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 .
I. We have a legal duty to safeguard your protected health information (PHI)
We are legally required to protect the privacy of your health information. We call this information protected health information, or PHI for short. PHI includes information that can be used to identify you that we've created or received about your past, present, or future health conditions, the provision of health care to you, or the payment of this health care. We must provide you with notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice.
However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in our office reception areas. You can also request a copy of this notice from our staff at any time or you can view and print a copy of the notice on our website at www.puebloradiology.com .
II. How we may use and disclose your protected health information
We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below we describe the different categories of our uses and disclosures and give you some examples in each category.
- Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations
We may use and disclose your PHI for the following reasons:
- For Treatment: We may disclose your PHI to physicians, nurses, medical students, and other health care personnel who provide you with health care services or who are involved in your care. For example, if you're being treated for a knee injury, we may disclose your PHI to the physical rehabilitation facility in order to coordinate your care.
- To Obtain Payment For Treatment: We may use and disclose your PHI in order to bill and collect payment for the services provided to you. For example, we may provide portions of your PHI to our billing company, your health plan, or other billing / collection entities to get paid for the health care services we provided to you. Also, we may need to inform your insurance 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 Healthcare Operations: We may disclose your PHI in order to operate this facility. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we're complying with the laws that affect us.
- Certain Uses and Disclosures Do Not Require Your Authorization
We may use and disclose your PHI without your authorization for the following reasons:
- When a disclosure is required by federal, state, or local law enforcement: For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot or other wounds; or when ordered in a judicial or administrative proceeding.
- For public health activities: For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information.
- For health oversight activities: For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
- For purposes of organ donation: We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
- For research purposes: In certain circumstances, we may provide PHI in order to conduct medical research.
- To avoid harm: In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.
- For specific government functions: We may disclose PHI of military personnel and veterans in certain situations. And we may disclose PHI for national security purposes, such as protecting the president of the United States or conducting intelligence operations.
- For workers' compensation purposes: We may provide PHI in order to comply with workers' compensation laws.
- Appointment reminders and health-related benefits or services: We may use PHI to provide appointment reminders or give you information about treatment alternatives or other healthcare services or benefits we offer.
- Uses and Disclosures That Require You To Have The Opportunity To Object
Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your heath care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
- All Other Uses and Disclosures Require Your Prior Written Authorization
In any other situation not described in Sections IIIA, B, and C, above, we will ask for 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 (to the extent that we haven't taken any action relying on the authorization).
- What Rights You Have Regarding Your PHI
You have the following rights with respect to your PHI:
- The Right To Request Limits On Uses and Disclosures Of Your PHI
You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
- The Right To Choose How We Send PHI To You
You have the right to ask that we send information to you at an alternate address (for example, sending information to your work address rather than your home address) or by alternate means ( for example, email instead or regular mail ). We must agree to your request so long as we can easily provide it in the format you requested.
- The Right To See And Get Copies Of Your PHI
In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we don't have your PHI but know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge you ($5.00/report, $10.00/film, and $25.00/CD) accordingly. Instead of providing the PHI you requested, we may provide you with a summary or an explanation of the PHI as long as you agree to that and to the cost in advance.
- The Right To Get A List Of The Disclosures We Have Made
You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory. The list also won't include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, on or before April 14, 2003.
We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for disclosure. We will provide the list to you at no charge, but if you make more than one request within the same year, we will charge you $25.00 for each additional request.
- The Right To Correct Or Update Your PHI
If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.
- Person To Contact About This Notice or To Complain About Our Privacy Practices
If you have any questions about this notice or any complaints about our privacy practices please contact:
c/o Pueblo Radiology Medical Group
2320 Bath Street, Suite 113
Santa Barbara, CA 93105
call: (805) 682-7984
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed above. You may also send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, DC 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.
- Effective Date of This Notice
This notice went into effect on April 14, 2003.