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HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: APRIL 1, 2003
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 is provided to you pursuant to the Health Insurance Portability
and Accountability Act of 1996 (“HIPAA”). It is designed to
tell you how we may, under federal law, use or disclose your Health Information.
- We May Use or Disclose Your Health Information for Purposes of Treatment,
Payment or Healthcare Operations and Here is One Example of Each:
The health care administrative and professional staffs in our office
may access your information for purposes of providing care to you. Our staff
may send, mail, fax or courier your formal report and/or films to/or from
other health care providers, including your referring physician, for the
sole purpose of providing a continuum of care.
Our billing department may access your information and send relevant
parts to your insurance company to allow us to be paid for the services
we render to you.
We may access or send your information to our attorneys or accountants
in the event we need the information in order to address one of our own
business functions.
We will make reasonable efforts to limit the Health Information we
use or disclose to the “minimum necessary” to accomplish
the stated purpose.
- We May Also Use or Disclose Your Health Information Under the Following
Circumstances without Obtaining Your PriorWritten Authorization:
To Notify and/or Communicate with your Family. We cannot discuss
or provide your Health Information to your family or friends unless
you verbally agree or we are reasonably able to infer from the circumstances
that you do not object to the sharing of this information (e.g., you
bring your spouse into the treatment area). Otherwise, we can only share
your Health Information with your family or friends if,
- you signed an Authorization specifically allowing us to do so;
- you are not present (or your agreement cannot be obtained because
of incapacity or an emergency circumstance) and the disclosure is in
your best interests in which case we will only disclose that amount
which is directly relevant to the particular family member or friend’s
involvement with your care;
- a public or private entity (e.g., the Red Cross) requires the Health
Information to assist in disaster relief efforts for the purpose
of notifying your family, personal representative or someone else responsible
for your care, of your location, general condition or death;
- we need to use or disclose your Health Information to notify your
family, a personal representative or someone else involved in your care
of your location, general condition or death.
In the Event of Emergencies: We may use or disclose your Health Information
to provide information in the event of your own personal health emergency,
natural disasters or fire emergency in the facility.
For Public Health Activities: We may use or disclose your Health
Information to provide information to the New Jersey Department of Health
and Senior Services and/or other state or federal public health authorities,
as required by law to prevent or control disease, injury or disability;
to report child abuse or neglect; report adult abuse, neglect or domestic
violence; to report to persons subject to the Food and Drug Administration
information relating to products and/or adverse reactions to medications;
and report disease or infection exposure as required by law to conduct
a public health intervention or investigation.
For Health Oversight Activities: We may use or disclose your Health
Information to health oversight agencies, such as JCAHO, as required
during the course of audits, investigations, inspections, accreditations,
licensure and other proceedings as authorized by law.
For Purposes of Obtaining Radiopharmaceuticals: We may use or disclose
your Health Information in order to obtain appropriately dosed and
labeled radiopharmaceuticals for your care.
For Service and Repair of Equipment: We may use or disclose your
Health Information in the course of any service or repair of computers
or medical imaging equipment containing the justification for the service
call. The equipment vendors are required to sign a HIPAA regulated “Business
Associate Agreement” which requires them to maintain the privacy
and security of the Health Information to give to them.
For Purposes of Off-Site Storage: We may use or disclose your Health
Information in the course of storing or retrieving information maintained
off-site. The vendors are required to sign a HIPAA regulated “Business
Associate Agreement”.
In Response to Subpoenas or for Judicial and Administrative Proceedings:
We may use or disclose your Health Information in response to a court
order. We will require an attorney requesting your Health Information
in private, civil matters, to satisfy us that you have been made aware
of the request for your Health Information prior to providing it to
them.
To Law Enforcement Personnel. We may disclose your Health Information
to a law enforcement official to report certain types of wounds as
required by law in response to an officer’s request for information
to identify or locate a suspect, fugitive, material witness or missing
person, or to comply with a court order or subpoena issued by a judicial
officer, a grand jury or other administrative tribunal.
If you are suspected to be the victim of a crime, we may also disclose
your Health Information in response to a law enforcement officer’s
request, but only if you agree or we are unable to obtain your agreement
because of emergency circumstances and the law enforcement official
presents information that the disclosure is necessary to determine that
someone else is the perpetrator of the crime, that the information will
not be used against you or that some immediate law enforcement activity
depends on the disclosure of the Health Information. We may disclose
your information if we believe it constitutes evidence of criminal conduct
that occurred on our premises.
To Coroners or Funeral Directors or the Medical Examiner. We may
use or disclose your Health Information for purposes of communicating
with coroners, funeral directors and may provide them information about
your death.
To Members of the Clergy. We may use or disclose your limited Information
to members of the Clergy as requested. You may object to such disclosure
by contacting our staff.
For Purposes of Organ Donation. We may use or disclose your Health
Information for purposes of communicating to organizations involved
in procuring, banking or transplanting organs and tissues.
For Public Safety. We may use or disclose your Health Information
in order to prevent or lessen a serious and imminent threat to the health
or safety of a particular person or the general public. We will only
disclose information to someone able to prevent or lessen the threat
or the target of the threat.
To Aid Specialized Government Functions. If necessary, we may use
or disclose your Health Information for military if you are a member
of the Armed Forces and if required by the military or to a federal
officer for national security purposes.
For Worker’s Compensation. We may use or disclose your Health Information
as necessary to comply with worker’s compensation laws.
To Correctional Institutions or Law Enforcement Officials, if You
are an Inmate.
- We May Also Use or Disclose Your Health Information for the Following
Purposes:
Appointment Reminders. We may use your Health Information in order
to contact you (by mail or telephone) to provide appointment reminders
or information about treatment alternatives or health-related benefits
and services offered by us that may be of interest to you.
Change of Ownership. In the event that our practice is sold or merged
with another organization, we may provide your Health Information
as part of the pre-sale due diligence process and, upon completion of
the sale, your Health Information will become the property of the new
owner.
- For All Other Circumstances, We May Only Use or Disclose Your Health
Information to a Third-Party (Even Upon Your Request), if You Have
Signed a HIPAA-Compliant Authorization. (A copy of our form of Authorization
is available, upon request, and posted on our website.) If you authorize
us to use or disclose your Health Information for another purpose,
you may provide us with a written revocation at any time. The revocation
will not apply to the extent we have taken action in reliance on it.
- Your Rights
- You have the right to request restrictions of the uses and disclosures
of your Health Information for treatment, payment, healthcare operations
and those uses or disclosures that are made to individual involved
in your care. Any such request must be placed in writing and directed
to the Privacy Officer. We are not required to comply with your request.
- You have the right to request to receive communications of your
Health Information through an alternative means or at an alternative
location. We will accommodate reasonably requests. Any such request
must be placed in writing and directed to the Privacy Officer.
- You have the right to inspect and copy your Health Information.
We may charge you a reasonable cost-based fee to cover copying, postage
and/or preparation of a summary. We will advise you of these costs in
advance. In certain circumstances, we may deny you access. In those
circumstances, we will provide you with a written reason for the denial
and advise you whether, under the law, you have the right to a review
of the denial by a licensed health care professional who was not involved
in the process. A complete description of this process is available
upon request.
- You have the right to request that we amend any Health Information
we have that you believe is incorrect or incomplete. We are not required
to change your Health Information but will provide you with the reasons
for our denial and how you can include a written disagreement of
our denial in your record.
- You have the right to receive an accounting of our disclosures
of your Health Information, except that we do not have to account for
disclosures: authorized by you; made for treatment, payment, health
care operations; those disclosures made directly to you; disclosures
made to notify and communicate with family or friends under emergency
circumstances or when approved by you; those made in connection with
national security or intelligence activities; and appointment reminders
we are sending to you.
- You have a right to a paper copy of this Notice of Privacy Practices.
If you would like to have a more detailed explanation of these rights
or if you would like to exercise one or more of these rights, contact
the HIPAA Privacy Officer at 732-390-0040.
- Our Duties.
We are required by law to maintain the privacy of your Health Information
and to provide you with a copy of this Notice.
We are also required to abide by the terms of this Notice.
We reserve the right to amend this Notice at any time in the future
and to make the new Notice provisions applicable to all your Health
Information we have – even if it was created prior to the change
in the Notice. If such amendment is made, we will immediately display
the revised Notice at our office and provide you with a copy of the
amended Notice upon your next visit to our Practice. We will also
provide you with a copy, at any time, upon request.
- Complaints to the Government.
You may make complaints to us or to the Secretary of the Department
of Health and Human Services if you believe your rights as described
herein have been violated. If you have a complaint regarding the use
or disclosure of your Health Information, you may contact the Privacy
Officer, either by telephone or in writing. Complaints made to the
DHHS must be filed in writing. A complaint must include a description
of the acts or omissions you believe have resulted in a violation
of your rights. A complaint must be filed within 180 days of when
you found out about the violation, unless you have “good cause” for
filing later.
We promise not to retaliate against you for any complaint you make
to the government about our privacy practices.
- Contact Information.
You may contact us about our privacy practices by calling the Privacy
Officer at: (732)390-0040 or in writing at: University Radiology
Group, 579A Cranbury Road, East Brunswick, NJ 08816 Attention: Privacy
Officer.
You may contact the DHHS at: The Department of Health of Human
Services, 200 Independence Avenue, S.W., Washington, DC 20201, Phone
toll free (877)696-6775
- Electronic Notice
This Notice of Privacy Practices is also available on our web page
at www.Univrad.com.
A copy of this “Notice” is available at any of the imaging
offices.
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