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This
notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please
read it carefully.
Our goal is
to take appropriate steps to attempt to safeguard any medical or
other personal information that is provided to us. We are required
to: (i) maintain the privacy of medical information provided
to us; (ii) provide notice of our legal duties and privacy practices;
and (iii) abide by the terms of our Notice of Privacy Practices
currently in effect.
INFORMATION
COLLECTED ABOUT YOU
In the ordinary
course of receiving treatment and health care services from us,
you will be providing us with personal information such as:
- Your name,
address, phone number, fax number, and e-mail address.
- Information
relating to your medical history.
- Your insurance
information and coverage.
- Information
concerning your doctor, nurse or other medical providers.
- Date of birth,
drivers license number, and social security number.
In addition,
we will gather certain medical information about you and will create
a record of the care provided to you. Some information also
may be provided to us by other individuals or organizations that
are part of your “circle of care”- such as the referring
physician, your other doctors, your health plan, and close friends
or family members.
HOW WE MAY USE
AND DISCLOSE INFORMATION ABOUT YOU.
We may use and
disclose personal and identifiable health information about you
in different ways. All of the ways in which we may use and
disclose information will fall within one of the following categories,
but not every use or disclosure in a category will be listed.
For Treatment. We
will use health information about you to furnish services and supplies
to you, in accordance with our policies and procedures. For
example, we will use your medical history, such as any presence
or absence of heart disease, to assess your health and perform requested
diagnostic services.
For Payment. 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 they 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 sometimes
arrange for accreditation organizations, auditors or other consultants
to review our practice, evaluate our operations, and tell us how
to improve our services.
Public Policy
Uses and Disclosures. There are a number of public policy reasons
why we may disclose information about you.
We may disclose
health information about you when we are required to do so by federal,
state, or local law.
We may disclose
protected health information about you in connection with certain
public health reporting activities. For instance, we may disclose
such information to a public health authority authorized to collect
or receive Protected Health Information (PHI) for the purpose of
preventing or controlling disease, injury or disability, or at the
direction of a public health authority, to an official of a foreign
government agency that is acting in collaboration with a public
health authority. Public health authorities include state 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 a few.
We are also
permitted to disclose protected health information to a public health
authority or other government authority authorized by law to receive
reports of child abuse or neglect. Additionally we may disclose
protected health information to a person subject to the Food and
Drug Administration’s power for the following activities:
to report adverse events, product defects or problems, or biological
product deviations, to track products, to enable product recalls,
repairs or replacements, or to conduct post marketing surveillance.
We may disclose
your protected health information in situations of domestic abuse
or elder abuse.
We may disclose
protected health information in connection with certain health oversight
activities of licensing and other agencies. Health oversight activities
include audit, investigation, inspection, licensure or disciplinary
actions, and civil, criminal, or administrative proceedings or actions
or any other activity necessary for the oversight of 1) the health
care system, 2) governmental benefit programs for which health information
is relevant to determining beneficiary eligibility, 3) entities
subject to governmental regulatory programs for which health information
is necessary for determining compliance with program standards,
or 4) entities subject to civil rights laws for which health information
is necessary for determining compliance.
We may disclose
information in response to a warrant, subpoena, or other order of
a court or administrative hearing body, and in connection with certain
government investigations and law enforcement activities.
We may release
personal health information to a coroner or medical examiner to
identify a deceased person or determine the cause of death. We
also may release personal health information to organ procurement
organizations, transplant centers, and eye or tissue banks.
We may release
your personal health information to workers’ compensation
or similar programs.
Information
about you also will be disclosed when necessary to prevent a serious
threat to your health and safety or the health and safety of others.
We may use or
disclose certain personal health information about your condition
and treatment for research purposes where an Institutional Review
Board or a similar body referred to as a Privacy Board determines
that your privacy interests will be adequately protected in the
study. We may also use and disclose your protected health information
to prepare or analyze a research protocol and for other research
purposes.
If you are a
member of the Armed Forces, we may release personal health information
about you as required by military command authorities. We also
may release personal health information about foreign military personnel
to the appropriate foreign military authority.
We may disclose
your protected health information for legal or administrative proceedings
that involve you. We may release such information upon order
of a court or administrative tribunal. We may also release
protected health information in the absence of such an order and
in response to a discovery or other lawful request, if efforts have
been made to notify you or secure a protective order.
If you are an
inmate, we may release protected health information about you to
a correctional institution where you are incarcerated or to law
enforcement officials.
Finally, we
may disclose protected health information for national security
and intelligence activities and for the provision of protective
services to the President of the United States and other officials
or foreign heads of state.
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.
Individuals
Involved in Your Care or Payment for Your Care. We may disclose
information to individuals involved in your care or in the payment
for your care, but we will obtain your agreement before doing so. This
includes people and organizations that are part of your "circle
of care" -- such as your spouse, your other doctors, or an
aide who may be providing services to you. Although we must
be able to speak with your other physicians or health care providers,
you can let us know if we should not speak with other individuals,
such as your spouse or family.
Appointment
Reminders. We may use and disclose medical information to contact
you as a reminder that you have an appointment or that you should
schedule an appointment.
Treatment Alternatives. We
may use and disclose your personal health information in order to
tell you about or recommend possible treatment options, alternatives
or health-related services that may be of interest to you.
OTHER
USES AND DISCLOSURES OF PERSONAL INFORMATION
We are required
to obtain written authorization from you for any other uses and
disclosures of medical information other than those described above. If
you provide us with such permission, you may revoke that permission,
in writing, at any time. If you revoke your permission, we
will no longer use or disclose personal information about you for
the reasons covered by your written authorization. We will
be unable to take back any disclosures already made based upon your
original permission.
INDIVIDUAL
RIGHTS
You have the
right to ask for restrictions on the ways in which we use and disclose
your medical information beyond those imposed by law. We will
consider your request, but we are not required to accept it.
You have the
right to request that you receive communications containing your
protected health information from us by alternative means or at
alternative locations. For example, you may ask that we only
contact you at home or by mail.
Except under
certain circumstances, you have the right to inspect and copy medical
and billing records about you. If you ask for copies of this
information, we may charge you a fee for copying and mailing.
If you believe
that information in your records is incorrect or incomplete, you
have the right to ask us to correct the existing information or
correct the missing information. Under certain circumstances,
we may deny your request.
You have a right
to ask for a list of instances when we have used or disclosed your
medical information for reasons other than your treatment, payment
for services furnished to you, our health care operations, or disclosures
you give us authorization to make. If you ask for this information
from us more than once every twelve months, we may charge you a
fee.
You have the
right to a copy of this Notice in paper form. You may ask us
for a copy at any time. You may also obtain a copy of this form
at our web site ratc.com.
To exercise
any of your rights, please contact us in writing at the address
on the bottom of this notice.
CHANGES
TO THIS NOTICE
We reserve the
right to make changes to this notice at any time. We reserve
the right to make the revised notice effective for personal health
information we have about you as well as any information we receive
in the future. In the event there is a material change to this
Notice, the revised Notice will be posted. In addition, you
may request a copy of the revised Notice at any time.
COMPLAINTS/COMMENTS
If you have
any complaints concerning our Privacy Policy, you may contact the
Secretary of the Department of Health and Human Services, at 200
Independence Avenue, S.W., Room 509F, HHH Building, Washington,
D.C. 20201 (e-mail:ocrmail@hhs.gov). You also may contact
us at the address provided at the bottom of this notice.
To obtain a
copy of this notice, make a complaint or comment concerning this
notice or obtain more information about the Notice of Privacy Practices,
you may contact our Privacy Officer at:
Radiology Associates
of Tarrant County
Attn:
Privacy Officer
1350 S.
Main
Suite
4200
Ft. Worth,
TX 76104
817-321-0318
blindsey@ratc.com
This Privacy
Policy is effective April 14, 2003 |
