HIPAA 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 review it carefully.

If you have any questions about this Notice please contact our Privacy Officer, Dennis Fine at (404) 943-9796.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website www.NorthsideRadiology.com, calling the office and requesting that a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.

Uses and Disclosures of Protected Health Information

Treatment, Payment and Healthcare Operations

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.

Following are examples of the types of uses and disclosures of your protected health care information that the physician’s office is permitted to make without your specific authorization or consent. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, we would disclose your protected health information, as necessary, to your primary care physician or specialist who has referred you to us. We will also disclose protected health information to other physicians or health care providers who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. Quite simply, a bill may be sent to you or your insurance company for payment. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. This may also include activities your insurance company may undertake before it approves or pays for the health care services we recommend or perform for you such as determining your eligibility for coverage or medical necessity for the treatment For example, obtaining an approval for a MRI diagnostic study may require that your relevant protected health information, such as name and diagnosis, be disclosed to the insurance company to obtain approval to perform the MRI.

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of our physicians’ practice. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and time of arrival. We may also call you by name in the waiting room when your physician is ready to see you or when it is time to perform your test or procedure. Additionally, we may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We will also share your protected health information with third party "business associates" that perform various activities (e.g. billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or expanded services that may be of interest to you. For example, your name and address may be used to send you a newsletter or brochure about our practice and the services we offer. You may contact our Privacy Officer to request that these materials not be sent to you.

Finally, we may use or disclose your personal health information in the course of performing quality improvement activities. For example, members of our staff may use information in your health record to assess the care and results or outcomes in your case and others like it for quality improvement activities.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May be Made with your Consent, Authorization or Opportunity to Object

You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information in the following examples.

 

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. All requests for copying or inspection of your medical record will be fulfilled within 30 days of the request. A "designated record set" contains medical and billing records that your physician and the practice use for making decisions about you.

Under federal law, however, you may not inspect or copy information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. This request must be in writing and we will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.

You may have the right to have your physician amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the Privacy Officer and we may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal.

You have a right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us at any time upon request.

Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

You may contact our Privacy Officer, at (404) 943-9796 for further information about the complaint process.

This notice was published and becomes effective on April 14, 2003


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