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May 24, 2017


 

 

OUR NOTICE OF PRIVACY PRACTICES 

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. WHO WILL FOLLOW THIS NOTICE

This Notice describes the privacy practices of our personnel, including associates, employees, and staff. All of our personnel will follow the terms of this notice. In addition, our personnel may share medical information with each other for treatment, payment or health care operations purposes described in this notice.

II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION(PHI)

We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive from us.  We need this record to provide you with quality care and to comply with certain legal requirements.  This Notice applies to all of the records of your care generated by us, whether made by our personnel or doctors involved in your care.

This Notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.  We are required by law to:

·         make sure that medical information that identifies you is kept private;

·         give you this Notice of our legal duties and privacy practices with respect to medical information about you; and

·         follow the terms of the Notice that is currently in effect.

III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following categories describe different ways that we use and disclose medical information.  For each category, we will explain what we mean and give at least one example.  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 within one of the categories.

A. Uses and Disclosures Relating to Treatment, Payment, or Health Care

Operations. We may use and disclose your PHI for the following reasons:

1. For Treatment. We may use medical information about you to provide you

with diagnostic services.  We may disclose medical information about you to doctors or other personnel who are involved in your care.  For example, we will use your medical history to assess your health and perform the requested diagnostic services.

We may disclose medical information about you to other health care professionals who provide you with health care services or supplies as a result of an order from the doctor that is overseeing your care.  For example, if your personal doctor orders x-rays, we will disclose the interpretation of those x-rays.

We also may disclose medical information about you to people outside the organization who may be involved in your continuing medical care after you leave the facility, such as your family doctor, specialist, another health care provider to whom you are referred, family members or others that provide services that are part of your care.

2. For Payment.  We may use and disclose medical information about you so

that the services you receive may be paid for by an insurance company or a third party.  For example, we may need to give your health plan information about your current medical condition so that the plan will pay us for the diagnostic services that we have furnished you.  We may also inform your health plan of the tests you are going to receive in order to obtain prior approval or to determine whether the service is covered.

3. For Health Care Operations.  We may use and disclose medical

information about you for healthcare operations.  This is necessary to run the organization and make sure that all of our patients receive quality care.  For example, we may use medical information to review our services and to evaluate the performance of our staff in caring for you.  We may also disclose information to doctors and other personnel for review and learning purposes.  We will remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific individuals are.

  

B. Certain Uses and Disclosures That Do Not Require Your Authorization

1. Public Health Activities.  We may disclose medical information about you

for public health activities. These activities generally include the prevention or control of disease, reports of abuse or neglect, and to report problems with drugs or medical devices.  We will only make these disclosures when allowed or required by law.

2. Health Oversight Activities.  We may disclose medical information to a

health oversight agency for activities authorized by law.  Oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government-sponsored programs, and compliance with civil rights laws.

3. Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we

may disclose medical information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only when we have been provided confirmation that you have been notified.

4. Law Enforcement.  We may release medical information if asked to do so

by a law enforcement official in response to a court order, subpoena, warrant or similar request.  We may also disclose limited information about the victim of a crime, a fugitive or a material witness.

5. As Required by Law.  We will disclose medical information about you when

required to do so by federal, state or local law.  For example, Florida law requires us to report certain injuries that may have been the result of unlawful activity.

6. To Avert a Serious Threat to Health or Safety.  We may use and disclose

medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be to someone able to respond to the threat.

7. Military and Veterans. If you are a member of the armed forces, we may

release medical information about you as required by military command authorities.  We may also release medical information about foreign military personnel to the appropriate foreign military authority.

8. Workers' Compensation.  We may release medical information about you

for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

C. Uses and Disclosures to Individuals Involved in Your Care or Payment

     for Your Care.

1. Individuals Involved in Your Care or Payment for Your Care

We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are receiving care from us.

2.  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 for diagnostic tests.  The information we use or disclose will be limited to the date, time and location of the appointment.

D. All other Uses and Disclosures Require Your Prior Written

     Authorization

     In any other situation not described in Sections III A, B, above, we may ask

     for your written authorization before using or disclosing any of your PHI. If

     you choose to sign an authorization to disclose your PHI, you can later

     revoke that authorization in writing to stop any future uses and disclosures.

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

You have the following rights regarding medical information we maintain about you:

A. Right to Access.  You have the right to access medical information that may

be used to make decisions about your care.  Usually, this includes medical and billing records.  To access medical information that may be used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

B. Right to Amend or Correct.  If you feel that medical information we have

about you is incorrect or incomplete, you may ask us to amend or correct the information.  You have the right to request an amendment for as long as the information is kept by or for us.  To request an amendment, your request must be made in writing.  In addition, you must provide a reason that supports 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 medical information kept by or for us;

·         Is not part of the information which you would be permitted to access; or

·         Is already accurate and complete.

C. Right to an Accounting of Disclosures.  You have the right to request an

"accounting of disclosures."  This is a list of the disclosures we made of medical information about you, other than for treatment, payment or healthcare operations as previously described.

To request an accounting of disclosures, you must submit your request in writing.  Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.  The first list you request within a 12-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.

 

D. Right to Request Restrictions.  You have the right to request a restriction or

limitation on the medical information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.We are not required to agree to your request.

To request restrictions, you must make your request in writing.  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.

E. Right to Request Confidential Communications.  You have the right to

request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing.  We will not ask you the reason for your request.  We will attempt to accommodate all reasonable requests.

F. Right to a Paper Copy of This Notice.  You have the right to a paper copy

of this Notice.  You may ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

You may obtain an electronic copy of this Notice www.pensacolaradiology.com

V. CHANGES TO THIS NOTICE

We reserve the right to revise or amend the Privacy Notice to allow for additional uses or disclosures of PHI without patient authorization. In the event there is a material change to this Notice, the revised Notice will be posted. In addition, you may request a copy of the revised Notice at any time.

 

VI. INQUIRIES ABOUT THIS NOTICE, EXERCISE OF PRIVACY

      RIGHTS, AND COMPLAINTS

 

If you have a question about this Notice, or you wish to exercise your rights described in this Notice, or you believe your privacy rights have been violated, you may contact us at:

Pensacola Radiology Consultants, P.A.

Attn: HIPAA Privacy Officer

P.O. Box 9210

Pensacola, FL 32504 

850-473-1058 

All complaints must be submitted in writing.  You will not be penalized for filing a complaint.  A complaint may also be filed with the U.S. Department of Health and Human Services at the following address:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: 1-800-368-1019

 

 Pensacola Radiology Consultants, P.A.

 

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Pensacola Radiology Consultants
P.O. Box 9210
Pensacola, Florida
35213


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