"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"
PRIVACY NOTICE
This page describes the type of information we gather about you,
with whom that information may be shared and the safeguards we
have in place to protect it. You have the right to the
confidentiality of your medical information and the right to
approve or refuse the release of specific information except when
the release is required by law. If the practices described in this
brochure meet your expectations, there is nothing you need to do.
If you prefer that we not share information we may honor your
written request in certain circumstances described below. If you
have any questions about this notice, please contact our Privacy
Officer at the address below.
WHO WILL FOLLOW THIS NOTICE
This notice describes Health Medical Imaging’s practices
regarding the use of your medical information and that of:
- Any health care professional authorized to enter information
into your hospital chart or medical record.
- All departments and units of the hospitals, clinics or
doctor’s offices you may visit.
- Any member of a volunteer group we allow to help you while
you are in the hospital.
- All employees, staff and other personnel who may need access
to your information.
- All entities, sites and locations of Health Medical Imaging
follow the terms of this notice. In addition, these entities,
sites and locations may share medical information with each
other for treatment, payment or health care purposes described
in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health
is personal. Protecting medical information about you is
important. We create a record of the care and services you
receive. 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 Health Medical
Imaging, whether made by health care professionals or other
personnel.
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:
- keep medical information that identifies you 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.
HOW WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU
The following categories describe different ways that we may use
and disclose medical information. For each category of uses or
disclosures we will try to give some examples. Not every use or
disclosure in a category will be listed.
For Treatment. We may use
medical information about you to provide you with medical
treatment or services. We may disclose medical information about
you to doctors, nurses, technicians, training doctors, or other
health care professionals who are involved in taking care of you.
For example, a doctor treating you for a broken leg may need to
know if you have diabetes because diabetes may slow the healing
process. In addition, the doctor may need to tell the dietitian if
you have diabetes so that we can arrange for appropriate meals.
Different health care professionals also may share medical
information about you in order to coordinate the different things
you need, such as prescriptions, lab work and x-rays. We also may
disclose medical information about you to people outside the
hospital who may be involved in your medical care after you leave
the hospital or that provide services that are part of your care.
For Payment. We may use and
disclose medical information about you so that the treatment and
services you receive may be billed to and payment may be collected
from you, an insurance company or a third party. For example, your
insurance may need to know about surgery you received so they will
pay us or reimburse you for the surgery. We may also use and
disclose medical information about you to obtain prior approval or
to determine whether your insurance will cover the treatment.
For Health Care Purposes. We
may use and disclose medical information about you for health care
purposes. This is necessary to make sure that all of our patients
receive quality care. For example, we may use medical information
to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also disclose
information to doctors, nurses, technicians, training doctors,
medical students, and other hospital personnel for review and
learning purposes. We may 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 patients are.
Appointment Reminders. We may
use and disclose medical information to contact you as a reminder
that you have an appointment for treatment or medical care.
Treatment Alternatives. We may
use and disclose medical information to tell you about or
recommend possible treatment options or alternatives that may be
of interest to you.
Health-Related Benefits and Services.
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to
you.
Hospital Directory. We may
include certain limited information about you in the hospital
directory while you are a patient at the hospital. This
information may include your name, location in the hospital, your
general condition (e.g., fair, stable, etc.) and your religious
affiliation. The directory information, except for your religious
affiliation, may also be released to people who ask for you by
name. Your religious affiliation may be given to a member of the
clergy, such as a priest or rabbi, even if they don’t ask for
you by name. This is so your family, friends and clergy can visit
you in the hospital and generally know how you are doing.
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 in the hospital. In addition, we
may disclose medical information about you to an entity assisting
in a disaster relief effort so that your family can be notified
about your condition, status and location.
Research. Under certain
circumstances, we may use and disclose medical information about
you for research purposes. For example, a research project may
involve comparing the health and recovery of all patients who
received one medication to those who received another, for the
same condition. All research projects, however, are subject to a
special approval process. This process evaluates a proposed
research project and its use of medical information, trying to
balance the research needs with patients' need for privacy of
their medical information. Before we use or disclose medical
information for research, the project will have been approved
through this research approval process, but we may, however,
disclose medical information about you to people preparing to
conduct a research project, for example, to help them look for
patients with specific medical needs, so long as the medical
information they review does not leave the hospital. We will
almost always ask for your specific permission if the researcher
will have access to your name, address or other information that
reveals who you are, or will be involved in your care at the
hospital.
As Required By Law. We will
disclose medical information about you when required to do so by
federal, state or local law.
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 help prevent the threat.
Fundraising Activities. We may
use medical information about you in an effort to raise money for
the Health Medical Imaging and its operations. We may disclose
medical information to a foundation related to the hospital so
that the foundation may raise money for the hospital. We only
would release contact information, such as your name, address and
phone number. If you do not want the Health Medical Imaging to
contact you for fundraising efforts, you must notify our Privacy
Officer in writing at the address below.
SPECIAL SITUATIONS
Organ and Tissue Donation. If
you are an organ donor, we may release medical information to
organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary
to facilitate organ or tissue donation and transplantation.
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.
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.
Public Health Risks. We may disclose medical information about you
for public health activities. These activities generally include
the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with
products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or
condition;
- to notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect or domestic
violence.
Health Oversight Activities.
We may disclose medical information to a health oversight agency
for activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government to
monitor the health care system, government programs, and
compliance with civil rights laws.
Lawsuits and Disputes. We may
disclose medical information about you in response to a subpoena,
discovery request, or other lawful order from a court.
Law Enforcement. We may
release medical information if asked to do so by a law enforcement
official as part of law enforcement activities; in investigations
of criminal conduct or of victims of crime; in response to court
orders; in emergency circumstances; or when required to do so by
law.
Coroners, Medical Examiners and Funeral
Directors. We may release medical information to a
coroner or medical examiner. This may be necessary, for example,
to identify a deceased person or determine the cause of death. We
may also release medical information about patients of the
hospital to funeral directors as necessary to carry out their
duties.
Protective Services for the President,
National Security and Intelligence Activities. We may
release 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
investigations, or for intelligence, counterintelligence, and
other national security activities authorized by law.
Inmates. If you are an inmate
of a correctional institution or under the custody of a law
enforcement official, we may release medical information about you
to the correctional institution or law enforcement official. This
release would be necessary (1) for the institution to provide you
with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security of
the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
ABOUT YOU
You have the following rights regarding medical information we
maintain about you:
Right to Inspect and Copy. You
have the right to inspect and copy medical information that may be
used to make decisions about your care. Usually, this includes
medical and billing records, but does not include psychotherapy
notes.
To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to
our Privacy Officer at the address on the last page. 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.
We may deny your request to inspect and copy in certain very
limited circumstances. If you are denied access to medical
information, you may request that the denial be reviewed. Another
licensed health care professional chosen by Health Medical Imaging
will review your request and the denial. The person conducting the
review will not be the person who denied your request. We will
comply with the outcome of the review.
Right to Amend. If you feel
that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the
right to request an amendment for as long as the information is
kept.
To request an amendment, your request must be made in writing and
submitted to our Privacy Officer. 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 Health
Medical Imaging;
- Is not part of the information which you would be permitted
to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of
Disclosures. You have the right to request an
"accounting of disclosures." This is a list of certain
disclosures we made of medical information about you.
To request an accounting of disclosures, you must submit your
request in writing to our Privacy Officer.
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. If we do agree, we
will comply with your request unless the information is needed to
provide you emergency treatment.
To request restrictions, you must make your request in writing to
our Privacy Officer at the address below. 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
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 to our Privacy Officer. We will not ask you the reason
for your request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to a paper 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 a copy of this notice in MS
Word format here,
To obtain a paper copy of this notice, please request one in
writing from our Privacy Officer at the address below.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right
to make the revised or changed notice effective for medical
information we already have about you as well as any information
we receive in the future. We will post a copy of the current
notice. The notice will contain on the first page, in the top
right-hand corner, the effective date.
COMPLAINTS
If you believe your privacy rights have been violated, you may
file a complaint with the Health Medical Imaging or with the
Secretary of the Department of Health and Human Services. To file
a complaint with Health Medical Imaging, contact our Privacy
Officer at the address and phone number listed below. All
complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to us will be made only with
your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that
permission, in writing, at any time. If you revoke your
permission, thereafter we will no longer use or disclose medical
information about you for the reasons covered by your written
authorization. You understand that we are unable to take back any
disclosures we have already made with your permission, and that we
are required to retain our records of the care that we provided to
you.
PRIVACY OFFICER:
Thomas P. Valenti
Chief Privacy Officer
tel: 708-952-9400
tpvalenti@healthmedicalimaging.com
This page revised on
04/8/2003
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