
and maintain about you;
·
Abide by the terms
of this Notice;
·
Notify you if we
cannot accommodate a requested restriction or request; and
·
Accommodate your
reasonable requests regarding methods to communicate health information with
you.
·
Accommodate your
request for an accounting of disclosures.
We reserve the right to amend,
change, or eliminate provisions in our privacy practices and access practices
and to enact new provisions regarding the protected health information we
maintain. If our information practices change, we will amend our
Notice. You are entitled to receive a revised copy of the Notice by
calling and requesting a copy of our “Notice” or by visiting our office and
picking up a copy.
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you make contact Bryan Henson, Director of Imaging at 931-528-1800.
Additionally, if you believe
your privacy rights have been violated, you may file a written complaint at our
office by delivering the written complaint to Bryan Henson. You may also
file a complaint by mailing it or e-mailing it to the Secretary of Health and
Human Services and/or Premier Diagnostic Imaging, whose street address and
e-mail address is 315 N. Washington, Suite 103, Cookeville, TN
38501 and bhenson@premierdiagnostic.com.
·
We cannot, and
will not, require you to waive the right to file a complaint with the Secretary
of Health and Human Services (HHS) as a condition of receiving treatment from
the office.
·
We cannot, and
will not, retaliate against you for filing a complaint with the Secretary of
Health and Human Services.
We may contact you to provide you with appointment reminders, with information about treatment alternatives or with information about other health-related benefits and services that may be of interest to you.
Unless you object, we may use
or disclose your protected health information to notify, or assist in
notifying, a family member; personal representative, or other person
responsible for your care, about your location and about your general condition
or your death.
Communication with Family –
Using our best judgment, we may disclose to a family member, other relative,
close personal friend, or any other person you identify, health information
relevant to that person’s involvement in your care or in payment for such care
if you do not object or in an emergency. We may share medical information
about unemancipated minors with a parent, legal guardian, or other person
acting in loco parentis if not otherwise limited by law
We may use and disclosure your protected health information to assist in disaster relief efforts.
Controlling Disease – As required by law, we may disclose your protected
health information to public health or legal authorities charged with preventing
or controlling disease, injury or disability.
Child Abuse & Neglect - We may disclose protected health information to
public authorities as allowed by law to report child abuse or neglect.
Food and Drug Administration
(FDA) – We may disclose to the FDA your protected health information relating
to adverse events with respect to food, supplements, products and product
defects, or post-marketing surveillance information to enable product recalls,
repairs, or replacements.
Work related injury or
illness. We may disclose work
related injury or illness your protected health information pertaining to the
work related injury or illness to the employer if the employee needs the
findings in order to comply with OSHA regulations.
We can disclose protected
health information to governmental authorities to the extent the disclosure is
authorized by statute or regulation and in the exercise of professional
judgment the doctor believes the disclosure is necessary to prevent serious
harm to the individual or other potential victim.
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight agencies to include audits, civil, administrative or criminal investigations; inspections; licensures or disciplinary actions, and for similar reasons related to the administration of healthcare.
We may disclose your protected
health information in the course of any judicial or administrative proceeding
as allowed or required by law, or as directed by a proper court order or
administrative tribunal, provided that only the protected health information
released is expressly authorized by such order, or in response to a subpoena,
discover y request or other lawful process.
We may disclose your protected
health information for law enforcement purposes as required by law, such as
when required by court order, including laws that require reporting of certain
types of wounds or other physical injury.
We may disclose your protected
health information to funeral directors or coroners consistent with applicable
law to allow them to carry out their duties.
Consistent with applicable
law, we may disclose your protected health information to organ procurement
organizations or other entities engaged in the procurement, banking, or
transplantation of organs, eyes, or tissue for the purpose of donation and
transplant.
We may disclose information to
researchers when their research has been approved by an institutional review
board that has reviewed the research proposal and established protocols to
ensure the privacy of your protected health information.
To avert a serious threat to
health or safety, we may disclose your protected health information consistent
with applicable law to prevent or lessen a serious, imminent threat to the
health or safety of a person or the public.
We may disclose your protected
health information for specialized government functions as authorized by law
such as to Armed Forces personnel, for national security purposes, or to public
assistance program personnel.
If you are an inmate of a
correctional institution, we may disclose to the institution or its agents the
protected health information necessary for your health and the health and
safety of other individuals.
If you are seeking
compensation through Workers Compensation, we may disclose your protected
health information to the extent necessary to comply with laws relating to
Workers Compensation.
NATIONAL SECURITY AND
INTELLIGENCE ACTIVITIES: We may
release medical information about you to authorized federal officials for
intelligence, counterintelligence and other national security activities as
authorized by law.
PROTECTIVE SERVICES TO THE
PRESIDENT AND OTHERS: We may disclose
medical information about you to authorized federal officials so they may
provide protection to the President, other authorized persons or foreign heads
of state or conduct special investigation.
·
Other uses and
disclosures besides those identified in this Notice will be made only as
otherwise authorized by law or with your written authorization which you may
revoke except to the extent information or action has already been taken.