| Notice
of Privacy Practices
Medical
Imaging of Baltimore
The
Privacy Rule (164.520) requires a notice be provided to
each individual, prior to any treatment being administered
or obtaining any information from the individual. The notice
defines the rights of the patient and how this office will
use and disclose their protected health information.
This
office has always had a strong commitment to safeguard the
protected health information of patients and the written
practices reflect this standard. The principals outlined
in the Notice of Privacy Practices of this office are also
legal obligations of this practice under the Privacy Rule.
Provide
a Notice of Privacy Practice to every new patient
A
signed acknowledgement of receipt of the Notice of Privacy
Practices will be obtained prior to the first interaction
with the patient or potential patient (164.520.c.2.) after
April 14, 2003 with the exceptions noted below. For existing
patients, verification that a signed acknowledgement of
receipt has been obtained will be necessary prior to any
treatment.
- Emergencies when
it is not possible or practical to obtain one. As soon
as possible the notice will be given to the patient and
the signature of receipt obtained. Conditions must be
documented for the patient file.
- Appointments may
be made for patients referred to this office by another
health care practice and the necessary PHI may be requested
to prepare and schedule that appointment
Medical
Imaging of Baltimore
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. |
Understanding
Your MRI and/or PET/CT Health Record Information
Each
time you visit a hospital, a physician, or another health
care provider, the provider makes a record of your visit.
Typically, this record contains your health history, current
symptoms, examination and test results, diagnoses, treatment,
and plan for future care or treatment. This information,
often referred to as your medical record, serves as the
following:
- Basis for planning
your care and treatment.
- Means of communication
among the many health professionals who contribute to
your care.
- Legal document
describing the care that you received.
- Means by which
you or a third-party payer can verify that you actually
received the services billed for.
- Tool in medical
education.
- Source of information
for public health officials charged with improving the
health of the regions they serve.
- Tool to assess
the appropriateness and quality of care that you received.
- Tool to improve
the quality of health care and achieve better patient
outcomes.
Understanding
what is in your health records and how your health information
is used helps you to--
- Ensure its accuracy
and completeness.
- Understand who,
what, where, why, and how others may access your health
information.
- Make informed
decisions about authorizing disclosure to others.
- Better understand
the health information rights detailed below.
Your
Rights under the Federal Privacy Standard
Although
your health records are the physical property of Medical
Imaging of Baltimore, you have the following rights with
regard to the information contained therein:
- Request restriction
on uses and disclosures of your health information for
treatment, payment, and health care operations. “Health
care operations” consist of activities that are necessary
to carry out the operations of the provider, such as quality
assurance and peer review. The right to request restriction
does not extend to uses or disclosures permitted or required
under the following sections of the federal privacy regulations:
§ 164.502(a)(2)(i) (disclosures to you), 164.510(a)
(for facility directories, but note that you have the
right to object to such uses), or 164.512 (uses and disclosures
not requiring a consent or an authorization). The latter
uses and disclosures include, for example, those required
by law, such as mandatory communicable disease reporting.
In those cases, you do not have a right to request restriction.
The consent to use and disclose your individually identifiable
health information provides the ability to request restriction.
We do not, however, have to agree to the restriction.
If we do, we will adhere to it unless you request otherwise
or we give you advance notice. You may also ask us to
communicate with you by alternate means, and if the method
of communication is reasonable, we must grant the alternate
communication request. You may request restriction or
alternate communications on the consent form for treatment,
payment, and health care operations.
•
Obtain a copy of this notice of information
practices. Although we have posted a copy in prominent locations
throughout the facility , you have a right to a hard copy
upon request.
•
Inspect and copy your health information
upon request. Again, this right is not absolute. In certain
situations, such as if access would cause harm, we can deny
access. You do not have a right of access to the following:
•
Psychotherapy notes. Such notes consist of
those notes that are recorded in any medium by a health
care provider who is a mental health professional documenting
or analyzing a conversation during a private, group, joint,
or family counseling session and that are separated from
the rest of your medical record.
•
Information compiled in reasonable anticipation
of or for use in civil, criminal, or administrative actions
or proceedings.
•
Protected health information (“PHI”) that
is subject to the Clinical Laboratory Improvement Amendments
of 1988 (“CLIA”), 42 U.S.C. § 263a, to the extent that
giving you access would be prohibited by law.
•
Information that was obtained from someone
other than a health care provider under a promise of confidentiality
and the requested access would be reasonably likely to reveal
the source of the information.
In
other situations, we may deny you access, but if we do,
we must provide you a review of our decision denying access.
These “reviewable” grounds for denial include the following:
•
A licensed healthcare professional, such as your attending
physician, has determined, in the exercise of professional
judgment, that the access is reasonably likely to endanger
the life or physical safety of yourself or another person.
•
PHI makes reference to another person (other than a health
care provider) and a licensed health care provider has determined,
in the exercise of professional judgment, that the access
is reasonably likely to cause substantial harm to such other
person.
•
The request is made by your personal representative and
a licensed health care professional has determined, in the
exercise of professional judgment, that giving access to
such personal representative is reasonably likely to cause
substantial harm to you or another person.
For
these reviewable grounds, another licensed professional
must review the decision of the provider denying access
within 60 days. If we deny you access, we will explain why
and what your rights are, including how to seek review.
If
we grant access, we will tell you what, if anything, you
have to do to get access. We reserve the right to charge
a reasonable, cost-based fee for making copies.
•
Request amendment/correction of your health
information. We do not have to grant the request if the
following conditions exist:
•
We did not create the record. If, as in the
case of a consultation report from another provider, we
did not create the record, we cannot know whether it is
accurate or not. Thus, in such cases, you must seek amendment/correction
from the party creating the record. If the party amends
or corrects the record, we will put the corrected record
into our records.
•
The records are not available to you as discussed
immediately above.
•
The record is accurate and complete.
If
we deny your request for amendment/correction, we will notify
you why, how you can attach a statement of disagreement
to your records (which we may rebut), and how you can complain.
If we grant the request, we will make the correction and
distribute the correction to those who need it and those
whom you identify to us that you want to receive the corrected
information.
•
Obtain an accounting of nonroutine uses and
disclosures, those other than for treatment, payment, and
health care operations. We do not need to provide an accounting
for the following disclosures:
•
To you for disclosures of protected health
information to you.
•
For the facility directory or to persons
involved in your care or for other notification purposes
as provided in § 164.510 of the federal privacy regulations
(uses and disclosures requiring an opportunity for the individual
to agree or to object, including notification to family
members, personal representatives, or other persons responsible
for your care, of the your location, general condition,
or death).
•
For national security or intelligence purposes
under § 164.512(k)(2) of the federal privacy regulations
(disclosures not requiring consent, authorization, or an
opportunity to object).
•
To correctional institutions or law enforcement
officials under § 164.512(k)(5) of the federal privacy
regulations (disclosures not requiring consent, authorization,
or an opportunity to object).
•
That occurred before April 14, 2003.
We
must provide the accounting within 60 days. The accounting
must include the following information:
•
Date of each disclosure.
•
Name and address of the organization or person
who received the protected health information.
•
Brief description of the information disclosed.
•
Brief statement of the purpose of the disclosure
that reasonably informs you of the basis for the disclosure
or, in lieu of such statement, a copy of your written authorization
or a copy of the written request for disclosure.
The
first accounting in any 12-month period is free. Thereafter,
we reserve the right to charge a reasonable, cost-based
fee.
•
Revoke your consent or authorization to use or disclose
health information except to the extent that we have taken
action in reliance on the consent or authorization.
Our
Responsibilities under the Federal Privacy Standard
In
addition to providing you your rights, as detailed above,
the federal privacy standard requires us to take the following
measures:
•
Maintain the privacy of your health information,
including implementing reasonable and appropriate physical,
administrative, and technical safeguards to protect the
information.
•
Provide you this notice as to our legal duties
and privacy practices with respect to individually identifiable
health information that we collect and maintain about you.
•
Abide by the terms of this notice.
•
Train our personnel concerning privacy and
confidentiality.
•
Implement a sanction policy to discipline
those who breach privacy/ confidentiality or our policies
with regard thereto.
•
Mitigate (lessen the harm of) any breach
of privacy/confidentiality.
WE
RESERVE THE RIGHT TO CHANGE OUR PRACTICES AND TO MAKE
THE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY
IDENTIFIABLE HEALTH INFORMATION THAT WE MAINTAIN.
IF WE CHANGE OUR INFORMATION PRACTICES, WE WILL MAIL
A REVISED NOTICE TO THE ADDRESS THAT YOU HAVE GIVEN
US. |
We
will not use or disclose your health information without
your consent or authorization, except as described in this
notice or otherwise required by law.
How
to Get More Information or to Report a Problem
If
you have questions and/or would like additional information,
you may contact our privacy officer at Privacy Officer,
Medical Imaging of Baltimore, 6715 N. Charles Street , Baltimore
, Maryland 21204 or telephone 410-296-5610.
Examples
of Disclosures for Treatment, Payment, and Health Operations
·
If you give us consent, we will use your health information
for treatment.
Example:
A physician, a physician's assistant, a therapist or a counselor,
a nurse, or another member of your health care team will
record information in your record to diagnose your condition
and determine the best course of treatment for you. The
primary caregiver will give treatment orders and document
what he or she expects other members of the health care
team to do to treat you. Those other members will then document
the actions they took and their observations. In that way,
the primary caregiver will know how you are responding to
treatment.
We
will also provide your physician, other health care professionals,
or a subsequent health care provider copies of your records
to assist them in treating you once we are no longer treating
you.
·
If you give us consent, we will use your health information
for payment.
Example:
We may send a bill to you or to a third-party payer, such
as a health insurer. The information on or accompanying
the bill may include information that identifies you, your
diagnosis, treatment received, and supplies used.
·
If you give us consent, we will use your health information
for health operations.
Example:
Members of the medical staff, the risk or quality improvement
manager, or members of the quality assurance team may use
information in your health record to assess the care and
outcomes in your cases and the competence of the caregivers.
We will use this information in an effort to continually
improve the quality and effectiveness of the health care
and services that we provide.
•
Business associates: We provide some services through
contracts with business associates.
Examples
include certain diagnostic tests, a copy service to make
copies of medical records, and the like. When we use these
services, we may disclose your health information to the
business associates so that they can perform the function(s)
that we have contracted with them to do and bill you or
your third-party payer for services provided. To protect
your health information, however, we require the business
associates to appropriately safeguard your information.
·
Notification: We may use or disclose information
to notify or assist in notifying a family member, a personal
representative, or another person responsible for your care,
your location, and general condition.
·
Communication with family: Unless you object,
health professionals, using their best judgment, may disclose
to a family member, another relative, a close personal friend,
or any other person that you identify health information
relevant to that person's involvement in your care or payment
related to your care.
·
Research: We may disclose information to researchers
when their research has been approved by an institutional
review board that has reviewed the research proposal and
established protocols to ensure the privacy of your health
information.
·
Funeral directors: We may disclose health information
to funeral directors consistent with applicable law to enable
them to carry out their duties.
·
Marketing/continuity of care: We may contact
you to provide appointment reminders or information about
treatment alternatives or other health-related benefits
and services that may be of interest to you.
·
Food and Drug Administration (“FDA”): We may
disclose to the FDA health information relative to adverse
effects/events with respect to food, drugs, supplements,
product or product defects, or postmarketing surveillance
information to enable product recalls, repairs, or replacement.
·
Workers compensation: We may disclose health
information to the extent authorized by and to the extent
necessary to comply with laws relating to workers compensation
or other similar programs established by law.
·
Public health: As required by law, we may disclose
your health information to public health or legal authorities
charged with preventing or controlling disease, injury,
or disability.
·
Correctional institution: If you are an inmate
of a correctional institution, we may disclose to the institution
or agents thereof health information necessary for your
health and the health and safety of other individuals.
·
Law enforcement: We may disclose health
information for law enforcement purposes as required by
law or in response to a valid subpoena.
·
Health oversight agencies and public health authorities:
If a member of our work force or a business associate
believes in good faith that we have engaged in unlawful
conduct or otherwise violated professional or clinical standards
and are potentially endangering one or more patients, workers,
or the public, they may disclose your health information
to health oversight agencies and/or public health authorities,
such as the department of health.
·
The federal Department of Health and Human Services
(“DHHS”): Under the privacy standards, we must disclose
your health information to DHHS as necessary to determine
our compliance with those standards.
Effective
date: April 14, 2003
Signature:
/s/ Lisa Lucido
Title:
Facility Administrator
Name
of entity: Medical Imaging of Baltimore
|
