NORTHSIDE RADIOLOGY ASSOCIATES, P.C.
NOTICE OF PRIVACY PRACTICES
Northside Radiology Assocites, P.C. is committed to protecting your privacy and understands the importance of safeguarding your medical information. We are required by federal law to maintain the privacy of health information that identifies you or that could be used to identify you, known as “protected health information”.
This Notice of Privacy Practices describes how Northside Radiology Associates, P.C. (“we”) may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition, your health care, and payment for such past, present or future health care. We are required by federal law, the Health Insurance Portability and Accountability Act (“HIPAA”), to maintain the privacy of your health information and to provide you with this Notice which describes our legal duties and privacy practices regarding your protected health information.
We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice and to apply the revised Notice to all protected health information we maintain, including to information created or received before the Notice was changed. You have the right to request and receive a copy of this Notice. A copy of this Notice may be obtained by accessing our website,www.NorthsideRadiology.com, or by calling our office at (404) 252-4709 and requesting that the current Notice be sent to you in the mail, by e-mail or by fax. This Notice is also available at our office, and you can also ask for a copy at the time of your next appointment. You can obtain a copy of any revised Notice by visiting our website, visiting our office, contacting the Privacy Officer in writing or by phone, or by asking for a copy when you receive services from us.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We may use and disclose PHI in the ways summarized below.
Your protected health information may be used and disclosed by Northside Radiology Associates, P.C., our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.
Following are examples of the types of routine uses and disclosures of your protected health information that our office is permitted to make without your specific authorization or consent. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.
Treatment: We may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, we may disclose your protected health information, as necessary, to your primary care physician or specialist who has referred you to us. We may also disclose protected health information to other physicians or health care providers who may be treating you or are involved in your care. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information may be used and disclosed, as needed, to obtain payment for the health care services we provide you. We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, a bill may be sent to you or your insurance company for payment. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. This may also include activities your insurance company may undertake before it approves or pays for the health care services we recommend or perform for you such as determining your eligibility for coverage or medical necessity for the treatment. For example, obtaining an approval for a MRI diagnostic study may require that your relevant protected health information, such as name and diagnosis, be disclosed to the insurance company to obtain approval to perform the MRI.
Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities and operations of our physicians’ practice. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and time of arrival. We may also call you by name in the waiting room when your physician is ready to see you or when it is time to perform your test or procedure. Additionally, we may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. Health care operations activities also include, but are not limited to, quality assessment activities, practice accreditation, performance evaluations of our employees, billing, and licensing, marketing, legal advice, accounting support and conducting or arranging for other business activities.
We may also share your protected health information with third party “business associates” that perform various activities (e.g. billing, transcription services) for the practice. “Business associates” under HIPAA have written contracts that contain specific assurances regarding privacy and security of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or expanded services that may be of interest to you. For example, your name and address may be used to send you a newsletter or brochure about our practice and the services we offer. You may contact our Privacy Officer to request that these materials not be sent to you or sent to you by alternative means.
Finally, we may use or disclose your personal health information in the course of performing quality improvement activities. For example, members of our staff may use information in your health record to assess the care and results or outcomes in your case and others like it for quality improvement activities.
Others involved in your healthcare: Unless you object, we may disclose to a person named in your advance directive or Durable Power of Attorney for Health Care (if you have one), a member of your family, a relative, a close friend or any other person you identify, orally or in writing, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure because of incapacity or emergency treatment circumstances, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information, such as regarding your location or general condition, to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.
Required by the Secretary of the Department of Health and Human Services: We may be required to disclose your protected health information to the Secretary of the Department of Health and Human Services (“Secretary”) to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information.
Required by Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
Public Health Activities: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, as permitted by HIPAA’s public health provisions, regarding a workplace injury or illness.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency, such as Medicare, Medicaid, Department of Health and Human Services or Office of Civil Rights for activities authorized by law, such as audits, inspections, investigations, and licensure activities. Oversight agencies include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse and Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such reports. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations; track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal, under certain conditions in response to a subpoena, discovery request or other lawful process, and according to Georgia state law.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. We may also disclose protected health information to law enforcement authorities as permitted by HIPAA, such as to locate or apprehend an individual or report a crime.
Decedents (Coroners Medical Examiners, Funeral Directors): We may disclose a deceased patient’s protected health information as authorized by federal and state law, including based on the signed authorization of the estate’s personal representative (executor or court appointed administrator). We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may disclose protected health information to funeral directors as necessary for them to carry out their duties.
Organ, Eye and Tissue Donation: If you are an organ donor, and as permitted by HIPAA, we may disclose your protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to aid in its organ or tissue donation and transplantation process.
Research: We may disclose your protected health information for research purposes when such research has been approved by an institutional review board or privacy board that has reviewed the research project and established protocols to address and ensure the privacy of your protected health information.
Avert a Serious Threat to Health or Safety: We may disclose your protected health information if we believe that disclosing such information is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is made to someone we reasonably believe is able to prevent or lessen the threat.
Specialized Government Functions (Military and Veterans and National Security and Intelligence Activities): As permitted by HIPAA, we may disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including providing protective services to the President.
Workers Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement officer, we may use or disclose your protected health information to the correctional institution or a law enforcement officer as permitted by HIPAA.
Business Associates. We may disclose your protected health information to our Business Associates, which are persons or entities that assist us in providing services to you. Business Associates have written agreements with us which contain specific assurances for the privacy and security of your protected health information.
Personal Representatives. We may use or disclose your protected health information to persons who are authorized by law to make health care decisions for you.
Organized Health Care Arrangements. As permitted by HIPAA, we may use or disclose your protected health information in an integrated clinical setting or organized health care system where you receive services.
Note: Georgia and/or Federal law provide additional protections for certain types of health information, including regarding alcohol or drug abuse, mental health, genetics and HIV/AIDS, and these laws may limit how and whether we disclose this information about you to others.
Marketing. We must obtain your written authorization to use and disclose your protected health information for most marketing purposes.
Sale of Protected Health Information. We must obtain your written authorization for any disclosure of your protected health information which constitutes a sale of protected health information.
Any other uses and disclosures of your protected health information not described in this Notice will be made only with your written authorization. You may revoke a signed authorization at any time in writing, except to the extent that we have already relied on the authorization.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. Please submit any such requests in writing to the Privacy Officer at the following address: 5775 Glenridge Dr. Suite 525, Bldg B, Atlanta, GA. 30328. You may also call the Privacy Officer at (404) 252-4709 if you have any questions regarding these rights.
You have the right to inspect and request a copy of your protected health information.This means you may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information. We are required to provide you access to such protected health information for inspection and copying within 30 days after receipt of your request (with up to a 30-day extension if needed). A “designated record set” contains medical and billing records that your physician and the practice use for making decisions about you. Please note there may be a reasonable cost-based fee associated with completing your request, such as copying costs.
In certain situations that are defined by law, we may deny your request. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your protected health information.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request, except as explained below. If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If we do agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. Please discuss any restriction you wish to request with our Privacy Officer.
You also have the right to request that we restrict disclosure of your protected health information to your health plan, if the disclosure is for purposes of payment or health care operations, is not required by law, and the protected health information pertains only to a health care item or service for which you or another person has paid in full out of pocket. We are required to agree to this restriction.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. This request must be in writing and we will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.
You may have the right to request an amendment of your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. We will respond to your request within 60 days (with up to a 30-day extension if needed). In certain cases, we may deny your request for an amendment. If we deny your request for amendment, we will send you a written explanation and allow you to file a statement of disagreement with the Privacy Officer. We may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal.
You have a right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies only to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. This right also does not apply to disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You must specify a time period for the accounting, which may not be longer than 6 years and cannot include any date before April 14, 2003. You may request a shorter timeframe. You have the right to one free request within any 12-month period, but we may charge you for any additional requests in the same 12-month period. We will notify you about any such charges, and you are free to withdraw or modify your request in writing before any charges are incurred. We will respond to your request within 60 days (with up to a 30-day extension if needed). The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to receive notifications of a breach of unsecured protected health information if you are an affected individual, as required by HIPAA.
You have the right to obtain a paper copy of this Notice from us at any time upon request, including if you previously agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.
You have the right to opt out of receiving fundraising communications from us. We may contact you for fundraising purposes. You have the right to opt out of receiving these communications.
COMPLAINTS AND CONCERNS
You may submit a complaint to us and/or to the Secretary of the United States Department of Health and Human Services (HHS) 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 at 5775 Glenridge Dr. Suite 525, Bldg B, Atlanta, GA. 30328. You may contact our Privacy Officer at (404) 252-4709 for further information, including about any concerns or questions you may have, or about the complaint process. We will not retaliate against you for filing a complaint.
You may visit the following website for information on filing a complaint with (HHS):http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. You may also file a complaint by mail to Regional Manager, Office of Civil Rights, HHS, Sam Nunn Atlanta Federal Center, Suite 16T70, 61 Forsyth Street, SW, Atlanta, GA 30303-8909. You may also contact HHS by phone at 800-368-1019.
This Notice was published and first became effective on April 14, 2003.