NOTICE OF PRIVACY PRACTICES
Effective Date:
April 14, 2003.
THIS
NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect patient confidentiality and will only release
your personal health information in accordance with NY State
and Federal laws. This notice describes our policies related
to the use of your personal health information records generated
by Radiology Associates Of New Hartford.
Privacy Contact If you have any questions about this policy
or your rights contact our Privacy Compliance Coordinator
at 315-793-8806.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide care, there are instances
in which we need to share your Personal Health Information
(PHI) with others beyond Radiology Associates Of New Hartford.
With your permission, we may use or disclose PHI about you.
These instances may include:
Treatment
We may disclose your personal health information(PHI) to
provide, coordinate, or manage your care or any related
services, including sharing information with others outside
Radiology Associates Of New Hartford with whom we are consulting
or referring.
Payment
We may disclose your PHI to obtain payment for the treatment
and services provided. This may include contacting your
health insurance company for prior approval of planned treatment
or for billing purposes.
Healthcare
Operations We may disclose your PHI to coordinate
healthcare operations. This may include setting up appointments,
reviewing your care and training staff.
INFORMATION
DISCLOSED WITHOUT YOUR CONSENT: Under State
and Federal law, your PHI may be disclosed without your
consent in the following circumstances:
Medical
Emergencies Sufficient information may be shared
to address an immediate emergency situation that you may
encounter.
Follow
Up Appointments/Care We may contact you regarding
appointment changes or other health-related instances that
may arise in your care with us.
As
Required by Law This includes situations which
require disclosure of your PHI for a subpoena, court order,
or a mandate to provide public health information, such
as communicable diseases or suspected abuse and neglect
such as child abuse, elder abuse, or institutional abuse.
Coroners,
Funeral Directors We may disclose PHI to a
coroner or personal health examiner and funeral directors
for the purposes of carrying out their duties.
Governmental
Requirements We may disclose information to
government agencies for activities authorized by law, such
as audits, investigations, inspections and national security
issues. There may be a need to share your information with
the Food and Drug Administration in relation to adverse
events or product defects. We are also required to share
information, if requested, with the Department of Health
and Human Services to determine our compliance with Federal
laws related to health care.
Criminal
Activity or Danger to Others Information about
you may also be disclosed when necessary to prevent a serious
threat to your health and safety or the health and safety
of others.
PATIENT
RIGHTS: You have the following rights under
NY State and Federal law:
Copy
of Records You are entitled to inspect the
personal health record Radiology Associates Of New Hartford
has generated about you. We may charge you a reasonable
fee for copying and mailing your record.
Release
of Records You may consent in writing to the
release of your records to others, for any purpose you choose.
This may include your attorneys, employers, or others who
you wish to have knowledge of your care. You may revoke
this consent at any time, but only to the extent no action
has been taken in reliance on your prior authorization.
Any revocation must be in writing.
Restriction
on Record You may ask us not to use or disclose
all or part of your PHI. This request must specify any and
all restrictions in writing. Radiology Associates of New
Hartford is not required to agree to your request if we
believe it is in your best interest to permit use and disclosure
of the information. The request should be given to the HIPAA
Coordinator who will consult with the staff involved in
your care to determine if the request can be granted.
Patient Contact You may request
that we send information to an alternative address or by
alternative means. You may also request limits on disclosure
of information to those involved with your care. Limitation
requests must be specified in writing. We have the right
to verify that the payment information you provide us is
correct. It is our policy not to provide information by
email.
Amending
Record If you believe that something in your
record is incorrect or incomplete, you may request that
it be amended. To amend your record, contact the HIPAA Coordinator
and ask for a Request to Amend Health Information form.
In certain instances, we may deny this request. If we deny
your request for an amendment, you have a right to file
a statement that you disagree with us. We will then file
our response and your statement and our response will be
added to your record.
Accounting
for Disclosures You may request a listing of
any disclosures we have made related to your PHI. Exceptions
to this disclosure policy include information used in your
treatment, payment information and our health care operations.
Information shared with you or your family, or information
that you have given specific consent to release falls into
this exceptions category. It also excludes information required
for release to government or law enforcement agencies. To
receive information regarding disclosure made for a specific
time period no longer than six years and after April 14,
2003, please submit your request in writing to our Privacy
Coordinator. We will notify you of the cost involved in
preparing this list.
Questions
and Complaints If you have questions or have
complaints, you may contact our Privacy Coordinator, in
writing, at 185 Genesee Street, Suite 600, Utica, NY 13501.
You also may contact the Secretary of Health and Human Services
if you believe Radiology Associates Of New Hartford has
violated your privacy rights. You will not be subject to
negative actions should you decide to file a complaint.
Changes
in Policy Radiology Associates Of New Hartford
reserves the right to change its Privacy Policy based on
the needs of this practice and changes in state and federal
law.
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