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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.
. All our employees, Radiologists, medical staff, and volunteers.
. Any business associate or partner with whom we may share health information for the purpose of treatment, payment or health care operations.
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, and phone number.
. Information relating to your medical history.
. Your insurance information and coverage.
. Information concerning your doctor, nurse or other medical providers.
. Other personal identifying information such as age, birth date, 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.
We reasonably ensure that the personal and identifiable health information we request, use and disclose for any purpose is the minimum amount of information necessary for that purpose. 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 it will pay us for the x-ray 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.
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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. Subject to certain requirements, we may give out medical information about your without prior authorization. Examples include: 1) public health purposes, 2) law enforcement, 3) to coroners, 4) to medical examiners, 5) to military command authorities, 6) for national security activities, 7) for abuse or neglect reporting, 8) for health oversight audits or inspections, 9) for research studies, 10) for funeral arrangements, 11) for organ donation, 12) for workers' compensation purposes, and 13) for emergencies.
Our Business Associates.
We sometimes work with outside individuals and businesses that 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.
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.
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.
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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.
To exercise any of your rights, contact us in writing at:
HIPAA Privacy Officer
Mid-America Imaging LLC
1512 North Green Mount Road
O’Fallon, IL 62269
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.
If you have any complaints concerning our Privacy Policy, you may contact the U.S. Department of Health and Human Services Office for Civil Rights. You also may contact our HIPAA Privacy Officer at 1512 North Green Mount Road, O’Fallon, IL 62269.
This Privacy Policy is effective
April 14, 2003.
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