HAZLETON RADIOLOGY ASSOCIATES
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Our goal is to take appropriate steps
to attempt to safeguard any medical or other personal information
that is provided to us. We are required to: (i) maintain the
privacy of medical information provided to us; (ii) provide
notice of our legal duties and privacy practices; and (iii)
abide by the terms of our Notice of Privacy Practices currently
in effect.
WHO WILL FOLLOW THIS NOTICE
This notice describes the practices
of our employees and staff as well as:
- All registration/reception personal, billing
clerks, radiology technologists, business manager, and radiologists
of Hazleton Radiology Associates Twill follow this notice.
All of these individuals, entities, sites, and locations will
follow the terms of this notice. In addition, these individuals,
entities, sites, and locations may share medical information
with each other for the treatment, payment, or health care
operations purposes described in this notice.
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, nurse or
other medical providers.
In addition. Ave 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 **1**
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 fumished 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 product, 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.
If HRA elects to
limit uses or disclosures that it is permitted to make, HRA
may describe its more limited uses and disclosures provided
that it may not limit its right to use or disclose protected
health information to avoid a serious threat to the health or
safety o£ the public or an individual.
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
where 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. W e 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 the 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.
[To the extent another state or federal law restricts
the ability of the practice to use or disclose protected health
information as discussed above, the practice's description of
the use or disclosure must reflect the more stringent law.]
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.
Fundraising. We may use your protected
health information to contact you in an effort to raise funds
for our operations.
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.
INDIVIDUALRIGHTS
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 instances
when we have used or disclosed your medical information for
reasons other than your treatment, payment for services furnished
to you, our health care operations, or disclosures you give
us authorization to make. 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.
To exercise any of your rights, please contact
us in writing at:
Privacy Officer
Hazleton Radiology Associates
20 N. Laurel St.
Hazleton, PA 18201
CHANGES TO THIS NOTICE
We reserve the right to make changes to this
notice at any time. We reserve the right to make the revised
notice effective for personal health information we have about
you as well as any information we receive in the future. 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.
COMPLAINTS/COMMENTS
If you have any complaints concerning our Privacy
Policy, you may contact the Secretary of the Department of
Health and Human Services, at 200 Independence Avenue, S.W.,
Room 509F, HHH Building, Washington, D.C. 20201 (e-mail: ocrmail@hhs.gov).
You also may contact us at: Privacy Officer, Hazleton Radiology
Associates. 20 N. Laurel St., Hazleton PA 18201; (570) 455-3608
To obtain more information concerning this Notice of Privacy
Practices, you may contact our Privacy Officer at (570) 455-3608.
This Privacy Policy is effective 200__.
Copyright
© 2003-2007 Hazleton Radiology Associates.
All rights reserved.
