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SUMMARY NOTICE OF PRIVACY PRACTICES
This notice
describes how medical information about patients may be used and
disclosed and how they can get access to this information.
If you
have any questions about this Notice,
please
contact:
John Ising: Administrator
(816) 561-5858 - Fax: (816) 561-1014
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information
about you and your health is personal and we are committed to protecting
it. We create a record of the care and services you receive at our
organization 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 our organization, whether made by our
employees or your physician. Private physician offices may have
different policies or notices regarding the physician's use and
disclosure of your medical information created in the physician's
office.
The law requires us 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.
WHO WILL FOLLOW THIS NOTICE:
This notice describes Medical
Plaza Imaging Associations' practices and that of:
- Any health care professional
authorized to enter information into your medical record.
- All departments within our organization.
- All employees, volunteers, and
physicians.
HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION ABOUT YOU:
The following are examples of
the types of uses and disclosures of your protected health information
that our organization is permitted to make.
For Treatment -
We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about
you to doctors, nurses, technicians, medical students, or other
employees who are involved in taking care of you. We will also provide
your physician or a subsequent healthcare provider with copies of
various reports that should assist him or her in treating you.
For Payment -
We may use and disclose medical information about you so that that
the treatment and services you receive may be billed to and payment
may be collected from you, an insurance company or a third party
payer. Unless a restriction is requested, the guarantor/responsible
party will have access to information created during the episode
of treatment.
For Healthcare Operations
- We may use and disclose medical information
about you for healthcare operations. These uses and disclosures
include the following: quality assessment and improvement activities;
reviewing competence or qualifications of healthcare professionals;
reviews by external agencies for licensure, accreditation, or auditing.
For Other Benefits and Services
- We may use or disclose your protected
health information, as necessary, to provide you with information
about treatment alternatives or other health-related benefits and
services that may be of interest to you. We may also use and disclose
your protected health information for other activities, such as
to send you a newsletter about our practices and the services we
offer.
OTHER PERMITTED OR REQUIRED
USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION
OR OPPORTUNITY TO OBJECT
We may use and disclose your protected
health information in the following instances:
Individuals Involved in Your
Healthcare - We will only disclose to
to a member of your family, a relative, a close friend, or any other
person you identify, your protected health information that directly
relates to that person's involvement with your healthcare. You will
be asked to provide the names of these individuals. Any individuals
you identify that will be receiving information about you over the
phone must provide your date of birth and social security number.
If you are unable to agree or object to such a disclosure, we may
disclose such information as necessary if we determine that it is
in your best interest based on our professional judgement.
Disaster Relief - Finally,
we may disclose your protected health information to an authorized
public or private entity to assist in disaster relief efforts and
to coordinate uses and disclosures to family or other individuals
involved in your healthcare.
Emergencies -
We may use or disclose your protected health information in an emergency
situation. If this happens, we shall try to obtain your acknowledgement
as soon as reasonably practicable after the delivery of treatment.
Communication Barriers -
We may use and disclose your protected health information if we
attempt to obtain consent from you but are unable to do so due to
substantial communication barriers and it is determined, using professional
judgement, that you intend to consent to use disclosure under the
circumstances.
Appointment Reminders/Scheduling/Follow-up
Calls - We may use and disclose health
information to contact you as a reminder that you have an appointment,
have been referred to schedule a visit, or to follow-up with you
on a recent visit. We may leave a brief reminder on your answering
machine/voicemail system unless you tell us not to.
Fundraising Activities -
We may use or disclose your demographic information and the dates
that you received treatment, as necessary, in order to contact you
for fundraising activities supported by our organization.
OTHER PERMITTED OR REQUIRED
USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR CONSENT, AUTHORIZATION
OR OPPORTUNITY TO OBJECT
We may use or disclose your protected
health information in the following situations without your consent
or authorization. These situations include:
Required by law - When
required to do so by federal, state, or local law, including those
that require the reporting of certain types of wounds or physical
injuries.
Public Health - For
public health activities and purposes of controlling disease, injury,
disability; reporting births and deaths; and reporting types of
abuse, neglect, or domestic violence.
Health Oversight -
To a health oversight agency for activities authorized by law, such
as audits, investigations, and inspections that oversee the health
care system.
Food and Drug Administration
- To a person or company required by the
Food and Drug,
Legal Proceedings - In
the course of any judicial or administrative proceeding, in response
to a court order or an administrative tribunal.
Law Enforcement -
Law enforcement purposes include: identification or location of
a suspect, report details of a suspicious death, or legal processes
required by law.
Coroners, Funeral Directors,
and Organ Donation - To any of these groups
with the minimum necessary information.
Research - 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 protected health information.
Criminal Activity:
Consistent with applicable federal and state laws, if we 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.
Military Activity and National
Security - When the appropriate conditions
apply, we may use or disclose protected health information for individuals
involved with these groups.
Workmans' Compensation -
As authorized to comply with workmans' comp laws and other similar
legally established programs.
Inmates - If
you are an inmate of a correctional facility and your physician
created or received your protected health information in the course
of providing cue to you.
PATIENT RIGHTS REGARDING THEIR
MEDICAL INFORMATION
In addition to your rights as
a patient, we also ask that you respect the rights of other patients
by not discussing any information you may see or hear while receiving
treatment in our facilities.
You have the following rights
regarding medical information we maintain about you:
Right to Inspect and Copy
- You may inspect and obtain a copy of
your personal health information that is contained in a designated
record set for as long as we maintain the protected health information.
We may deny your request to inspect and copy based on the federal
laws above.
Right to Amend -
This means that 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 our organization,
Right to an Accounting of
Disclosures - This means that you have
the right to request an "accounting of disclosures". This
is a list of the disclosures we make of medical information about
you for purposes other than treatment. payment or healthcare operations
as described in this Notice of Privacy Practices.
Right to Request Restrictions
- This means that you have the right to
request a restriction of limitation on the medical information we
use or disclose about you for treatment, payment or healthcare operations.
You also have the right to request a limit on the medical information
we disclose about you to someone who is invo ve in your care or
the payment for your care. WE ARE NOT REQUIRED TO AGREE WITH YOUR
REQUEST
Right to Request Confidential
Communications - This means that 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 you request in writing
to our administrator. We "ill not ask you the reason for your
request.
Right to Paper Copy of This
Notice - This means that you have the
right to a paper copy of this notice. YOU may ask us to give you
a copy of this notice at anytime. Even if you have agreed to receive
this notice electronically, you are still entitled to a paper copy
of this notice. To obtain a paper copy of this notice, contact our
Privacy Officer or the registration area at any of our entities.
CHANGES TO THIS NOTICE:
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 at MPIA.
The notice wilt contain the effective date in the bottom left hand
comer of each page in the notice.
COMPLAINTS - If
you believe your privacy rights have been violated, you may file
a complaint with our organization or with the Secretary of the Department
of Health and Human Services.
200 Independence Ave. SW
Room 509 F
HHH Building
Washington D.C. 20201
ocrmail@hhs.gov
To file a complaint with the organization,
contact our Administrator. All complaints must be submitted in writing.
A Complaint form is available on our webpage, you can request a
complaint form at our office. YOU
WILL NOT BE PENALIZED FOR FILING A COMPLAINT.
SLOIC 303.14/03
HIPAA
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