HIPAA NOTICE OF
This notice describes how medical information about you may be used and disclosed and how you can get access to the information.
Please review it carefully.
This notice is effective as of September 23, 2013.
The Zwanger-Pesiri Radiology Group understands that your medical information is private and confidential. We are required by law to maintain the privacy of “protected health information.” “Protected health information” includes any individually identifiable information that we obtain from you or others that relate to your past, present or future physical or mental health, the health care you have received, or payment for your health care.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of your protected health information. We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always request a written copy of our most current privacy notice from Zwanger-Pesiri Radiology Group’s Privacy Officer at (631) 225-7200, ext 4333.
PERMITTED USES & DISCLOSURES
We can use or disclose your protected health information for purposes of treatment, payment, and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every particular use of disclosure in every category will be listed.
Treatment means the provision, coordination or management of your health care, including consultations between health care providers regarding your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate to your care.
Payment means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage, and utilization review activities. For example, prior to providing health care services, we may need to provide information to your Third Party Payor about your medical condition to determine whether the proposed course of treatment will be covered. When we subsequently bill the Third Party Payor for the services rendered to you, we can provide the Third Party Payor with information regarding your care if necessary to obtain payment. Federal or State law may require us to obtain a written release from you prior to disclose certain specially protected health information for payment purposes, and we will ask you to sign a release when necessary under applicable law.
Health care operations means the support functions of the Zwanger-Pesiri Radiology Group related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient comments and complaints, physician reviews, compliance programs, audits, business planning, development, management, and administrative activities. For example, we may use your protected health information and information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. In addition, we may remove information that identifies you from your patient information so that others can use the de-identified information to study health care and health care delivery without learning who you are.
OTHER USES & DISCLOSURES OF PROTECTED HEALTH INFORMATION
In addition to using and disclosing your information for treatment, payment, and health care operations, we may use your protected health information in the following ways:
i. We may contact you to provide appointment reminders for treatment or medical care.
ii. We may contact you to tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be of interest to you.
iii. We may disclose to your family or friends or any other individual identified by you, protected health information directly relevant to such person’s involvement with your care or payment for your care. We may use or disclose your protected health information to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care of your location, general condition, or death. If you are present or otherwise available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not present or otherwise available, we will determine whether a disclosure to your family or friends in your best interest, taking into account the circumstances and based upon our professional judgment.
iv. When permitted by law, we may coordinate our uses and disclosures of protected health information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
v. We will allow your family and friends to act on your behalf to pick up radiologic films, reports, related supplies, and other forms of protected health information when we determine, in our professional judgment, that it is in your best interest to make such disclosures.
vi. We may contact you as part of our efforts to market the Zwanger-Pesiri Radiology Group’s services as permitted by applicable law.
vii. Subject to applicable law, we may make incidental uses and disclosures of protected health information. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
viii. We may use or disclose your protected health information for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. All research projects are subject to a special approval process, which balances research needs with a patient’s need for privacy. When required, we will obtain a written authorization from you prior to using your health information for research.
ix. We will use or disclose protected health information about you when required to do so by applicable law. Note: In accordance with applicable law, we may disclose your protected health information to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workspace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the Zwanger-Pesiri Radiology Group as required by applicable law.
Subject to the requirements of applicable law, we will make the following uses and disclosures of your protected health information:
Organ and Tissue Donation
If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the Armed Forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
We may release health information about you for programs that provide benefits for work-related injuries or illnesses.
Public Health Activities
We may disclose health information about you for public health activities, including disclosures:
i. To prevent or control disease, injury or disability;
ii. To report births and deaths;
iii. To persons subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to the quality, safety, or effectiveness of FDA-regulated products or services and to report reactions to medications or problems with products;
iv. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
To notify the appropriate government authority if we believe that an adult patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if the patient agrees or when required or authorized by law.
Health Oversight Activities
We may disclose health information to Federal or State agencies that oversee our activities. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws or regulatory program standards.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if the Zwanger-Pesiri Radiology Group is given assurances that efforts have been made by the person making the request to tell you about the request or to obtain an order protecting the information requested.
We may release health information if asked to do so by a law enforcement official:
i. In response to a court order, subpoena, warrant, summons, or similar process;
ii. To identify or locate a suspect, fugitive, material witness, or missing person;
iii. About the victim of a crime under certain limited circumstances;
iv. About a death we believe may be the result of criminal conduct;
v. About criminal conduct on our premises;
vi. In emergency circumstances, to report a crime, the location of the crime or the victims, or the identity, description, or location of the person who committed the crime.
Coroners, Medical Examiners, and Funeral Directors
We may release health information to a coroner or medical examiner. Such disclosures may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties. Protected health information does not include health information of a person who has been deceased for more than 50 years.
National Security and Intelligence Activities
We may release health information about you to authorized Federal officials for intelligence, counterintelligence, or other national security activities authorized by law.
Protective Service for the President and Others
We may disclose health information about you to authorized Federal officials so they may provide protection to the President or other authorized persons or foreign heads of state or may conduct special investigations.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care, (2) to protect your health and safety or the health and safety of others, or (3) for the safety and security of the correctional institution.
As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
Note: HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records and other specially protected health information may enjoy certain special confidentiality protections under applicable State and Federal law. Any disclosures of these types of records will be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of protected health information not covered by this notice will be made only with your permission in a written authorization. The following uses and disclosures will be made only with your authorization:
i. Uses and disclosures for marketing purposes;
ii. Use and disclosures that constitute the sale of protected health information;
iii. Most uses and disclosures of psychotherapy notes (if the practice maintains psychotherapy notes); and
iv. Other uses and disclosures not described in the Notice.
You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
1. You have the right to request restrictions on our uses and disclosures of protected health information for treatment, payment, and health care operations. However, we are not required to agree to your request. To request a restriction, you must make your request in writing to the Zwanger-Pesiri Radiology Group’s Privacy Officer. However, if you request us to restrict disclosures to health plans that we would normally make as part of payment or health care operations, we must agree to that restriction if the protected health information relates to health care which you have paid out of pocket in full.
2. You have the right to reasonably request to receive confidential communications of protected health information by alternative means or at alternative locations. To make such a request, you must submit your request in writing to the Zwanger-Pesiri Radiology Group’s Privacy Officer.
3. You have the right to inspect and copy the protected health information contained in your medical and billing records and in any other Zwanger-Pesiri Radiology Group records used by us to make decisions about you, except:
i. For psychotherapy notes, which are notes that have been recorded by a mental health professional documenting or analyzing the contents of conversations during a private counseling session or a group, joint, or family counseling session and that have been separated from the rest of your medical record;
ii. For information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding;
iii. For protected health information involving laboratory tests when your access is restricted by law;
iv. If you are a prison inmate, obtaining a copy of your information may be restricted if it would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, or the safety of any officer, employee, or other person at the correctional institution or person responsible for transporting you;
v. If we obtained or created protected health information as part of a research study, your access to the health information may be restricted for as long as the research is in progress, provided that you agreed to the temporary denial or access when consenting to participate in the research;
vi. For protected health information contained in records kept by a Federal agency or contractor when your access is restricted by law; and
vii. For protected health information obtained from someone other than us under a promise of confidentiality when the access requested would be reasonably likely to reveal the source of the information.
In order to inspect and copy your health information, you must submit your request in writing to the Zwanger-Pesiri Radiology Group’s Privacy Officer. If you request a copy of your health information, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request. We may also deny request for access to protected health information if:
A licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger your life or physical safety or that of another person;
The protected health information makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person; or
The request for access is made by the individual’s personal representative and a licensed health care professional has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to you or another person.
If we deny a request for access for any of the three reasons described above, then you have the right to have our denial reviewed in accordance with the requirements of applicable law.
4. You have the right to request an amendment to your protected health information, but we may deny your request for amendment, if we determine that the protected health information or record that is the subject of the request:
i. was not created by us, unless you provide a reasonable basis to believe that the originator of the protected health information is no longer available to act on the requested amendment;
ii. is not part of your medical or billing records or other records used to make decisions about you;
iii. is not available for inspection as set forth above; or
iv. is accurate and complete.
In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your health information, you must submit your request in writing to the Zwanger-Pesiri Radiology Group’s Privacy Officer, along with a description of the reason for your request.
5. You have the right to receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you for the six years prior to your request, except for disclosures:
i. to carry out treatment, payment, and health care operations as provided above;
ii. incident to a use or disclosure otherwise permitted or required by applicable law;
iii. pursuant to a written authorization obtained from you;
iv. to persons involved in your care or for other notification purposes as provided by law;
v. for national security or intelligence as provided by law;
vi. to correctional institutions or law enforcement officials as provided by law;
vii. as part of a limited data set as provided by law; or
viii. that occurred prior to April 14, 2003.
To request an accounting of disclosures of your health information, you must submit your request in writing to the Zwanger-Pesiri Radiology Group’s Privacy Officer. Your request must state a specific time period for the accounting (e.g., the past three months). The first accounting you request within a twelve (12) month period will be free. For additional accountings, we may charge you for the cost of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
6. You have the right to electronic copies of your protected health information when requested. Where information is not readily producible in the form and format requested, the information must be provided in an alternative readable electronic format as agreed to by you and Zwanger-Pesiri Radiology Group may charge a reasonable cost based fee for labor in copying protected health information and postage where you request that information be transmitted via mail or courier.
7. You have the right to opt out of fundraising communications (if Zwanger-Pesiri Radiology Group conducts fundraising).
8. You have the right to receive notice in the event of a breach of unsecured protected health information. This means that you will receive notice if a breach of your protected health information is discovered within 60 days of discovery.
If you believe that your privacy rights have been violated, you should immediately contact the Zwanger-Pesiri Radiology Group’s Privacy Officer. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services.
If you have any questions or would like further information about this notice, please contact Dan Van Vorst, the Zwanger-Pesiri Radiology Group’s Privacy Officer, at
(631) 225-7200, ext 4333.