NOTICE OF PRIVACY PRACTICES
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.
Each time you visit or receive medical services from Southern New Hampshire Radiology Consultants, P.C. (“SNHRC”), it may be necessary for you to disclose your protected health information (“PHI”) to us in order for us to provide you with the medical services that you require. PHI includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. The federal Health Insurance Portability and Accountability Act (“HIPAA”) requires SNHRC to take steps to ensure that your PHI remains private. This notice is to inform you of the uses and disclosures of your PHI SNHRC can make without first obtaining your consent, and to inform you of your rights under HIPAA.
SNHRC must comply with all of the provisions of this notice once it comes into force on the effective date. We reserve the right to change the terms of this notice from time to time, and to make the terms of the revised notice effective for all PHI that we maintain. You can always obtain a written copy of our most current privacy notice from SNHRC`s Privacy Officer.
If you have any questions about this notice, or about your rights under HIPAA, please contact SNHRC`s Privacy Officer at 703 Riverway Place, Bedford, New Hampshire 03110, telephone (603) 627-1661, fax (603) 669-6944.
WHO MUST COMPLY WITH THESE PRIVACY PRACTICES
All SNHRC physicians and staff are required to keep your medical information confidential. We understand that you provide us with personal and private medical information about you and your health so that we may properly care for you. We are committed to protecting your information. We create a record of the care and services you receive from SNHRC. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to how we handle all of the records of your care generated by SNHRC.
SNHRC provides health care to our patients and clients in partnership with other physicians and with other professionals and organizations. The privacy practices described in this notice will be followed by:
- any healthcare professional who treats you at any of our locations;
- all employees of the departments and units of our organization; and
- any business associate or partner of SNHRC with whom we share your health information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We use health information about you for treatment, to obtain payment, and for healthcare operations such as practice administration and evaluation of the quality of care that you receive. Subject to certain requirements, we may use or disclose your PHI without your authorization only as outlined in the examples below. In any situation other than for treatment, to obtain payment, and for healthcare operations, we will ask for your written authorization before using or disclosing any of your identifyable PHI, unless the situation is one of the exceptions described below. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.
TREATMENT: Treatment is the actual provision of health care services. For example, we may provide your treating physician with the results of procedures performed. We may also provide information to other health care providers who may treat you in the future to assist in your treatment.
PAYMENT: Payment refers to actions that SNHRC may take in order to collect money that it is owed for providing you with medical services. For example, SNHRC may send a bill to you or your insurance company. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures performed on you, and supplies used.
HEALTH CARE OPERATIONS: Health care operations are the the support functions of our practice 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, SNHRC physicians, a risk or quality improvement manager, or members of a quality improvement team may use your PHI to assess the care and outcomes in your case and others like it. This information will be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
APPOINTMENT REMINDERS: SNHRC may use your PHI in order to contact you as a reminder that you have an appointment at SNHRC.
TREATMENT-RELATED PRODUCTS and HEALTH PROMOTION ACTIVITIES: SNHRC may contact you to provide information about treatment-related products or health promotion activities that may be of interest to you.
Please notify us if you do not wish to be contacted for appointment reminders, if you do not wish to receive communications about treatment-related products or health promotion activities, and we will comply with your directions.
ADDITIONAL REASONS FOR DISCLOSURE: In addition to using or disclosing your PHI for treatment, payment and health care operations, SNHRC may also use or disclose your PHI, without first obtaining your consent, for the following purposes:
- Organ and Tissue Donation. If you are an organ donor, we may release your PHI 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.
- Research. SNHRC may disclose your PHI for research purposes. We will only disclose de-identified PHI without first seeking your written authorization. De-identified PHI is PHI that cannot be attributed to any particular person. We will also seek your written authorization if the persons performing the research are involved in your care.
- Military and Veterans. If you are a member of the Armed Forces, we may release your PHI as required by military command authorities. We may also release the PHI belonging to foreign military personnel to the appropriate foreign military authority.
- Worker`s Compensation. We may release your PHI for programs that provide benefits for work-related injuries or illnesses.
- Public Health Activities. We may disclose your PHI for public health activities, including disclosures, to:
* prevent or control disease, injury or disability;
* report births and deaths;
* report child abuse or neglect;
* 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;
* notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
* 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 your PHI 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 your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if SNHRC receives 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.
- Law Enforcement. We may release your PHI 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 under certain limited circumstances;
* about a death we believe may be the result of criminal conduct;
* about criminal conduct on our premises; and
* 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 your PHI 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 your PHI about patients to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may release your PHI to authorized Federal officials for intelligence, counterintelligence, or other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose your PHI 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.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI 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.
- Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose your PHI 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.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
In all situations other than those described above, SNHRC will ask for your written authorization before using or disclosing your PHI. If you have given us your written authorization, you may revoke it at any time. If SNHRC has acted in reliance on your authorization, we will not be liable for any previous release of your PHI. However, SNHRC will not release your PHI after it receives your revocation. If you have any questions regarding authorizations, please contact the Privacy Officer.
YOUR LEGAL RIGHTS UNDER HIPAA
The federal privacy regulations give you the right to make certain requests to SNHRC regarding your PHI that SNHRC may hold. Except as noted, SNHRC is required to comply with your requests.
- You may request that we communicate with you in a certain way or at a certain location, such as by mail to your home, e-mail to your work or private account, or telephone to your business or other specified number. We will accommodate reasonable requests. Your request must be made in writing.
- You may request that we restrict the way we use or disclose health information about you in connection with healthcare operations, payment and treatment. If your request relates to disclosures to a health plan for purposes of payment or health care operations (and not for treatment purposes), and the information pertains solely to services for which we have been paid out of pocket in full, we will honor your request. Otherwise, we will consider but may not agree to honor your request. You will be required to submit your request for restrictions on the use of PHI to the Privacy Officer.
- You may request to inspect and copy your PHI that is contained in a Designated Record Set at any time, for as long as SNHRC retains your PHI. A Designated Record Set includes medical records, claims information, billing records, and any other records that SNHRC has created or used in making claim and coverage decisions that relate to you. In certain limited circumstances your request may be denied. For example, we may deny your request for psychotherapy notes; health care related information compiled in reasonable anticipation of, or for use in, any civil, criminal, or administrative action or proceeding; and any PHI that is subject to any federal law that prohibits access to that information. Your request for access to your PHI should be made in writing and addressed to the Privacy Officer. If we deny your request for access to your PHI, we will provide you with a written description of how you may exercise your rights to obtain a review of the denial.
- You may request to amend health information that is in your Designated Record Set. Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement. Your request to amend your information should be addressed to the Privacy Officer.
- You may request that we provide you with an accounting of certain disclosures of your PHI that we have made. Your request must be addressed to the Privacy Officer. We are not required to provide you with an accounting of all disclosures. For example, we are not required to account for disclosures made prior to April 14, 2003; disclosures made for the purposes of treatment, payment or health care operations as described above (unless such disclosures are made through an electronic health record on or after January 1, 2014); those made based on your written authorization; and others.
- You may request that we provide you with a copy of this notice at any time. To obtain such a copy, contact the Privacy Officer.
You may exercise any of these rights in person or through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that individual will have access to your PHI or be allowed to take any action for you. Examples of people who can act as your personal representative include: a person with a notarized power of attorney to make decisions relating to your health care; a person who has been appointed by a court order to act as your conservator or guardian; or your parent if you are a minor child. Unless your spouse has a notarized power of attorney to make health care decisions on your behalf, your spouse will not be able to exercise your rights on your behalf.
OUR LEGAL DUTIES
We are required by law to protect the privacy of your information, provide this notice about our information practices with respect to the information we collect and maintain about you, and follow the practices that are described in this notice. Should our information practices or policies change, we will post the revised notice on our website and in public areas within the organization. We agree to notify you if we are unable to agree to a requested restriction and to accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We will not use or disclose health information without your authorization, except as described in this notice. If there is a breach that compromises the security or privacy of your medical information, we will comply with the requirements of federal and state breach notification laws.
If you are concerned that we have violated your privacy rights, have further questions about the contents of this notice, or you disagree with a decision we made about access to your records, you may contact the Privacy Officer. You also may send a written complaint to the Secretary of U.S. Department of Health and Human Services. The Privacy Officer can provide you with the appropriate address upon request. There will be no retaliation for filing a complaint.
You may contact the Privacy Officer by mail, telephone, email or fax at:
Southern New Hampshire Radiology Consultants, P.C.
703 Riverway Place
Bedford, New Hampshire 03110
telephone: (603) 627-1661
fax: (603) 669-6944