Notice of Medical 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.
Our Duties
We are required by law to maintain the privacy of our clients' patients'
medical information and to provide notice of our legal duties and
privacy practices. We are required to abide by the terms of the Notice
of Privacy Practices currently in effect. We reserve the right to change
those terms and any changes made will be effective for all medical
information we maintain. A copy of a revised notice will be available on
our web site at www.radisphere.net, or from our Privacy
Coordinator by calling (216) 255-5720, or by writing to Radisphere, c/o Privacy Coordinator, 23625 Commerce Park, Suite 204,
Beachwood, OH, 44122. You may also address questions regarding our
privacy practices, your privacy rights, or requests for additional
information regarding your privacy to this person.
Permitted Uses and Disclosures
We may use and disclose your medical information in the ordinary course
of our business. We have described some of these uses and disclosures in
the following paragraphs:
- Treatment: We will provide your doctor or other health care providers
with the results of the diagnostic imaging exams we perform as needed.
- Payment: We will bill your insurance company, you directly, or
another person that may be responsible for payment of your account. We
may need to contact your health plan to see if they will pay for the
exams your doctor has ordered. Throughout this process, we may have to
release details of your exam and medical condition, if your health plan
or other payor requires this information to make payment.
- Health Care Operations: We often have to use specific patient
information to conduct our normal business operations. For example, we
routinely review past exams performed to maintain quality assurance
goals. One type of review we may conduct includes selecting images for
review by another radiologist. Another is to select your billing
information for review by our internal compliance team or by external
auditors. In addition, we may use specific patient information to
demonstrate our skills to an accreditation body. Accreditation is
important to our patients and us because the process causes us to
demonstrate some degree of proficiency in conducting examinations and
maintaining the quality of our equipment.
Disclosures without Authorization
We may use and disclose medical information about you, without your
specific authorization, as follows:
- Disclosures Required by Law: We may be required by federal, state, or
local law to disclose your medical information.
- Public Health Activities: We may disclose your medical information to
a public agency, such as the Food and Drug Administration (FDA).
- Victims of Abuse, Neglect, or Domestic Violence: We may be required
to disclose your medical information if we feel that you have been
abused or neglected.
- Health Oversight Activities: We may be required to disclose your
medical information to Medicare or a related agency if they select your
case for a medical review.
- Judicial and Administrative Proceedings: We may have to disclose your
medical information if we receive a subpoena from a judge or
administrative tribunal.
- Law Enforcement: We may have to disclose your medical information in
conjunction with a criminal investigation by a federal or state law
enforcement agency.
- Serious Threats to Health or Safety: We may be required to disclose
your medical information if, in our opinion, doing so will help avert a
serious threat to the public.
- Military Personnel: We may disclose your medical information to the
appropriate command authorities.
- Worker's Compensation: We may disclose your medical information to
comply with laws regarding worker's compensation.
Patient Rights
You have certain rights with respect to your medical information.
- Requesting Restrictions: You may ask us to limit our use or disclosure
of your protected health information. We are not required to agree to
your request, but if we agree to it, we will abide by your request
except as required by law, in emergencies, or when the information is
necessary to treat you. Your request must: 1) be in writing, 2) describe
the information that you want restricted, 3) state if the restriction is
to limit our use or disclosure, and 4) state to whom the restriction
applies. You may revoke your restriction at any time by contacting our
Privacy Coordinator as noted on the first page. We may ask to reschedule
your exam while we consider your request.
- Confidential Communications: You may ask that we communicate with you
in a particular way, or at a certain location, to maintain your
confidentiality. Your request must be in writing, tell us how you intend
to satisfy your financial responsibility, and specify an alternate way
that we can contact you confidentially. You do not have to give a reason
for your request. In certain circumstances, we may require payment in
full at the time you have your exam. You may revoke your request at any
time by contacting our Privacy Coordinator as noted on the first page.
We may ask to reschedule your exam while we consider your request.
- Inspect and Copy: You may request access to inspect and copy your
medical information maintained in our records, including medical and
billing records. Your request must be in writing. We will act on your
request for inspections within 5 working days after we get the request.
We will act on your request for copies within 15 days after we get the
request. If we must deny your request, we will send you a written
denial. If this happens, you may request a review of the denial. We may
charge you a fee for providing copies. If that is the case, we will
advise you of the cost of those copies at the time that we arrange for
you to pick them up or have them delivered to you. We will compute these
costs using state guidelines. You may also have to pay for the cost of
postage or shipping, depending on how you ask that we get these copies
to you.
- Amendment: You may ask us to amend your health information if you
believe that it is incorrect or incomplete. Your request must be in
writing and must include a reason to support the amendment. Your request
may be denied if we believe that the information is complete and
accurate, if the information is not part of the medical information that
you would be permitted to inspect or copy, or if we did not create the
information. You also have the option of submitting your own amendment.
This amendment must be in writing and cannot be longer than 250 words
per item that you are trying to correct. We will then include this
amendment when we release the records in question.
- Accounting of Disclosures: You may request a list of non-routine
disclosures that we have made of your medical information over the
previous six (6) years. This does not include disclosures we make for
your treatment, to seek payment for our services, or for our normal
business operations as noted in the section on permitted uses and
disclosures, or for those you authorize in writing. You may not request
an accounting for dates of service prior to April 14, 2003. Your first
request within a 12-month period is free, but we may charge for
additional lists within the same 12-month period.
- Paper Copy of This Notice: You are entitled to receive a paper copy
of our Notice of Privacy Practices by contacting our Privacy Coordinator
using the contact information on the first page.
- File a Complaint: If you believe that we have violated your privacy
rights, you may file a complaint directly with our Privacy Coordinator
using the contact information on the first page. You may also file a
complaint with the Secretary of the Department of Health and Human
Services. We will not penalize you for complaining.
Patient Authorizations for Certain Disclosures
We will request your written authorization for uses and disclosures of
your medical information that we did not identify in this notice or for
those not otherwise permitted by law. These disclosures include your
requests to provide exam results to your attorney, for exams related to
life insurance or disability insurance applications, or for
pre-employment physicals, among others. You may revoke your
authorization in writing at any time by contacting our Privacy
Coordinator using the contact information on the first page. You may
demand a copy of your authorization at any time.
If you wish to make any requests listed above under "Your Rights",
you should submit your request in writing to:
Radisphere
Privacy Officer
23625 Commerce Park, Suite 204
Beachwood, OH 44122
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