NOTICE OF PRIVACY PRACTICES
effective April 14th, 2003
Advanced Medical Imaging respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you allow us to do so, or unless the law authorizes or requires us to do so.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information could include your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations
- Information obtained by a, physician, technologist, nurse, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you. For example, the presence or absence of allergies, heart disease, or diabetes will be used by us to assess your health and when performing the requested exams.
- We will also provide information to others providing you care, such as your referring practitioner, or someone you may be referred to in the future. This will inform them about your diagnosis. Departments internal or external to our practice may also need your medical information in order to coordinate different treatments you need such as lab work, etc.
- 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 examinations or other services that we have furnished 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 may arrange for accreditation organizations, health consultants or auditors to review our practice, evaluate our operations, and tell us how to improve our services.
- We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff or students involved in healthcare.
- Unless you object, we may contact you and remind you of an appointment. For example, we may call you on the phone to remind you of an appointment scheduled with our practice. We may leave a message simply stating who we are and that we are reminding you of your appointment at (day and time). We may contact you to give you information about treatment/diagnostic alternatives or other health-related benefits and services.
- In regard to mammography, we are required to mail you the results of your exam, and also to mail you reminders when it is time to make an appointment. These letters will arrive in sealed envelopes addressed to you.
- We may contact you to raise funds for our operations.
- We may use and disclose your information to conduct or arrange for services, including:
- medical quality review by your health plan;
- accounting, legal, risk management, and insurance services;
- audit functions, including fraud and abuse detection and compliance programs.
Other Disclosures and Uses of Protected Health Information
Notification of Family and Others
- Unless you object, we may release health information about you to a family member or friend who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition or that you are in a hospital/physician's office. In addition, we may disclose health information about you to assist in disaster relief efforts.
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 we hire them to do. Our business associates must guarantee to us that they will respect the confidentiality of your personal and identifiable health information.
We may use and disclose your protected health information without your authorization, as required by law and other special circumstances, as follows:
- With Medical Researchers — if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
- To Funeral Directors/Coroners consistent with applicable law to allow them to carry out their duties.
- To Organ Procurement Organizations (tissue donation and transplant) or persons who obtain, store, or transplant organs.
- To the Food and Drug Administration (FDA) relating to problems with food, supplements, and products.
- To Comply With Workers' Compensation Laws — if you make a workers' compensation claim.
- For Public Health and Safety Purposes as Allowed or Required by Law:
- to prevent or reduce a serious, immediate threat to the health or safety of a person or the public.
- to public health or legal authorities (these include state or county 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 some)
- to protect public health and safety
- to prevent or control disease, injury, or disability
- to report reactions to medications or problems with products
- to report vital statistics such as births or deaths
- To Report Suspected Abuse or Neglect to public authorities.
- To Correctional Institutions if you are in jail or prison, as necessary for your health and the health and safety of others.
- For Law Enforcement Purposes such as when we receive a subpoena, court order, or other legal process, or you are the victim of a crime.
- For Health and Safety Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
- For Disaster Relief Purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
- For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site.
- To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.
- In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.
- For Specialized Government Functions. For example, we may share information for national security purposes.
Other Uses and Disclosures of Protected Health Information
- Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
Your Health Information Rights
The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you.
You have a right to:
- Receive, read, and ask questions about this Notice;
- Request restrictions. Although we must be able to speak with your other physicians or health care providers, you 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, such as a family member of friend. We are not required to grant the request. We will comply with any request granted, unless the information is necessary to provide you with emergency treatment.
To request restrictions, deliver the request in writing to our Privacy Officer, location listed at the end of this Notice. 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).
- Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information ("Notice");
- Request that you be allowed to see and get a copy of your protected health information. This includes your medical and billing records. You may make this request in writing, to the Privacy Officer, location listed at the end of this Notice. We have a form available for this type of request. We are permitted by law to charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
Our practice may deny your request (above) to inspect and/or copy your records in certain limited circumstances; however, if this occurs, you have the right to request a review of this denial-except in certain circumstances. Another licensed health care professional other than the one who denied your request, will review the denial. We will comply with the outcome of the review. You will be informed of the outcome.
- Ask us to change your health information if you believe it is incorrect or incomplete. Please give us this request in writing. You must provide us with a reason that supports your request for the amendment. We may deny your request if you ask us to amend information that 1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; 2) is not part of the medical information kept by this practice; 3) is not part of the information which you would be permitted to inspect and copy; and 4) is accurate and complete. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
- You may request an "accounting of disclosures." This is a list of certain non-routine disclosures we made of the medical information about you. The accounting of disclosures does not require us to list, for example, a doctor sharing information with the technologist, another doctor, or to third-party payers. The request must state a time period, which may not be longer than 6 (six) years and may not include dates before April 14, 2003 . You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months and you may withdraw your request before you incur any costs.
- Ask that your health information be given to you by another means or at another location. For example, you may request that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible. Please sign, date, and give us your request in writing.
- Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
For questions during normal business hours regarding these rights, please contact:
Privacy Officer (Operations Director)
1780 NW Myhre Rd. #1220
Silverdale , WA 98383
We are required to:
- Keep your protected health information private;
- Give you this Notice;
- Follow the terms of this Notice.
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting any one of our offices to pick one up.
To Ask for Help or Complain
If you have questions, want more information, or wish to file a complaint about the handling of your protected health information, you may contact:
Privacy Officer/Operations Director
Advanced Medical Imaging
1780 NW Myhre Rd. #1220
Silverdale, WA 98383
Your complaint will be thoroughly investigated, and you will be notified in writing of the results of our investigation within 30 days of our receipt of your complaint. Should you choose to file a privacy complaint with U.S. Secretary of Health and Human Services Office for Civil Rights (OCR), you may do so at the following address:
Region X Seattle Regional Manager
2201 Sixth Ave., Suite 900
Seattle, WA 98121-1831
(206) 615-2287 / FAX (206) 615-2297 / TDD (206) 615-2296