Effective Date: September 23, 2013
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.
It is important to read and understand this Notice of Privacy Practices. If you have any questions about this Notice or would like further information concerning your privacy rights, please contact:
Jefferson Radiology, P.C.
111 Founder’s Plaza, Suite 400
East Hartford, CT 06108
Purpose of the Notice of Privacy Practices
This Notice of Privacy Practices (the “Notice”) is meant to inform you of the uses and disclosures of protected health information that we may make. It also describes your rights to access and control your protected health information and certain obligations we have regarding the use and disclosure of your protected health information.
Your “protected health information” is information about you created and received by us, including demographic information, that may reasonably identify you and that relates to your past, present or future physical or mental health or condition, or payment for the provision of your health care. We are required by law to maintain the privacy of your protected health information. We are also required by law to provide you with this Notice of our legal duties and privacy practices with respect to your protected health information and to abide by the terms of the Notice that is currently in effect. However, we may change our Notice at any time. The new revised Notice will apply to all of your protected health information maintained by us. You will not automatically receive a revised Notice. If you would like to receive a copy of any revised Notice, you should access our web site at www.jeffersonradiology.com, contact Jefferson Radiology at 860.289.3375, or ask at your next appointment.
How We May Use or Disclose Your Protected Health Information
You will also be asked to acknowledge receipt of this Notice. The following categories describe some of the different ways that we may use or disclose your protected health information. Even if not specifically listed below, Jefferson Radiology may use and disclose your protected health information as permitted or required by law or as authorized by you. We will make reasonable efforts to limit access to your protected health information to those persons or classes of persons, as appropriate, in our workforces who need access to carry out their duties. In addition, if required, we will make reasonable efforts to limit the protected health information to the minimum amount necessary to accomplish the intended purpose of any use or disclosure and to the extent such use or disclosure is limited by law.
The following are the ways we may use and disclose your protected health information:
- For Treatment – to provide you with medical treatment and related services. For example, your protected health information may be used to provide radiological readings to your referring physician of record. If we are permitted to do so, we may also disclose your protected health information to individuals or facilities that will be involved with your care after you leave Jefferson Radiology and for other treatment reasons. We may also use or disclose your protected health information in an emergency situation.
- For Payment – so that we can bill and receive payment for the treatment and related services you receive. For billing and payment purposes, we may disclose your health information to your payment source, including an insurance or managed care company, Medicare, Medicaid, or another third party payor. For example, we may need to give your health plan information about the treatment you received so your health plan will pay us or reimburse us for the treatment, or we may contact your health plan to confirm your coverage or to request prior authorization for a proposed treatment.
- For Health Care Operations – as necessary for operations of Jefferson Radiology, such as quality assurance and improvement activities, reviewing the competence and qualifications of health care professionals, medical review, legal services and auditing functions, and general administrative activities of Jefferson Radiology. For example, Jefferson Radiology may use or disclose protected health information when determining standard treatment protocols for patient care and procedures and/or exam room operations.
- Business Associates – There may be some services provided by our business associates, such as a billing service, transcription company or legal, accounting or information technology consultants. We may disclose your protected health information to our business associates so that they can perform the job we have asked them to do. All of our business associates are obligated, by law and under their contract with us, to protect the privacy of your health information, and are not allowed to use or disclose any information other than as specified by law or in the contract.
- Appointment Reminders – to contact you as a reminder that you have an appointment at Jefferson Radiology.
- Electronic Mail and Text Messages – to contact you, including by electronic mail or text messaging, to provide information for administrative purposes, including, but not limited to, providing appointment reminders, authorization and intake forms or examination preparation information for upcoming procedures, and providing information about health-related products or services of Jefferson Radiology and its affiliates. E-mail communication and text messaging between you and Jefferson Radiology is not secure because it is transmitted through public communication lines (the Internet). There is a possibility that e-mail transmitted using the Internet and text messaging could be intercepted or received by an unauthorized person. We will not communicate with you by e-mail for treatment purposes.
- Individuals Involved in Your Care or Payment of Your Care/Disaster Relief – Unless you object, we may disclose your protected health information to a person who is involved in your medical care or who helps pay for your care, such as a family member or friend. We may also notify the person of your location or general condition or payment related to your health care. In addition, we may disclose your protected health information to a public or private entity authorized by law to assist in a disaster relief effort.
- Public Health Activities – to a public health authority that is authorized by law to collect or receive such information, such as for the purpose of preventing or controlling disease, injury, or disability; reporting births, deaths or other vital statistics; reporting child abuse or neglect; notifying individuals of recalls of products they may be using; notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
- Health Oversight Activities – to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, accreditation, licensure and disciplinary actions.
- Judicial and Administrative Proceedings – If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to your authorization or a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process if such disclosure is permitted by law.
- Law Enforcement – for certain law enforcement purposes if permitted or required by law. For example, to comply with a court order, warrant, or similar legal process; or to answer certain requests for information concerning crimes.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations – to a coroner, medical examiner, funeral director, or, if you are an organ donor, to an organization involved in the donation of organs and tissues.
- Research Purposes – for research purposes, but only if the use and disclosure of your information has been reviewed and approved by a special Privacy Board or Institutional Review Board, or if you provide authorization.
- To Avert a Serious Threat to Health or Safety – when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.
- Military and National Security – If you are a member of the armed forces, as required by military command authorities or the Department of Veterans Affairs. We may release your protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by law. We may disclose your protected health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Workers’ Compensation – as permitted by laws relating to workers’ compensation or related programs.
Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and HIV-Related Information – For disclosures concerning protected health information relating to care for psychiatric conditions, substance abuse or HIV related testing and treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special Authorization or a court orders the disclosure.
- Mental Health and Substance Abuse health information. for treatment, payment and health care operations as permitted or required by law. Otherwise, we will only disclose such information pursuant to an authorization, court order or as otherwise required by law.
- HIV related information. as permitted or required by applicable State law. For example, your HIV-related information, if any, may be disclosed without your authorization for treatment purposes, certain health oversight activities, pursuant to a court order, or in the event of certain exposures to HIV by personnel of Jefferson Radiology, another person, or a known partner.
- Minors. We will comply with applicable State law when using or disclosing protected health information of minors. For example, if you are an unemancipated minor consenting to a health care service and you have not requested that another person be treated as a personal representative, you may have the authority to consent to the use and disclosure of your health information.
When We May Not Use or Disclose Your Protected Health Information
Subject to certain exceptions, we must obtain your written authorization when using or disclosing psychotherapy notes about you (if we record or maintain such notes), when using or disclosing your protected health information for marketing, or if we intend to sell your protected health information. Except as described in this Notice, or as permitted by applicable State or Federal law, we will not use or disclose your protected health information without your written authorization. Your written authorization will specify particular uses or disclosures that you choose to allow. Under certain limited circumstances, Jefferson Radiology may condition treatment on the provision of an authorization, such as for research related to treatment. If you do authorize us to use or disclose your protected health information for reasons other than treatment, payment or health care operations, you may revoke your authorization in writing at any time by contacting Jefferson Radiology’s Privacy Officer. If you revoke your authorization, we will no longer use or disclose your protected health information for the purposes covered by the authorization, except where we have already relied on the authorization.
Your Health Information Rights
You have the following rights with respect to your protected health information. The following briefly describes how you may exercise these rights.
You have the right to:
- Request Restrictions of Your Protected Health Information – You may request certain restrictions or limitations on the protected health information we use or disclose about you. You may request a restriction or revise a restriction on the use or disclosure of your protected health information by providing a written request stating the specific restriction requested. We are not required to agree to your requested restriction. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you with emergency treatment. In addition, you and Jefferson Radiology may terminate the restriction if the other party is notified in writing of the termination. Unless you agree, the termination of the restriction is only effective with respect to protected health information created or received after we have informed you of the termination. You may request, and we must agree to the request, that we not disclose to a health plan for purposes of payment or health care operations your protected health information about a health care item or service for which you have paid us in full.
- Receive Confidential Communications – You may request a reasonable accommodation regarding how you receive communications of protected health information. You have the right to request an alternative means of communication or an alternative location where you would like to receive communications. You may submit a request in writing to Jefferson Radiology requesting confidential communications. You can obtain a Request for Confidential Communications form from Jefferson Radiology.
- Access, Inspect and Copy Your Protected Health Information – You may access, inspect and obtain a copy of your protected health information that is used to make decisions about your care for as long as the protected health information is maintained by or for Jefferson Radiology. You must submit your request in writing to Jefferson Radiology. If you request a copy of the information, we may charge a fee for the costs of preparing, copying, mailing or other supplies associated with your request. We may deny, in whole or in part, your request to access, inspect and copy your protected health information under certain limited circumstances. If we deny your request, we will provide you with a written explanation of the reason for the denial. You may have the right to have this denial reviewed by an independent health care professional designated by us to act as a reviewing official. You may also have the right to request a review of our denial of access through a court of law. All requirements, court costs and attorney’s fees associated with a review of denial by a court are your responsibility. You have the right to request an electronic copy of your health record.
- Amend Your Protected Health Information – You may request an amendment to your protected health information for as long as the information is maintained by or for Jefferson Radiology. You may make an oral request to amend a scriveners’ error. All other requests to amend your protected health information must be made in writing to Jefferson Radiology and must state the reason for the requested amendment. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
- Receive An Accounting of Disclosures of Protected Health Information – You may request an accounting of certain disclosures of your protected health information by Jefferson Radiology or by others on our behalf. To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning on or after April 14, 2003 that is within six (6) years from the date of your request. To request an accounting of disclosures that includes purposes of treatment, payment, or operations, you must submit a request in writing, stating a time period that is within three (3) years from the date of your request. The first accounting provided within a twelve-month period will be free. We may charge you a reasonable, cost-based fee for each future request for an accounting within a single twelve-month period.
- Receive Notification of Breach – You shall receive notifications of breaches of your unsecured protected health information.
- Obtain A Paper Copy of Notice – You may obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time by contacting Jefferson Radiology. In addition, you may obtain a copy of this Notice at our web site, www.jeffersonradiology.com.
- Complain – You may file a complaint with us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. You will not be penalized for filing a complaint and we will make every reasonable effort to resolve your complaint with you.