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How Your Private Health Information Will Be Used and How You Have Access To It! PRIVACY NOTICE - Effective Date: 4-1-03 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. WHO WILL FOLLOW THIS NOTICE
This notice describes the privacy practice of Medical
X-Ray Center and that of: §
Any
health care professional authorized to enter information into your medical
chart. §
All
departments and units of this clinic §
Any
member of a volunteer group we allow to help you while you are at our
clinic. §
All
employees, staff and other clinic personnel. OUR PLEDGE REGARDING MEDICAL
INFORMATION
We understand that medical information about you and
your health is personal. We are committed to protecting medical
information about you. We create a record of the care and service you
receive at the clinic. 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 the clinic,
whether made by clinic personnel or your personal doctor. 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: §
Make
sure that medical information that identifies you is kept 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 use and disclose medical information. For each category of uses or
disclosures we will explain what we mean and try to give some examples.
Not every use or disclosure in a category will be listed. However, all of
the ways we are permitted to use and disclose information will fall within
one of the categories. 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, medical students, health professionals in training, or other clinic personnel who are involved in taking care of you at the clinic. For example, different departments in the clinic also may share medical information about you in order to coordinate the different things you need, such as prescriptions and x-rays. We may also disclose medical information about you to people outside the clinic who may be involved in your medical care. For Payment. We may use and disclose your medical information, so
that the treatment and services you receive at Medical X-Ray Center
may be billed to and payment collected from you, an insurance
company or a third party. For example, we may need to provide
documentation that shows services were provided to you, so your insurance
company will pay us for those services. We may also provide your medical
information to our business associates, such as claims processing
companies. For Health Care Operations.
We may use and disclose medical information about you for clinic
operations. These uses and disclosures are necessary to run the clinic
and 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 combine medical information about many clinic patients to
decide what additional services the clinic should offer, what services are
not needed, and whether certain practices are effective. We may also
disclose information to doctors, nurses, technicians, medical students,
health professions in training, and other clinic personnel for review and
learning purposes. 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 at the clinic. 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. Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to others who are involved in your medical care. We may also give information to someone who helps pay for your care. 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,
studies on the effects of medications on certain diseases. 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 clinic. 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 clinic. §
In
response to a court order, subpoena, warrant, summons, or similar process; §
To
identify or locate a suspect, fugitive, material witness, or missing
person; §
About
the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement; §
About
a death we believe may be the result of criminal conduct; §
About
criminal conduct at the clinic; and §
In
emergency circumstances to report a crime; the location of the crime or
victims; or the identity, description or location of the person who
committed the crime. 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 clinic to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities.
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law. Protective Services for the President and Others.
We may disclose 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. 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 the Health Information Manager. 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 the clinic 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 by or for the clinic. To request an amendment, your request must be made in
writing and submitted to the Health Information Manager. 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 or for the clinic; §
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 the disclosures we made of medical information about you. To request this list or accounting of
disclosures, you must submit your request in writing to the Health
Information Manager. Your request must
state a time period which may not be longer than six years and may not
include dates before April 1, 2003. Your request should indicate in what
form you want the list (for example, on paper, electronically). The first
list you request within a 12-month period will be free of charge. For
additional lists, we may charge you for the costs of providing the list.
We will notify you of the cost involved and you may choose to withdraw or
modify your request at that time before any costs are incurred. 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
healthcare 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.
For example, you could ask that we not use or disclose information
about a surgery you had. 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 with emergency treatment. To request restrictions, you must make your request in writing to: Medical
X-Ray Center |
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