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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.
This notice describes the privacy practices of:
• River Radiology PLLC (“RR”)
• Ulster Radiologic Associates, P.C. (“URA”)
• Comprehensive Support Services, L.L.C. (“CSS”)
We understand that medical information about you and your
health is personal. We are committed to protecting the privacy
of medical information about you. We create a record of
the care and services you receive from us. We need this
record to provide you with quality care and to comply with
certain legal requirements. This notice applies to all of
the records of your care generated by RR, URA, or CSS. Your
personal doctor may have different policies or notices regarding
the doctor’s use and disclosure of your medical information
created in the doctor’s own office or clinic. This
notice will tell you about the ways in which we may use
and disclose medical information about you. We also describe
your rights and certain obligations we have regarding the
use and disclosure of medical information.
We are required by law to:
• make sure that medical information that identifies
you is kept private;
• give you this notice of our legal duties and privacy
practices with respect to medical information about you;
and
• follow the terms of the notice that is currently
in effect.
The following categories describe different ways that we
use and disclose medical information. For each category
of uses or disclosures we will explain what we mean and
try to give some examples. Not every use or disclosure in
a category will be listed. However, all of the ways we are
permitted to use and disclose information will fall within
one of the categories.
We may
record in your medical record medical information about
you and we may use this medical information to provide you
with medical treatment or services. We may disclose medical
information about you to your personal doctors, hospitals,
nurses, technicians, medical students, or other health care
personnel who are involved in taking care of you. This information
is necessary for these health care providers to determine
what medical treatment you should receive. We also may disclose
medical information about you to people who may be involved
in your medical care, such as family members in certain
circumstances, or other medical providers who will provide
services that are part of your care.
We may
use and disclose medical information about you so that the
treatment and services you receive from us may be billed
to and payment may be collected from you, an insurance company
or a third party. For example, we may need to give your
health plan information about tests we provided to you so
your health plan will pay us or reimburse you for the test.
We may also tell your health plan about a test or treatment
you are going to receive in order to obtain prior approval
or to determine whether your plan will cover the test or
treatment.
.
We may use and disclose medical information about you for
our operations. These uses and disclosures are necessary
to run RR, URA, or CSS, and make sure that all of our patients
receive quality care. For example, we may use medical information
about you to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also
combine medical information about many patients to decide
what additional services we should offer, what services
are not needed, and whether certain new tests or treatments
are effective. We may also disclose information to doctors,
nurses, technicians, medical students, and other personnel
for review and learning purposes. We may also combine the
medical information we have with medical information from
other medical providers to compare how we are doing and
see where we can make improvements in the quality of care
and services we offer.
We may use and disclose medical information to contact you
as a reminder that you have an appointment for a test or
treatment at RR, URA, or CSS.
. We may use and disclose
medical information to tell you about or recommend possible
treatment options or alternatives or health-related benefits
or services that may be of interest to you.
Unless you object, we may disclose to
a family member, other relative, close personal friend or
persons you identify information that is relevant to that
person’s involvement in your care or payment related
to your care. We may use or disclose information to assist
in notifying a family member, personal representative or
other person responsible for your care, information about
your location and general condition.
We may use or disclose medical information about you to
workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
If you are an
organ donor, we may release medical information about you
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.
We may release
medical information about you to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased
person or determine the cause of death.
Under certain
circumstances, we may use and disclose medical information
about you for research purposes. For example, a research
project may involve comparing the health and recovery of
all patients who received one test or treatment to those
who received another, for the same condition. All research
projects, however, must be approved by a privacy board that
has reviewed the research proposal and established protocols
to ensure the privacy of your medical information. We may
also disclose medical information about you to people preparing
to conduct a research project, for example, to help them
look for patients with specific medical needs, so long as
the medical information they review does not leave the RR,
URA, or CSS.
We may disclose medical information about you for public
health activities. These activities generally include the
following:
to prevent or control
disease, injury or disability;
to
report deaths;
to report child abuse
or neglect;
to report reactions
to medications or problems with products;
to notify people of
recalls of products they may be using;
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 a patient has been the
victim of abuse, neglect or domestic violence. We will only
make this disclosure if you agree or when required or authorized
by law.
We may disclose
medical information to a health oversight agency for activities
authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor
the health care system, government programs, and compliance
with civil rights laws.
We may use and disclose medical
information about you when necessary to prevent a serious
threat to the health and safety of you or another person.
Any disclosure, however, would only be to someone able to
help prevent the threat.
We
will disclose medical information about you when required
to do so by federal, state or local law.
If
you are involved in a lawsuit or a dispute, we may disclose
medical information about you in response to a court or
administrative order. We may also disclose medical information
about you in response to a subpoena, discovery request,
or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you
about the request or to obtain an order protecting the information
requested.
We
may release medical information about you if asked to do
so by a law enforcement official:
In
response to a court order, subpoena, warrant, summons or
similar process;
To
identify or locate a suspect, fugitive, material witness,
or missing person;
About the victim of
a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement;
About a death we believe
may be the result of criminal conduct;
About criminal conduct
at RR, URA, or CSS; and
In emergency circumstances
to report a crime; the location of the crime or victims;
or the identity, description or location of the person who
committed the crime.
If you are a member of the armed forces, we may release
medical information about you as required by military command
authorities. We may also release medical information about
foreign military personnel to the appropriate foreign military
authority.
We may release
medical information about you to authorized federal officials
for intelligence, counterintelligence, and other national
security activities authorized by law and for protective
services for certain public and foreign officials.
If you are
an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement
official. This release would be necessary (1) for the correctional
institution to provide you with health care; (2) to protect
the health and safety of you or other inmates; or (3) for
the safety and security of the correctional institution.
Other uses and disclosures of medical information not covered
by this notice or the laws that apply to us will be made
only with your written permission. If you provide us permission
to use or disclose medical information about you, you may
revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose
medical information about you for the reasons covered by
your written authorization, except to the extent that action
has already been taken by RR, URA, or CSS.
You have the following rights regarding medical
information we maintain about you:
You have the right to inspect and copy medical information
that may be used to make decisions about your care. Usually,
this includes medical and billing records. To inspect and
copy medical information that may be used to make decisions
about you, you must submit your request in writing to the
Privacy Officer. If you request a copy of the information,
we may charge a reasonable fee for the costs of copying,
mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain
very limited circumstances. If you are denied access to
medical information, you may request that the denial be
reviewed. Another licensed health care professional chosen
by RR, URA, or CSS will review your request and the denial.
The person conducting the review will not be the person
who denied your request. We will comply with the outcome
of the review.
If you
feel that medical information we have about you is incorrect
or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as
the information is kept by RR, URA, or CSS. To request an
amendment, your request must be made in writing and submitted
to the Privacy Officer. In addition, you must provide a
reason that supports your request. We may deny your request
for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny
your request if you ask us to amend information that:
Was
not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
Is not part of the medical
information kept by or for RR, URA, or CSS;
Is
not part of the information that the law permits you to
inspect and copy; or
Is accurate and complete.
You have the right to request an accounting of disclosures
of your protected health information. This accounting is
a list of certain disclosures we made of medical information
about you for reasons other than treatment, payment and
healthcare operations. To request this accounting of disclosures,
you must submit your request in writing to the Privacy Officer.
Your request must state a time period which may not be longer
than six years, and may not include dates before April 14,
2003. Your request should indicate in what form you want
the accounting (for example, on paper, electronically).
We may charge you for the costs of providing the accounting.
We will notify you of the cost involved and you may choose
to withdraw or modify your request at that time before any
costs are incurred.
You have the right to request a restriction or limitation
on the medical information we use or disclose about you
for treatment, payment or health care operations. You also
have the right to request a limit on the medical information
we disclose about you to someone who is involved in your
care or the payment for your care, like a family member
or friend. For example, you could ask that we not use or
disclose information about a procedure you had.
We are not required to agree to your request.
If we do agree, we will comply with your request unless
the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing
to the Privacy Officer. In your request, you must tell us
(1) what information you want to limit; (2) whether you
want to limit our use, disclosure or both; and (3) to whom
you want the limits to apply, for example, disclosures to
your spouse.
You have the right to request that
we communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask that
we only contact you at work or by mail. To request confidential
communications, you must make your request in writing to
the Privacy Officer. We will not ask you the reason for
your request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
You have the right to a paper copy of this
notice. You may ask us to give you a copy of this notice
at any time. Even if you have agreed to receive this notice
electronically, you are still entitled to a paper copy of
this notice. You may obtain a paper copy of this notice
by contacting the Privacy Officer.
We reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective for
medical information we already have about you as well as
any information we receive in the future. We will post a
copy of the current notice in all RR, URA and CSS offices.
The notice will contain on the first page, under the title
of this document, the effective date. If we revise our notice,
we will provide you with a revised copy the next time that
you come to RR, URA, or CSS for services.
If you have any questions about this notice or wish to request
further information, contact the Privacy Officer listed
below. If you believe your privacy rights have been violated,
you may file a complaint with our Privacy Officer or with
the Secretary of the Department of Health and Human Services.
All complaints must be submitted in writing. We
will not retaliate against you in any way for filing a complaint.
Privacy Officer
Debra Decker
45 Pine Grove Avenue
Kingston, New York 12401
(845) 340-4500 (Extension 1134)
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