Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
The following is the privacy policy ("Privacy Policy") of South Jersey
Radiology Associates, P.A. as described in the Health Insurance Portability
and Accountability Act of 1996 and regulations promulgated thereunder, commonly
known as HIPAA. HIPAA requires all health care providers by law to maintain
the privacy of your personal health information and to provide you with notice
of their legal duties and privacy policies with respect to your personal health
information. We are required by law to abide by the terms of this Privacy Notice.
Your Personal Health Information
We collect personal health information from you through treatment, payment
and related healthcare operations, other healthcare providers, or through other
means, as applicable. Your personal health information that is protected by
law broadly includes any information, oral, written or recorded, that is created
or received by certain health care entities, including health care providers,
such as physicians and hospitals, as well as, health insurance companies or
plans. The law specifically protects health information that contains data,
such as your name, address, social security number, and others, that could be
used to identify you as the individual patient who is associated with that health
information.
Uses or Disclosures of Your Personal Health Information
Generally, we may not use or disclose your personal health information without
your permission. Further, once your permission has been obtained, we must use
or disclose your personal health information in accordance with the specific
terms of that permission. The following are the circumstances under which we
are permitted by law to use or disclose your personal health information.
Without Your Consent
Without your consent, we may use or disclose your personal health information
in order to provide you with services and the treatment you require or request,
or to collect payment for those services, and to conduct other related health
care operations otherwise permitted or required by law. Also, we are permitted
to disclose your personal health information within and among our workforce
in order to accomplish these same purposes. However, even with your permission,
we are still required to limit such uses or disclosures to the minimal amount
of personal health information that is reasonably required to provide those
services or complete those activities.
Examples of treatment activities include: (a) the provision, coordination,
or management of health care and related services by health care providers;
(b) consultation between health care providers relating to a patient; or (c)
the referral of a patient for health care from one health care provider to another.
Examples of payment activities include: (a) billing and collection activities
and related data processing; (b) actions by a health plan or insurer to determine
or fulfill its responsibilities for coverage and provision of benefits under
its health plan or insurance agreement; (c) medical necessity and appropriateness
of care reviews, and utilization review activities; and (d) disclosure to consumer
reporting agencies of information relating to collections or reimbursement.
Examples of health care operations include: (a) development of clinical
guidelines; (b) contacting patients with information about treatment alternatives
or communications in connection with case management or care coordination; (c)
reviewing the qualifications of and training health care professionals; (d)
medical review, legal services, and auditing functions; and (e) general administrative
activities such as customer service and data analysis.
As Required By Law
We may use or disclose your personal health information to the extent that
such use or disclosure is required by law and the use or disclosure complies
with and is limited to the relevant requirements of such law.
Examples of instances in which we are required to disclose your personal
health information include: (a) public health activities including, preventing
or controlling disease or other injury, public health surveillance or investigations,
reporting adverse events with respect to food or dietary supplements or product
defects or problems to the Food and Drug Administration, medical surveillance
of the workplace or to evaluate whether the individual has a work-related illness
or injury in order to comply with Federal or state law; (b) disclosures regarding
victims of abuse, neglect, or domestic violence including, reporting to social
service or protective services agencies; (c) health oversight activities including,
audits, civil, administrative, or criminal investigations, inspections, licensure
or disciplinary actions, or civil, administrative, or criminal proceedings or
actions, or other activities necessary for appropriate oversight of government
benefit programs; (d) judicial and administrative proceedings in response to
an order of a court or administrative tribunal, a warrant, subpoena, discovery
request, or other lawful process; (e) law enforcement purposes for the purpose
of identifying or locating a suspect, fugitive, material witness, or missing
person, or reporting crimes in emergencies, or reporting a death; (f) disclosures
about decedents for purposes of cadaveric donation of organs, eyes or tissue;
(g) for research purposes under certain conditions; (h) to avert a serious threat
to health or safety; (i) military and veterans activities; (j) national security
and intelligence activities, protective services of the President and others;
(k) medical suitability determinations by entities that are components of the
Department of State; (l) correctional institutions and other law enforcement
custodial situations; (m) covered entities that are government programs providing
public benefits, and (n) for workers' compensation.
Miscellaneous Activities
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.
All Other Situations With Your Specific Authorization
Except as otherwise permitted or required, as described above, we may not use
or disclose your personal health information without your written authorization.
Further, we are required to use or disclose your personal health information
consistent with the terms of your authorization. You may revoke your authorization
to use or disclose any personal health information at any time, except to the
extent that we have taken action in reliance on such authorization, or, if you
provided the authorization as a condition of obtaining insurance coverage, other
laws provides the insurer with the right to contest a claim under the policy.
Your Rights With Respect to Your Personal Health Information
Under HIPAA, you have certain rights with respect to your personal health information.
The following is a brief overview of your rights and our duties with respect
to enforcing those rights.
Right To Request Restrictions On Use Or Disclosure
You have the right to request restrictions on certain uses and disclosures
of your personal health information about yourself. You may request restrictions
on the following uses or disclosures: (a) to carry out treatment, payment, or
healthcare operations; (b) disclosures to family members, relatives, or close
personal friends of personal health information directly relevant to your care
or payment related to your health care, or your location, general condition,
or death; (c) instances in which you are not present or your permission cannot
practicably be obtained due to your incapacity or an emergency circumstance;
(d) permitting other persons to act on your behalf to pick up filled prescriptions,
medical supplies, X-rays, or other similar forms of personal health information;
or (e) disclosure to a public or private entity authorized by law or by its
charter to assist in disaster relief efforts.
While we are not required to agree to any requested restriction, if we agree
to a restriction, we are bound not to use or disclose your personal healthcare
information in violation of such restriction, except in certain emergency situations.
We will not accept a request to restrict uses or disclosures that are otherwise
required by law.
Right To Receive Confidential Communications
You have the right to receive confidential communications of your personal
health information. We may require written requests. We may condition the provision
of confidential communications on you providing us with information as to how
payment will be handled and specification of an alternative address or other
method of contact. We may require that a request contain a statement that disclosure
of all or a part of the information to which the request pertains could endanger
you. We may not require you to provide an explanation of the basis for your
request as a condition of providing communications to you on a confidential
basis. We must permit you to request, and must accommodate reasonable requests
by you, to receive communications of personal health information from us by
alternative means or at alternative locations.
Right To Inspect And Copy Your Personal Health Information
Your designated record set is a group of records we maintain that includes
Medical records and billing records about you, or enrollment, payment, claims
adjudication, and case or medical management records systems, as applicable.
You have the right of access in order to inspect and obtain a copy your personal
health information contained in your designated record set, except for (a) psychotherapy
notes, (b) information compiled in reasonable anticipation of, or for use in,
a civil, criminal, or administrative action or proceeding, and (c) health information
maintained by us to the extent to which the provision of access to you would
be prohibited by law. We may require written requests. We must provide you with
access to your personal health information in the form or format requested by
you, if it is readily producible in such form or format, or, if not, in a readable
hard copy form or such other form or format. We may provide you with a summary
of the personal health information requested, in lieu of providing access to
the personal health information or may provide an explanation of the personal
health information to which access has been provided, if you agree in advance
to such a summary or explanation and agree to the fees imposed for such summary
or explanation. We will provide you with access as requested in a timely manner,
including arranging with you a convenient time and place to inspect or obtain
copies of your personal health information or mailing a copy to you at your
request. We will discuss the scope, format, and other aspects of your request
for access as necessary to facilitate timely access. If you request a copy of
your personal health information or agree to a summary or explanation of such
information, we may charge a reasonable cost-based fee for copying, postage,
if you request a mailing, and the costs of preparing an explanation or summary
as agreed upon in advance. We reserve the right to deny you access to and copies
of certain personal health information as permitted or required by law. We will
reasonably attempt to accommodate any request for personal health information
by, to the extent possible, giving you access to other personal health information
after excluding the information as to which we have a ground to deny access.
Upon denial of a request for access or request for information, we will provide
you with a written denial specifying the legal basis for denial, a statement
of your rights, and a description of how you may file a complaint with us. If
we do not maintain the information that is the subject of your request for access
but we know where the requested information is maintained, we will inform you
of where to direct your request for access.
Right To Amend Your Personal Health Information
You have the right to request that we amend your personal health information
or a record about you contained in your designated record set, for as long as
the designated record set is maintained by us. We have the right to deny your
request for amendment, if: (a) we determine that the information or record that
is the subject of the request was not created by us, unless you provide a reasonable
basis to believe that the originator of the information is no longer available
to act on the requested amendment, (b) the information is not part of your designated
record set maintained by us, (c) the information is prohibited from inspection
by law, or (d) the information is accurate and complete. We may require that
you submit written requests and provide a reason to support the requested amendment.
If we deny your request, we will provide you with a written denial stating the
basis of the denial, your right to submit a written statement disagreeing with
the denial, and a description of how you may file a complaint with us or the
Secretary of the U.S. Department of Health and Human Services ("DHHS").
This denial will also include a notice that if you do not submit a statement
of disagreement, you may request that we include your request for amendment
and the denial with any future disclosures of your personal health information
that is the subject of the requested amendment. Copies of all requests, denials,
and statements of disagreement will be included in your designated record set.
If we accept your request for amendment, we will make reasonable efforts to
inform and provide the amendment within a reasonable time to persons identified
by you as having received personal health information of yours prior to amendment
and persons that we know have the personal health information that is the subject
of the amendment and that may have relied, or could foreseeably rely, on such
information to your detriment. All requests for amendment shall be directed
to SJRA's Medical Director.
Right To Receive An Accounting Of Disclosures Of Your Personal
Health Information
Beginning April 14, 2003, you have the right to receive a written accounting
of all disclosures of your personal health information that we have made within
the six (6) year period immediately preceding the date on which the accounting
is requested. You may request an accounting of disclosures for a period of time
less than six (6) years from the date of the request. Such disclosures will
include the date of each disclosure, the name and, if known, the address of
the entity or person who received the information, a brief description of the
information disclosed, and a brief statement of the purpose and basis of the
disclosure or, in lieu of such statement, a copy of your written authorization
or written request for disclosure pertaining to such information. We are not
required to provide accountings of disclosures for the following purposes: (a)
treatment, payment, and healthcare operations, (b) disclosures pursuant to your
authorization, (c) disclosures to you, (d) for a facility directory or to persons
involved in your care, (e) for national security or intelligence purposes, (f)
to correctional institutions, and (g) with respect to disclosures occurring
prior to 4/14/03. We reserve our right to temporarily suspend your right to
receive an accounting of disclosures to health oversight agencies or law enforcement
officials, as required by law. We will provide the first accounting to you in
any twelve (12) month period without charge, but will impose a reasonable cost-based
fee for responding to each subsequent request for accounting within that same
twelve (12) month period. All requests for an accounting shall be directed to
SJRA's Office Manager.
Complaints
You may file a complaint with us and with the Secretary of DHHS if you believe
that your privacy rights have been violated. You may submit your complaint in
writing by mail or electronically to our privacy officer, Dr. William F. Muhr,
Jr. A complaint must name the entity that is the subject of the complaint and
describe the acts or omissions believed to be in violation of the applicable
requirements of HIPAA or this Privacy Policy. A complaint must be received by
us or filed with the Secretary of DHHS within 180 days of when you knew, or
should have known, that the act or omission complained of occurred. You will
not be retaliated against for filing any complaint.
Amendments to this Privacy Policy
We reserve the right to revise or amend this Privacy Policy at any time. These
revisions or amendments may be made effective for all personal health information
we maintain even if created or received prior to the effective date of the revision
or amendment.
On-going Access to Privacy Policy
We will provide you with a copy of the most recent version of this Privacy
Policy at any time upon your written request to our Office Manger or at the
following website: www.sjra.com. For
any other requests or for further information regarding the privacy of your
personal health information, and for information regarding the filing of a complaint
with us, please contact our privacy officer, Dr. William F. Muhr, Jr.